Baleanu Delia, Ritt Martin, Harazny Joanna, Heckmann Josef, Schmieder Roland E, Michelson Georg
Department of Ophthalmology, University of Erlangen-Nürnberg, Erlangen, Germany.
Invest Ophthalmol Vis Sci. 2009 Sep;50(9):4351-9. doi: 10.1167/iovs.08-3266. Epub 2009 Apr 1.
There is evidence that generalized retinal arteriolar narrowing, which can be measured by the arteriole-to-venule ratio (AVR) of retinal vessels, predicts cerebrovascular events. The wall-to-lumen ratio (WLR) and wall cross-sectional area (WCSA) of retinal arterioles reflect structural arteriolar parameters. The primary objective was to test the association between WLR and AVR in a distinct cohort of patients with cerebrovascular damage.
In this cross-sectional study, 23 patients (57.5 +/- 9.4 years) with acute transitory ischemic attack or lacunar cerebral infarct were compared with two age-matched control groups: 83 subjects with essential hypertension (53.7 +/- 5.5 years) and 16 normotensive subjects (52.2 +/- 8.3 years). Retinal arteriolar parameters (WLR, WTH, and WCSA) were assessed in vivo with scanning laser Doppler flowmetry (SLDF). AVR and a qualitative evaluation of retinal vessels were obtained from digital retinal color photographs. The intima-media thickness (IMT) of the carotid artery was measured.
WLR (0.44 +/- 0.1 vs. 0.34 +/- 0.1 vs. 0.30 +/- 0.1, P < 0.001) and carotid IMT (P < 0.05) were significantly greater in the cerebrovascular event group compared with normotensive subjects. WLR and WCSA were significantly higher in the cerebrovascular event group compared with subjects with mild arterial hypertension. AVR was similar in all three study groups (0.75 +/- 0.07 vs. 0.74 +/- 0.07 vs. 0.78 +/- 0.1, P = 0.18).
The increase in WLR and WCSA of retinal arterioles, as well as in IMT in patients with cerebrovascular damage suggests vascular hypertrophy in the microvascular and macrovascular bed. The lack of association between AVR of retinal vessels and WLR of retinal arterioles may point to different stages of cerebrovascular disease and/or different pathophysiological changes in the arteriolar wall.
有证据表明，可通过视网膜血管的动静脉比（AVR）测量的全身性视网膜小动脉狭窄能预测脑血管事件。视网膜小动脉的壁腔比（WLR）和壁横截面积（WCSA）反映了小动脉的结构参数。主要目的是在一组独特的脑血管损伤患者中测试WLR与AVR之间的关联。
在这项横断面研究中，将23例急性短暂性脑缺血发作或腔隙性脑梗死患者（57.5±9.4岁）与两个年龄匹配的对照组进行比较：83例原发性高血压患者（53.7±5.5岁）和16例血压正常的受试者（52.2±8.3岁）。使用扫描激光多普勒血流仪（SLDF）在体内评估视网膜小动脉参数（WLR、WTH和WCSA）。从数字化视网膜彩色照片中获取AVR和对视网膜血管的定性评估。测量颈动脉内膜中层厚度（IMT）。
与血压正常的受试者相比，脑血管事件组的WLR（0.44±0.1对0.34±0.1对0.30±0.1，P<0.001）和颈动脉IMT（P<0.05）显著更高。与轻度动脉高血压患者相比，脑血管事件组的WLR和WCSA显著更高。三个研究组的AVR相似（0.75±0.07对0.74±0.07对0.78±0.1，P = 0.18）。
脑血管损伤患者视网膜小动脉的WLR和WCSA增加，以及IMT增加，提示微血管和大血管床存在血管肥厚。视网膜血管的AVR与视网膜小动脉的WLR之间缺乏关联，可能表明脑血管疾病处于不同阶段和/或小动脉壁存在不同的病理生理变化。
