Glueck Charles J, Hutchins Robert K, Jurantee Joel, Khan Zia, Wang Ping
Cholesterol Center, Jewish Hospital of Cincinnati, Cincinnati, OH, USA.
Clin Ophthalmol. 2012;6:1377-84. doi: 10.2147/OPTH.S34627. Epub 2012 Aug 28.
The purpose of this research was to assess associations of thrombophilia with central retinal vein occlusion (CRVO), central retinal artery occlusion (CRAO), and amaurosis fugax (AF); to evaluate outcomes of normalizing high homocysteine; and to study CRVO, CRAO, and AF developing in estrogens/estrogen agonists in women subsequently shown to have thrombophilia.
Measures of thrombophilia-hypofibrinolysis were obtained in 132 CRVO cases, 15 CRAO cases, and 17 AF cases. Cases were compared to 105 healthy control subjects who did not differ by race or sex and were free of any ophthalmologic disorders. All cardiovascular disease (CVD) risk factors were compared to healthy general populations.
The main outcome measure of this study was thrombophilia.
CRVO cases were more likely than controls to have high homocysteine (odds ratio [OR] 8.64, 95% confidence intervals [CI]: 1.96-38), high anticardiolipin immunoglobulin M (IgM; OR 6.26, 95% CI: 1.4-28.2), and high Factor VIII (OR 2.47, 95% CI: 1.31-7.9). CRAO-AF cases were more likely than controls to have high homocysteine (OR 14, 95% CI: 2.7-71.6) or the lupus anticoagulant (OR 4.1, 95% CI: 1.3-13.2). In four of 77 women with CRVO (two found to have high homocysteine, two with inherited high Factor XI), CRVO occurred after starting estrogen-progestins, estrogen-testosterone, or estrogen agonists. In one of eight women with CRAO found to have high anticardiolipin antibody IgG, CRAO occurred after starting conjugated estrogens, and AF occurred after starting conjugated estrogens in one of eleven women with AF (inherited protein S deficiency). Therapy for medians of 21 months (CRVO) and 6 months (CRAO-AF) was 5 mg folic acid, 100 mg B6, and 2000 mcg/day B12 normalized homocysteine in 13 of 16 (81%) CRVO cases and all five CRAO-AF cases with pretreatment hyperhomocysteinemia. The CRVO cases had an excess of hypertension; CRAO-AF cases had an excess of type 2 diabetes and hypertension.
Treatable thrombophilia, hyperhomocysteinemia in particular, is more common in RVO cases than in normal controls. RVO occurs after estrogens or estrogen agonists were administered in women subsequently shown to have thrombophilia.
本研究旨在评估血栓形成倾向与视网膜中央静脉阻塞（CRVO）、视网膜中央动脉阻塞（CRAO）和一过性黑矇（AF）之间的关联；评估高同型半胱氨酸水平正常化后的结果；并研究在随后被证明患有血栓形成倾向的女性中，雌激素/雌激素激动剂引发的CRVO、CRAO和AF。
对132例CRVO患者、15例CRAO患者和17例AF患者进行了血栓形成倾向-纤溶功能减退的检测。将这些病例与105名健康对照者进行比较，这些对照者在种族或性别上无差异，且没有任何眼科疾病。将所有心血管疾病（CVD）风险因素与健康普通人群进行比较。
本研究的主要观察指标是血栓形成倾向。
CRVO患者比对照组更易出现高同型半胱氨酸（优势比[OR] 8.64，95%置信区间[CI]：1.96 - 38）、高抗心磷脂免疫球蛋白M（IgM；OR 6.26，95% CI：1.4 - 28.2）和高因子VIII（OR 2.47，95% CI：1.31 - 7.9）。CRAO - AF患者比对照组更易出现高同型半胱氨酸（OR 14，95% CI：2.7 - 71.6）或狼疮抗凝物（OR 4.1，95% CI：1.3 - 13.2）。在77例CRVO女性患者中，有4例（2例高同型半胱氨酸，2例遗传性高因子XI）在开始使用雌激素 - 孕激素、雌激素 - 睾酮或雌激素激动剂后发生CRVO。在8例CRAO女性患者中，有1例检测出高抗心磷脂抗体IgG，在开始使用结合雌激素后发生CRAO；在11例AF女性患者中，有1例（遗传性蛋白S缺乏）在开始使用结合雌激素后发生AF。对CRVO患者进行21个月中位数的治疗，对CRAO - AF患者进行6个月中位数的治疗，使用5毫克叶酸、100毫克维生素B6和2000微克/天维生素B12，使16例CRVO患者中的13例（81%）以及所有5例治疗前高同型半胱氨酸血症的CRAO - AF患者的同型半胱氨酸水平正常化。CRVO患者中高血压更为常见；CRAO - AF患者中2型糖尿病和高血压更为常见。
可治疗的血栓形成倾向，尤其是高同型半胱氨酸血症，在视网膜静脉阻塞（RVO）患者中比正常对照组更为常见。在随后被证明患有血栓形成倾向的女性中，使用雌激素或雌激素激动剂后会发生RVO。
