Hsieh Tsung-Cheng, Chou Chu-Lin, Chen Jin-Shuen, Kuo Chiu-Huang, Wang Yi-Chun, Lai Yu-Hsien, Lin Yu-Li, Wang Chih-Hsien, Fang Te-Chao
Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan.
Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
JAMA Ophthalmol. 2016 Feb;134(2):196-203. doi: 10.1001/jamaophthalmol.2015.5052.
Retinal vascular occlusion is considered a risk factor for cardiovascular diseases in the general population. However, the long-term outcomes of patients who undergo incident hemodialysis and subsequently develop retinal vascular occlusion have not been examined.
To determine the mortality rate and subsequent prevalence of systemic vascular diseases associated with retinal vascular occlusion among patients undergoing hemodialysis in Taiwan.
DESIGN, SETTING, AND PARTICIPANTS: Data from the Taiwan National Health Institutes research database were used, and we identified 105,956 patients undergoing hemodialysis during the period from January 1997 to December 2008. In total, 113 patients with retinal artery occlusion and 463 patients with retinal vein occlusion were enrolled and matched for age, sex, and the duration of hemodialysis (at a 1:5 ratio) with patients without ocular disorders.
Mortality and atherosclerotic events. A multivariate Cox regression model for mortality and a competing risk regression model for atherosclerotic events were used for this population-based retrospective cohort study.
Of 113 patients with retinal artery occlusion and 463 patients with retinal vein occlusion, 66 (58.4%) and 245 (52.9%) were females, respectively (ranging in age from ≤40 to 80 years). Our study showed there was a significant risk of mortality among patients undergoing hemodialysis who subsequently developed retinal artery occlusion or retinal vein occlusion compared with patients undergoing hemodialysis without ocular disorders. Patients with retinal artery occlusion had higher risks of ischemic stroke (adjusted hazard ratio [HR], 3.35 [95% CI, 2.00-5.59]; P < .001), coronary artery disease (adjusted HR, 1.70 [95% CI, 1.23-2.36]; P = .001), acute coronary syndrome (adjusted HR, 2.03 [95% CI, 1.24-3.33]; P = .002), and peripheral arterial occlusive disease (adjusted HR, 2.15 [95% CI, 1.26-3.66]; P = .002) than did patients without ocular disorders. Patients with retinal vein occlusion had higher risks of hemorrhagic stroke (adjusted HR, 2.54 [95% CI, 1.50-4.30]; P = .001), coronary artery disease (adjusted HR, 1.55 [95% CI, 1.31-1.83]; P < .001), and acute coronary syndrome (adjusted HR, 1.53 [95% CI, 1.14-2.06]; P = .002) than did patients without ocular disorders.
Our data demonstrate that the risks of mortality and atherosclerotic events were increased among patients undergoing incident hemodialysis who subsequently developed retinal vascular occlusion.
视网膜血管阻塞被认为是普通人群中心血管疾病的一个危险因素。然而，首次接受血液透析并随后发生视网膜血管阻塞的患者的长期预后尚未得到研究。
确定台湾接受血液透析患者中与视网膜血管阻塞相关的死亡率及随后全身性血管疾病的患病率。
设计、地点和参与者：使用了台湾国立卫生研究院研究数据库的数据，我们确定了1997年1月至2008年12月期间105,956例接受血液透析的患者。总共纳入了113例视网膜动脉阻塞患者和463例视网膜静脉阻塞患者，并按年龄、性别和血液透析时间（1:5比例）与无眼部疾病的患者进行匹配。
死亡率和动脉粥样硬化事件。对于这项基于人群的回顾性队列研究，使用了死亡率的多变量Cox回归模型和动脉粥样硬化事件的竞争风险回归模型。
在113例视网膜动脉阻塞患者和463例视网膜静脉阻塞患者中，分别有66例（58.4%）和245例（52.9%）为女性（年龄范围为≤40至80岁）。我们的研究表明，与无眼部疾病的血液透析患者相比，随后发生视网膜动脉阻塞或视网膜静脉阻塞的血液透析患者存在显著的死亡风险。视网膜动脉阻塞患者发生缺血性中风（调整后风险比[HR]，3.35[95%CI，2.00 - 5.59]；P <.001）、冠状动脉疾病（调整后HR，1.70[95%CI，1.23 - 2.36]；P =.001）、急性冠状动脉综合征（调整后HR，2.03[95%CI，1.24 - 3.33]；P =.002）和外周动脉闭塞性疾病（调整后HR，2.15[95%CI，1.26 - 3.66]；P =.002）的风险高于无眼部疾病的患者。视网膜静脉阻塞患者发生出血性中风（调整后HR，2.54[95%CI，1.50 - 4.30]；P =.001）、冠状动脉疾病（调整后HR，1.55[95%CI，1.31 - 1.83]；P <.001）和急性冠状动脉综合征（调整后HR，1.53[95%CI，1.14 - 2.06]；P =.002）的风险高于无眼部疾病的患者。
我们的数据表明，首次接受血液透析并随后发生视网膜血管阻塞的患者的死亡风险和动脉粥样硬化事件风险增加。
