无症状性颈动脉狭窄与视网膜神经纤维层厚度。一项基于社区的观察性研究。
Asymptomatic carotid artery stenosis and retinal nerve fiber layer thickness. A community-based, observational study.
作者信息
Wang Dandan, Li Yang, Zhou Yong, Jin Cheng, Zhao Qi, Wang Anxin, Wu Shouling, Wei Wen Bin, Zhao Xingquan, Jonas Jost B
机构信息
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
China National Clinical Research Center for Neurological Diseases, Beijing, China.
出版信息
PLoS One. 2017 May 11;12(5):e0177277. doi: 10.1371/journal.pone.0177277. eCollection 2017.
PURPOSE
To examine whether an abnormally thin retinal nerve fiber layer (RNFL) is associated with cerebrovascular insufficiency.
DESIGN
Community-based study.
METHODS
The Asymptomatic Polyvascular Abnormalities in Community Study included Chinese aged 40+ years and without histories of cerebrovascular incidents or coronary heart disease. Using transcranial Doppler and carotid duplex ultrasound examination, we assessed presence and degree of an intracranial arterial stenosis (ICAS) and extracranial carotid arterial stenosis (ECAS) and we measured the RNFL thickness by spectral-domain optical coherence tomography.
RESULTS
The study included 3,376 participants with a mean age of 54.3±10.3 years. Thinner RNFL was significantly correlated with a higher prevalence of ECAS (P = 0.035; standardized regression coefficient beta:-0.04; non-standardized regression coefficient B:-0.99; 95% confidence intervals(CI):-1.90,-0.07), after adjusting for age (P<0.001;beta:-0.25;B:-0.26;95%CI:-0.30,-0.22), gender (P = 0.001;beta:-0.07;B:-1.36;95%CI:-2.14,-0.58) and blood concentration of low-density lipoproteins (P = 0.03;beta:0.04;B:0.52;95%CI:0.05,0.98). In a reverse manner, prevalence of ECAS was associated with a thinner RNFL thickness (P = 0.007; odds ratio (OR):0.99; 95%CI:0.98,0.99) after adjusting for older age (P<0.001;OR:1.06;95%CI:10.05,10.7), higher prevalence of ICAS (P = 0.01;OR:1.34;95%CI:1.07,1.69) and higher prevalence of carotid artery plaques (P<0.001;OR:9.18;95%CI:6.93,12.2), and higher blood concentration of total cholesterol (P = 0.03;OR:1.12;95%CI:1.01,1.23). In univariate analysis, an increasing degree of ECAS was significantly correlated with a thinner RNFL.
CONCLUSIONS
Higher prevalence and degree of ECAS were correlated with thinner RNFL and vice versa. Patients with abnormally thin RNFL without ocular disease may undergo carotid artery examination to detect asymptomatic carotid artery stenosis. Examination of the RNFL is useful for the diagnosis of cerebrovascular disease.
目的
研究视网膜神经纤维层（RNFL）异常变薄是否与脑血管供血不足相关。
设计
基于社区的研究。
方法
社区无症状多血管异常研究纳入了40岁及以上且无脑血管事件或冠心病病史的中国人。通过经颅多普勒和颈动脉双功超声检查，我们评估了颅内动脉狭窄（ICAS）和颅外颈动脉狭窄（ECAS）的存在情况及程度，并通过光谱域光学相干断层扫描测量了RNFL厚度。
结果
该研究纳入了3376名参与者，平均年龄为54.3±10.3岁。在调整年龄（P<0.001；标准化回归系数β：-0.25；非标准化回归系数B：-0.26；95%置信区间（CI）：-0.30，-0.22）、性别（P = 0.001；β：-0.07；B：-1.36；95%CI：-2.14，-0.58）和低密度脂蛋白血浓度（P = 0.03；β：0.04；B：0.52；95%CI：0.05，0.98）后，较薄的RNFL与较高的ECAS患病率显著相关（P = 0.035；标准化回归系数β：-0.04；非标准化回归系数B：-0.99；95%置信区间：-1.90，-0.07）。反之，在调整年龄较大（P<0.001；比值比（OR）：1.06；95%CI：10.05，10.7）、较高的ICAS患病率（P = 0.01；OR：1.34；95%CI：1.07，1.69）、较高的颈动脉斑块患病率（P<0.001；OR：9.18；95%CI：6.93，12.2）和较高的总胆固醇血浓度（P = 0.03；OR：1.12；95%CI：1.01，1.23）后，ECAS患病率与较薄的RNFL厚度相关（P = 0.007；OR：0.99；95%CI：0.98，0.99）。在单因素分析中，ECAS程度增加与较薄的RNFL显著相关。
结论
较高的ECAS患病率和程度与较薄的RNFL相关，反之亦然。无眼部疾病但RNFL异常变薄的患者可能需要进行颈动脉检查以检测无症状颈动脉狭窄。RNFL检查对脑血管疾病的诊断有用。
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