Yannuzzi L A
Retina. 1987 Summer;7(2):111-31. doi: 10.1097/00006982-198700720-00009.
A consecutive series of newly-diagnosed patients with central serous chorioretinopathy (CSC) was compared to two independent control groups chosen from the same patient population for the presence of a Type A behavioral pattern based on the Jenkins Activity Survey. The patients selected as matched controls had painless, reduced central vision and other chorioretinal diseases (Group I), or non-chorioretinal ocular conditions (Group II). The Type A behavior was significantly more frequent in study patients than in either Control Group I (X2 = 6.1 and P less than 0.025) or Control Group II patients (X2 = 17.7 and P less than 0.001). When both control groups were combined for comparison to the CSP patients, there was also a highly significant difference with regard to Type A behavior (X2 = 14.1 and P less than 0.001). A comparison of Control Group I with Control Group II revealed no significant difference in Type A behavior. Subfactor analysis of the Type A behavior pattern was also studied. The results of this clinical study were used in conjunction with experimental evidence linking catecholamines with CSP in developing a multifactorial etiologic hypothesis. The hypothesis suggests that the eyes as an organ system, and the macula as an ultimate target area, can be intermittently or continuously stimulated adversely by Type A behavior and its physiological consequences, most notably a sympathetic discharge. The multifactorial concept alludes to other potential risk factors such as age, race, sex, refractive state, or unknown tissue susceptabilities. The pathogenesis implies an inter-relationship between finely balanced components of a complex biopsychological system involving an individual's genetic endowment, his environment, and his behavioral pattern. The concept also offers new possible lines of investigation for the treatment of CSP, utilizing pharmacological regulators and for its prevention through early identification of CSP-prone individuals. A review of the pertinent cardiovasculature literature linking the Type A behavior with coronary artery disease and the significant papers in the ophthalmic literature on central serous pigment epitheliopathy are included in the discussion.
选取一系列新诊断的中心性浆液性脉络膜视网膜病变（CSC）患者，与从同一患者群体中选出的两个独立对照组进行比较，根据詹金斯活动调查来确定是否存在A型行为模式。选为匹配对照组的患者患有无痛性、中心视力下降以及其他脉络膜视网膜疾病（第一组），或非脉络膜视网膜眼部疾病（第二组）。研究患者中A型行为的发生率显著高于第一对照组（X2 = 6.1，P < 0.025）或第二对照组患者（X2 = 17.7，P < 0.001）。当将两个对照组合并与CSC患者进行比较时，在A型行为方面也存在高度显著差异（X2 = 14.1，P < 0.001）。第一对照组与第二对照组之间的A型行为比较未发现显著差异。还对A型行为模式的子因素进行了分析。这项临床研究的结果与将儿茶酚胺与CSC联系起来的实验证据相结合，以形成多因素病因假说。该假说认为，作为一个器官系统的眼睛以及作为最终目标区域的黄斑，可能会受到A型行为及其生理后果（最显著的是交感神经放电）的间歇性或持续性不良刺激。多因素概念还暗示了其他潜在风险因素，如年龄、种族、性别、屈光状态或未知的组织易感性。其发病机制意味着一个复杂的生物心理系统中精细平衡的成分之间存在相互关系，该系统涉及个体的遗传禀赋、环境和行为模式。这一概念还为CSC的治疗提供了新的可能研究方向，即利用药物调节剂，以及通过早期识别易患CSC的个体来进行预防。讨论中包括了将A型行为与冠状动脉疾病联系起来的相关心血管文献综述，以及眼科文献中关于中心性浆液性色素上皮病变的重要论文。
