Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Department of Ophthalmology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Clin Neurol Neurosurg. 2022 Oct;221:107407. doi: 10.1016/j.clineuro.2022.107407. Epub 2022 Aug 3.
This study aimed to investigate the associations among retinal vessel density (RVD), neuroimaging features and cognitive impairment in patients with sporadic cerebral small vessel disease (CSVD).
This was a prospective observational study. A total of forty-nine patients with CSVD were recruited. The CSVD imaging burden was calculated by using a scoring system with a total score of 4 that assigns one point each for severe white matter hyperintensities (WMH), lacune, microbleeds (MBs), and basal-ganglia perivascular space (BG-PVS). Patients with a burden score ≥ 2 were classified as having a moderate/severe burden, and those with a score ≤ 1 were classified as the having a none/mild burden. The RVD in the superficial retinal capillary plexus (SRCP) and deep retinal capillary plexus (DRCP) was evaluated by using optical coherence tomography angiography (OCTA). The associations among the RVD values, CSVD imaging features, and cognitive impairment were evaluated.
Patients with a moderate/severe CSVD burden showed lower RVD values in the para-fovea and peri-fovea areas of the left DRCP than patients with none/mild burden (para-fovea, β coefficient= -0.185 [-0.351-0.015], P = 0.003; peri-fovea, β coefficient= -0.113 [-0.208-0.018], P = 0.021). The RVD values in the para-fovea and peri-fovea areas of the left DRCP were significantly associated with the CSVD burden score after adjusting for age and vascular risk factors (P = 0.030 and P = 0.021, respectively) and with severe WMH (para-fovea, R = -0.398, P = 0.005; peri-fovea, R= -0.443, P = 0.001) and BG-PVS (para-fovea, R = -0.445, P = 0.001; peri-fovea, R= -0.396, P = 0.005). Neither para-fovea nor peri-fovea RVD values had a marked association with cognition.
The RVD in the left DRCP may reflect the presence of cerebral small vessel lesions and might be a useful tool for predicting the neuroimaging-based burden of CSVD.
本研究旨在探讨散发性脑小血管病（CSVD）患者视网膜血管密度（RVD）、神经影像学特征与认知障碍之间的关系。
这是一项前瞻性观察性研究。共纳入 49 例 CSVD 患者。采用总分为 4 分的评分系统评估 CSVD 影像学负担，每出现严重脑白质高信号（WMH）、腔隙、微出血（MBs）和基底节血管周围间隙（BG-PVS）各计 1 分。CSVD 负担评分≥2 分者被归类为中重度负担，评分≤1 分者被归类为无/轻度负担。采用光学相干断层扫描血管造影（OCTA）评估浅层视网膜毛细血管丛（SRCP）和深层视网膜毛细血管丛（DRCP）的 RVD。评估 RVD 值、CSVD 影像学特征与认知障碍之间的关系。
中重度 CSVD 负担患者的左眼 DRCP 旁中心凹和中心凹周围区域的 RVD 值较无/轻度负担患者更低（旁中心凹，β系数=-0.185[-0.351-0.015]，P=0.003；中心凹周围，β系数=-0.113[-0.208-0.018]，P=0.021）。调整年龄和血管危险因素后，左眼 DRCP 旁中心凹和中心凹周围区域的 RVD 值与 CSVD 负担评分显著相关（P=0.030 和 P=0.021），且与严重 WMH（旁中心凹，R=-0.398，P=0.005；中心凹周围，R=-0.443，P=0.001）和 BG-PVS（旁中心凹，R=-0.445，P=0.001；中心凹周围，R=-0.396，P=0.005）显著相关。旁中心凹和中心凹周围区域的 RVD 值与认知功能均无显著相关性。
左眼 DRCP 的 RVD 可能反映脑小血管病变的存在，可能是预测 CSVD 基于神经影像学负担的有用工具。
