Tao Tianchang, Xu Hui, Ma Xiaoyun, Cheng Yong, Shi Xuan, Sun Yaoyao, Zhao Mingwei, Huang Lvzhen, Li Xiaoxin
Department of Ophthalmology, Peking University People's Hospital, Eye Diseases and Optometry Institute, Beijing, 100044, China.
Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, 100044, China.
Ophthalmol Ther. 2023 Apr;12(2):1033-1044. doi: 10.1007/s40123-023-00650-y. Epub 2023 Jan 21.
It remains controversial whether polypoidal choroidal vasculopathy (PCV) represents a subtype of neovascular age-related macular degeneration (nAMD) or is a distinct disease entity. This study aimed to compare and analyze systemic and serum risk factors for nAMD and PCV in an aging Chinese population.
A retrospective study was performed on 108 patients with nAMD, 131 patients with PCV, and 219 control subjects. Serum levels of total cholesterol (TC), triglycerides (TG), low-density lipoprotein (LDL), high-density lipoprotein (HDL), apolipoprotein A1 (APOA1), apolipoprotein B (APOB), complement 3 (C3), and complement 4 (C4) together with data on systemic risk factors, including hyperlipidemia, hypertension, diabetes mellitus (DM), coronary artery disease (CAD), and asthma, were collected. Chi-square tests, independent-samples t tests, and binary logistic regression analyses were performed to evaluate the associations of risk factors with nAMD and PCV.
Patients with PCV and those with nAMD were likely to have hyperlipidemia (P < 0.001). CAD (P = 0.020) and hypertension (P = 0.006) correlated significantly with nAMD and PCV, respectively. Although no association of age and asthma with PCV or nAMD was found (P > 0.05), DM was associated with PCV development (OR = 0.535, P = 0.044). Regarding serum risk factors, HDL, LDL, TG, APOB, and C3 were significantly associated with nAMD (OR < 0.001, P < 0.001; OR = 0.028, P < 0.001; OR = 0.175, P < 0.001; OR = 0.922, P = 0.022; OR < 0.001, P < 0.001) and PCV (OR = 0.001, P = 0.001; OR = 0.097, P = 0.003; OR = 0.410, P = 0.037; OR = 0.895, P = 0.001; OR = 0.001, P < 0.001). Compared with nAMD, higher levels of HDL (P = 0.003) and LDL (P = 0.016) and lower levels of TG (P = 0.039) were found in patients with PCV, but the association of systemic risk factors between the two diseases was not significant (P > 0.05).
Our findings indicate that hyperlipidemia is significantly associated with both nAMD and PCV. Serum lipid and complement levels have an effect on the pathogenesis of nAMD and PCV, and consideration of the differences between systemic and serum risk factors should be taken into account in clinical management.
息肉状脉络膜血管病变（PCV）是新生血管性年龄相关性黄斑变性（nAMD）的一种亚型还是一种独特的疾病实体，目前仍存在争议。本研究旨在比较和分析中国老年人群中nAMD和PCV的全身及血清危险因素。
对108例nAMD患者、131例PCV患者和219例对照者进行了一项回顾性研究。收集了总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白（LDL）、高密度脂蛋白（HDL）、载脂蛋白A1（APOA1）、载脂蛋白B（APOB）、补体3（C3）和补体4（C4）的血清水平，以及包括高脂血症、高血压、糖尿病（DM）、冠状动脉疾病（CAD）和哮喘在内的全身危险因素数据。进行卡方检验、独立样本t检验和二元逻辑回归分析，以评估危险因素与nAMD和PCV的关联。
PCV患者和nAMD患者都可能患有高脂血症（P＜0.001）。CAD（P = 0.020）和高血压（P = 0.006）分别与nAMD和PCV显著相关。虽然未发现年龄和哮喘与PCV或nAMD有关联（P＞0.05），但DM与PCV的发生有关（比值比[OR] = 0.535，P = 0.044）。关于血清危险因素，HDL、LDL、TG、APOB和C3与nAMD（OR＜0.001，P＜0.001；OR = 0.028，P＜0.001；OR = 0.175，P＜0.001；OR = 0.922，P = 0.022；OR＜0.001，P＜0.001）和PCV（OR = 0.001，P = 0.001；OR = 0.097，P = 0.003；OR = 0.410，P = 0.037；OR = 0.895，P = 0.001；OR = 0.001，P＜0.001）显著相关。与nAMD相比，PCV患者的HDL（P = 0.003）和LDL（P = 0.016）水平较高，TG水平较低（P = 0.039），但两种疾病之间全身危险因素的关联不显著（P＞0.05）。
我们的研究结果表明，高脂血症与nAMD和PCV均显著相关。血清脂质和补体水平对nAMD和PCV的发病机制有影响，在临床管理中应考虑全身和血清危险因素之间的差异。
