视网膜动脉硬化与缺血性脑卒中的关系及激光扫描眼镜检测的临床价值  

Investigation of relationship between retinal arteriosclerosis and ischemic stroke with scanning laser ophthalmoscope

作　　者：徐振强 王惠云 黎良达 陆勤康 XU Zhenqiang;WANG Huiyun;LI Liangda;LU Qinkang(Department of Ophthalmology,Ningbo Yinzhou People’s Hospital Community,Ningbo 315040,China)

机构地区：[1]宁波市鄞州人民医院眼科,315040 [2]宁波市鄞州人民医院神经内科,315040

出　　处：《浙江医学》2020年第20期2140-2145,I0002,共7页Zhejiang Medical Journal

基　　金：浙江省医药卫生科技项目(2018KY162);宁波市科技项目(2019C50053,2019C50085)。

摘　　要：目的探讨视网膜动脉硬化改变与缺血性脑卒中的关系及激光扫描眼镜检测的临床价值。方法选取2018年10月至2019年5月于宁波市鄞州人民医院就诊的缺血性脑卒中患者63例(117眼),无缺血性脑卒中病史的住院患者62例(115眼)。采用欧堡Daytona激光扫描检眼镜行免散瞳视网膜血管照相。分析传统视网膜动脉硬化评分、视网膜动脉硬化总评分及视网膜中央动脉等效直径(CRAE)是否为缺血性脑卒中的独立危险因素;比较视网膜动脉硬化总评分与传统视网膜动脉硬化评分评价缺血性脑卒的诊断效能;比较联合视网膜动脉硬化评估指标(视网膜动脉硬化总评分与CRAE)与其各个指标单独评价缺血性脑卒中的诊断效能。结果两组患者在吸烟史、高血压病史、糖尿病史、收缩压、舒张压、FPG、TC、TG、HDL、LDL、传统视网膜动脉硬化评分、视网膜动脉硬化总评分及CRAE方面比较差异均有统计学意义(均P<0.05),而在性别、年龄及酗酒史方面比较差异均无统计学意义(均P>0.05);散点图显示美国国立卫生研究院卒中量表(NIHSS)和视网膜动脉硬化总评分(r2=0.011)及CRAE(r2=0.004)均无明显线性关系;校正高血压、糖尿病史、高脂血症及其他危险因素(吸烟史、收缩压、舒张压、TC、FPG、HDL、LDL)前后,结果显示传统视网膜动脉硬化评分、视网膜硬化总评分及CRAE均与缺血性脑卒中相关(均P<0.05);采用传统视网膜动脉硬化评分、视网膜动脉硬化总评分、CRAE及视网膜动脉硬化总评分联合CRAE评估缺血性脑卒中发作风险的AUC(95%CI)分别为0.567(95%CI:0.494~0.641)、0.597(95%CI:0.524~0.670)、0.774(95%CI:0.715~0.832)及0.897(95%CI:0.859~0.935),最佳参数值分别为1.50(灵敏度0.923,特异度0.191)、10.50(灵敏度0.735,特异度0.435)、10.08(灵敏度0.730,特异度0.692)及0.04(灵敏度0.709,特异度0.913)。结论缺血性脑卒中患者的视网膜动脉硬化程度较严重,提�Objective To investigate the relationship between retinal arteriosclerosis and ischemic stroke and the clinical valve of detection by using laser scanning ophthalmoscope.Methods A total of 125 patients admitted to our hospital from October 2018 to May 2019 were enrolled,including 63 cases of ischemic stroke(117 eyes)and 62 cases of non-stroke patients(115 eyes).Retinal arteriosclerosis score was applied for changes in retinal arteriosclerosis by using Panoramic Ophthalmoscope-Daytona.The association of traditional score of retinal arteriosclerosis,total score of retinal arteriosclerosis and central retinal artery equivalent(CRAE)with ischemic stroke was analyzed.And the total score of retinal arteriosclerosis and traditional score of retinal arteriosclerosis were compared for the diagnostic efficiency of ischemic stroke.The combination of retinal arteriosclerosis assessment indicators(total score of retinal arteriosclerosis and CRAE)and their respective indicators were compared to evaluate the diagnostic efficiency of ischemic stroke.Results There were statistically significant differences in history of smoking,history of hypertension,history of diabetes,systolic blood pressure,diastolic blood pressure,FPG,TC,TG,HDL,LDL,traditional score of retinal arteriosclerosis,total score of retinal arteriosclerosis and CRAE between stroke group and non-strokegroup(all P<0.05),whiletherewerenosignificant differences ingender,age,andhistory of alcoholismbetweentwogroups(P>0.05).The scatter plot showed no significant linear relationship between NIHSS score and total score of retinal arteriosclerosis(r2=0.011)or CRAE(r2=0.004).After adjusting for hypertension,diabetes,hyperlipidemia and other risk factors(history of smoking,systolic blood pressure,diastolic blood pressure,TC,FPG,HDL,LDL),the results showed that traditional score of retinal arteriosclerosis,total score of retinal arteriosclerosis and CRAE were all associated with ischemic stroke(all P<0.05).The AUC of traditional score of retinal arteriosclerosis,total score of

关 键 词：视网膜动脉硬化 缺血性脑卒中 激光扫描检眼镜 诊断效能 视网膜中央动脉等效直径 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R774.1[医药卫生—临床医学]