高血压性视网膜病变患者脑卒中发病风险的多因素分析  

Multivariate analysis of the risk of stroke in the patients with hypertensive retinopathy

作　　者：李成武[1] 周尚昆 刘静[1] 包银兰[1] 胡爱华[1] 王颖[1] 王嘉玉 LI Chengwu;ZHOU Shangkun;LIU Jing(Wangjing Hospital of China Academy of Chinese Medical Sciences,Beijing 100102,China)

机构地区：[1]中国中医科学院望京医院,北京100102

出　　处：《中国中医眼科杂志》2021年第5期337-340,共4页China Journal of Chinese Ophthalmology

基　　金：北京市中医药薪火传承“3+3”工程建设单位;唐由之名老中医工作室中国中医科学院望京医院分站;中国中医科学院望京医院科研课题(WJYY2016-PY-041)。

摘　　要：目的探讨高血压视网膜病变患者中相关因素与脑卒中发病风险的关系。方法采用横断面研究的方法收集中国中医科学院望京医院眼科门诊的无糖尿病和高脂血症且高血压性视网膜病变Ⅱ级及以上的高血压病患者100例(200只眼)。充分散瞳下应用TOPCON眼底照相机采集100例患者双眼的眼底彩照,并按照Keith-Wagener法进行高血压性视网膜病变分级,采用ImageJ1.46软件测量视网膜动脉直径和静脉直径,采用Logistic回归分析对脑卒中发病危险因素年龄、高血压病分级、病程、视网膜病变临床分级、视网膜动静脉直径比值进行多因素分析。结果受试者的年龄(63.90±9.92)岁,高血压病程(7.80±5.03)年。高血压性视网膜病变眼数分别为Ⅱ级154只眼(77.0%),Ⅲ级39只眼(19.5%),Ⅳ级7只眼(3.5%)。缺血性脑卒中28例(28%),出血性脑卒中2例(2%),合计30例(30%)。经多因素Logistic回归分析,年龄(OR值1.033~1.906)、高血压病分级(OR值1.552~1.673)、高血压病病程(OR值1.407~2.673)、高血压性视网膜病变临床分级(OR值1.463~1.682)、视网膜动静脉直径比值(OR值1.040~1.603)对脑卒中的发病风险均有统计学意义(P<0.05)。结论高血压病患者脑卒中发病风险与年龄、高血压病分级、病程、视网膜病变临床分级、视网膜动静脉直径比值等因素之间有相关性,病程是影响脑卒中发生的最重要因素。OBJECTIVE To explore the relationship between the factors related to hypertensive retinopathy and the risk of stroke in patients with hypertension. METHODS A cross-sectional study was conducted to collect 100 patients(200 eyes) in the ophthalmology clinic of Wangjing Hospital of China Academy of Chinese Medical Sciences. These patients were with hypertensive retinopathy of grade Ⅱ and above, without diabetes and hyperlipidemia. Both eyes of all patients in the pupil fully dispersed state were examined by TOPCON fundus camera to collect the fundus color photographs. The hypertensive retinopathy was graded according to the Keith-Wagener method. The diameters of retinal arteries and veins were measured by ImageJ1.46 software.Logistic regression analysis was used to analyze the relationship of risk factors, for example the age,the grade of hypertension, the course of hypertension, the clinical grade of hypertensive retinopathy,and arteriovenous diameter ratio. RESULTS The age of the subjects was 63.90±9.92 years old, and the course of hypertension was 7.80±5.03 years. The number of hypertensive retinopathy eyes was grade Ⅱ 154(77.0%), grade Ⅲ 39(19.5%), and grade Ⅳ 7(3.5%). There were 28 cases(28%) with ischemic stroke and 2 cases(2%)with hemorrhagic stroke, a total of 30 cases(30%). Age(OR value 1.033 ~1.906), hypertension grade(OR value1.552 ~1.673), hypertension course(OR value 1.407~2.673), hypertensive retinopathy clinical grade(OR value 1.463~1.682), arteriovenous diameter ratio(OR value 1.040~1.603) were statistically significant in the risk of stroke. The course of disease was the most important factor affecting risk of stroke(multivariate logistic regression analysis).CONCLUSIONS There is a correlation between the risk of stroke in patients with hypertension and age, hypertension grade, course of hypertension, clinical grade of hypertensive retinopathy, arteriovenous diameter ratio, etc. The course of disease is the most important factor affecting the occurrence of stroke.

关 键 词：高血压性视网膜病变 脑卒中 多因素分析 

分 类 号：R276.7[医药卫生—中医五官科学]