视网膜中央动脉阻塞伴颈内动脉狭窄35例临床分析  

Clinical characteristics of central retinal artery occlusion in 35 patients with internal carotid artery stenosis

作　　者：李杰宾 李松峰[2] 贵玉[3] 张敬[1] 丁宁[1] Li Jiebin;Li Songfeng;Gui Yu;Zhang Jing;Ding Ning(Department of Emergency Medicine,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China;Beijing Tongren Eye Center,Beijing Tongren Hospital,Capital Medical University,Beijing Key Laboratory of Ophthalmology and Visual Sciences,Beijing 100730,China;Department of Ultrasound,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京同仁医院急诊科,100730 [2]首都医科大学附属北京同仁医院、北京同仁眼科中心眼科与视觉科学北京市重点实验室,100730 [3]首都医科大学附属北京友谊医院超声科,100050

出　　处：《眼科》2023年第4期332-337,共6页Ophthalmology in China

基　　金：北京市经济技术开发区创新工程领军人才2021。

摘　　要：目的比较视网膜中央动脉阻塞(CRAO)伴与不伴颈内动脉狭窄(ICAS)患者的临床特点。设计回顾性病例系列。研究对象2014-2021年北京同仁医院92例CRAO患者。方法CRAO伴ICAS的35例患者为颈内动脉狭窄组(CRAO-ICAS),CRAO无合并ICAS的57例患者为非颈内动脉狭窄组(CRAO-NICAS)。对两组患者人口特征、症状、血管危险因素、合并内科疾病、实验室及影像学检查、治疗方法、治疗后1周及1年视力改善情况及随访1年内血管事件(缺血性卒中、急性心肌梗死、死亡)进行对比分析。主要指标临床表现,视力改善情况,随访1年内血管事件。结果CRAO-ICAS组和CRAO-NICAS组患者眼别、视野缺损、眼压升高、吸烟史、心脑血管疾病家族史、冠状动脉疾病史、合并糖尿病及心房颤动差异无统计学意义(P均>0.05)。男性(OR=5.765,P=0.003)、高脂血症(OR=3.638,P=0.028)及高血压病(OR=3.769,P=0.020)是CRAO-ICAS的独立危险因素。CRAO-ICAS组患者发病前一过性黑朦(χ^(2)=5.845,P=0.016)及合并急性脑梗死(χ^(2)=9.563,P=0.004)较CRAO-NICAS组明显增加。CRAO-ICAS组27例患者经眼动脉超选择性插管溶栓后1周有12例(44.4%)视力改善,随访1年内新增2例视力改善,原12例视力改善患者,有5例视力恢复>0.1,1例>0.5;CRAO-NICAS组40例患者动脉溶栓后1周有19例(47.5%)视力改善,随访1年内原19例视力改善患者,有7例视力恢复>0.1。早期溶栓治疗(<24小时)对CRAO-ICAS(χ^(2)=9.258,P=0.002)和CRAO-NICAS(χ^(2)=10.639,P=0.001)患者视力改善均效果显著。CRAO-ICAS组1年内发生心脑血管事件者9例(25.7%),其中脑梗死8例,急性心肌梗死1例;CRAO-NICAS组1年内心脑血管事件5例(8.8%),均为脑梗死;两组比较有统计学意义(χ^(2)=4.825,P=0.038)。结论伴与不伴ICAS的CRAO患者发病24小时内经眼动脉超选择性插管溶栓治疗视力恢复相对较好。CRAO伴ICAS患者发病时合并急性脑梗死及随访后心脑血管事件发生率高。Objective To compare the clinical characteristics of central retinal artery occlusion(CRAO)in patients with or without internal carotid artery stenosis(ICAS).Design Retrospective case series.Participants 92 patients with CRAO treated in Beijing Tongren Hospital from 2014 to 2021.Methods Thirty five patients(35 eyes)who had CRAO with ICAS formed CRAO-ICAS group and the other 57 patients(57 eyes)who only had CRAO formed CRAO-NICAS group.Demographic factors,clinical symptoms,vascular risk factors,internal medicine comorbidities,laboratory parameters and imaging examinations,treatment,1-week and 1-year visual acuity improvement after treatment,and 1-year follow-up vascular events(e.g.,ischemic stroke,acute myocardial infarction,death)were analyzed by comparing the two groups.Main Outcome Measures Clinical features,visual acuity improvement,1-year follow-up vascular events.Results There was no statistically difference between CRAO-ICAS group and CRAO-NICAS group in affected eye,visual field defect,increased intraocular pressure,history of smoking,history of family cardiovascular and cerebrovascular disease,history of coronary artery disease,diabetes and atrial fibrillation(all P>0.05).Male(OR=5.765,P=0.003),hyperlipidemia(OR=3.638,P=0.028),hypertension(OR=3.769,P=0.020)were the independent risk factors for CRAO with ICAS.Compared with the CRAO-NICAS group,the CRAO-ICAS group was characterized by the higher rates of transient amaurosis before the onset,and acute cerebral infarction,and the difference were statistically significant(χ^(2)=5.845,P=0.016;χ^(2)=9.563,P=0.004).The visual acuity was significantly improved in 12 cases(44.4%)of the 27 patients with CRAO-ICAS at 1 week after thrombolysis via super-selective ophthalmic artery catheterization,partially improved in 5 cases above 0.1,1 case above 0.5 at 1 year of follow-up,furthermore improved in 2 new cases.The visual acuity was significantly improved in 19 cases(47.5%)of the 40 patients with CRAO-NICAS at 1 week after thrombolysis,partially improved in 7 cases a

关 键 词：视网膜动脉阻塞 颈内动脉狭窄 动脉溶栓 血管事件 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R771.3[医药卫生—临床医学]