视网膜中央动脉阻塞患者脑血管造影特征分析及预后研究  

Cerebral angiographic features and prognostic study in patients with central retinal artery occlusion

作　　者：亚·娜仁 刘闫 周霞[1] 朱德坤[2] 陈枫[2] 马争飞[3] 李传辉[4] 孙中武[1] Ya·Naren;Liu Yan;Zhou Xia;Zhu Dekun;Chen Feng;Ma Zhengfei;Li Chuanhui;Sun Zhongwu(Department of Neurology,The First Affiliated Hospital of Anhui Medical University,Hefei 230000,China;Department of Neurology,Shihezi City People's Hospital,Shihezi 832000,Xinjiang Uygur Autonomous Region,China;Department of Neurology,The Affiliated Suzhou Hospital of Anhui Medical University,Suzhou 234000,Anhui Province,China;Department of Neurology,Xuanwu Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]安徽医科大学第一附属医院神经内科,合肥230000 [2]石河子市人民医院神经内科,新疆石河子832000 [3]安徽医科大学附属宿州医院神经内科,安徽宿州234000 [4]首都医科大学宣武医院神经内科,北京100730

出　　处：《首都医科大学学报》2025年第1期15-21,共7页Journal of Capital Medical University

基　　金：国家自然科学基金项目(81771154)。

摘　　要：目的对视网膜中央动脉阻塞(central retinal artery occlusion,CRAO)患者脑血管造影特征进行分析并对其预后进行研究。方法回顾性分析2014年1月1日至2024年6月1日在首都医科大学宣武医院、安徽医科大学第一附属医院、安徽医科大学附属宿州医院及石河子市人民医院就诊的182例CRAO患者。所有患者均在发病1个月内进行了全脑血管造影检查,并收集了患者的基线特征、治疗情况及随访数据。采用Spearman秩相关系数评价眼动脉与同侧颈动脉血管造影特征之间的相关性,并通过Logistics回归分析探讨患者预后的相关因素。结果全脑血管造影结果显示,81.3%的患者眼部供血来自于同侧颈内动脉,12.1%来自于同侧颈外动脉,6.6%来自于同侧大脑中动脉。80例患者(44.0%)存在患侧眼动脉不同程度的狭窄或闭塞,其中69例患者(86.3%)的眼动脉狭窄位于眼动脉起始部。135例患者(74.2%)存在同侧颈动脉不同程度的狭窄或闭塞,其中110例患者(60.4%)的颈动脉狭窄位于颈动脉球部,88例患者(48.3%)的颈动脉病变为单发,41例患者(22.5%)的颈动脉病变为多发。相关性分析表明,患者眼动脉狭窄程度和颈动脉狭窄程度显著相关(r=0.76,P=0.006)。多因素Logistic回归分析结果显示,症状发作至入院时间(OR=0.93,95%CI:0.85~0.98,P=0.018)、氧合的灌注不足性黄斑病变(oxygenation-based hypoperfusion maculopathy,OHM)分级(OR=3.12,95%CI:1.09~6.34,P=0.005)、静脉溶栓治疗(intravenous thrombolysis,IVT)(OR=2.75,95%CI:1.08~5.35,P=0.031)、眼动脉无狭窄(OR=1.33,95%CI:1.02~3.41,P=0.026)是患者预后的独立预测因素。结论CRAO患者眼动脉狭窄程度和颈动脉狭窄程度显著相关,症状发作至入院时间、OHM分级、IVT、眼动脉无狭窄是CRAO患者预后的独立影响因素。Objective To analyze the cerebral angiographic characteristics of patients with central retinal artery occlusion(CRAO)and to study their prognosis.Methods A retrospective study was conducted,with 182 CRAO patients enrolled,who were treated at Xuanwu Hospital,Capital Medical University,the First Affiliated Hospital of Anhui Medical University,the Affiliated Suzhou Hospital of Anhui Medical University,and the People's Hospital of Shihezi City from January 1,2014,to June 1,2024.All patients underwent cerebral angiography within one month of onset.The baseline characteristics,treatment details,and follow-up data were collected.The Spearman rank correlation coefficient was used to evaluate the correlation between the characteristics of the ophthalmic artery and the ipsilateral carotid artery angiography,and Logistic regression analysis was performed to explore factors related to patient prognosis.Results Cerebral angiography results showed that 81.3%of patients had ocular blood supply from the ipsilateral internal carotid artery,12.1%from the ipsilateral external carotid artery,and 6.6%from the ipsilateral middle cerebral artery.Among the patients,80(44.0%)had varying degrees of stenosis or occlusion of the affected ophthalmic artery,with 69 patients(86.3%)showing stenosis at the origin of the ophthalmic artery.Additionally,135 patients(74.2%)had varying degrees of stenosis or occlusion of the ipsilateral carotid artery,with 110 patients(60.4%)showing stenosis at the carotid bulb,88 patients(48.3%)having unilateral carotid lesions,and 41 patients(22.5%)having multiple lesions.Correlation analysis indicated a significant correlation between the degree of stenosis in the ophthalmic artery and the carotid artery(r=0.76,P=0.006).Univariate and multivariate Logistic regression analyses revealed that the time from symptom onset to hospital admission(OR=0.93,95%CI:0.85-0.98,P=0.018),the grading of oxygenation-based hypoperfusion maculopathy(OHM)(OR=3.12,95%CI:1.09-6.34,P=0.005),intravenous thrombolysis(IVT)(OR=2.75,95%CI:1.0

关 键 词：视网膜中央动脉阻塞 脑血管造影 预后 

分 类 号：R743[医药卫生—神经病学与精神病学]