Retinal microvascular changes and subsequent vascular events after ischemic stroke
Retinal microvascular changes and subsequent vascular events after ischemic stroke
复制标题
DOI：
10.1212/wnl.0b013e31822c623b
复制
发表时间：
2011-08-01
期刊：
影响因子：
9.9
通讯作者：
Wong, M. -C.
中科院分区：
文献类型：
--
作者：
De Silva, D. A.;Manzano, J. J. F.;Wong, M. -C.
目的：健康人群中视网膜微血管的变化与包括中风在内的血管事件相关。目前尚不清楚视网膜微血管变化是否可以预测缺血性中风后复发性血管事件。我们检查了 2005 年至 2007 年新加坡一家三级医院收治的 652 名急性缺血性中风患者的前瞻性队列中视网膜微血管体征与随后血管事件之间的关系。 方法：以遮蔽方式评估中风发病 1 周内拍摄的视网膜照片，以进行定量和定性测量。通过标准化电话访谈获得2-4年的随访数据，然后根据病历进行验证。使用 Cox 回归模型确定复发性血管事件（脑血管、冠状动脉、血管性死亡和复合血管事件）的预测因子。 结果：队列中 89%（652 名患者）获得了中位 29 个月的随访数据。对包括传统危险因素和指标卒中病因在内的协变量进行调整后，与无 AVN 的患者相比，患有严重动静脉缺损 (AVN) 的患者更有可能发生复发性脑血管事件（风险比 [HR] 2.28，95% 置信区间 [CI] 1.20-4.33）。与无 FAN 的患者相比，患有严重局灶性小动脉狭窄 (FAN) 的患者更有可能发生复发性脑血管事件（HR 2.75，95% CI 1.14-6.63）或随后发生复合血管事件（HR 2.77，95% CI 1.31-5.86）。 结论：视网膜微血管变化可预测缺血性卒中后的后续血管事件，与传统危险因素和卒中无关亚型。因此，视网膜成像在预测缺血性中风后血管事件复发的风险和了解新的血管危险因素方面具有潜在作用。神经病学（R）2011；77：896-903
Objectives: Retinal microvasculature changes are associated with vascular events including stroke in healthy populations. It is not known whether retinal microvascular changes predict recurrent vascular events after ischemic stroke. We examined the relationship between retinal microvascular signs and subsequent vascular events in a prospective cohort of 652 acute ischemic stroke patients admitted to a tertiary hospital in Singapore from 2005 to 2007.Methods: Retinal photographs taken within 1 week of stroke onset were assessed in a masked manner for quantitative and qualitative measures. Follow-up data over 2-4 years were obtained by standardized telephone interview and then were verified from medical records. Predictors of recurrent vascular events (cerebrovascular, coronary, vascular death, and composite vascular events) were determined using Cox regression models.Results: Follow-up data over a median of 29 months were obtained for 89% (652 patients) of the cohort. After adjustment for covariates including traditional risk factors and index stroke etiology, patients with severe arteriovenous nicking (AVN) were more likely to have a recurrent cerebrovascular event (hazard ratio [HR] 2.28, 95% confidence interval [CI] 1.20-4.33) compared with those without AVN. Patients with severe focal arteriolar narrowing (FAN) were more likely to have a recurrent cerebrovascular event (HR 2.75, 95% CI 1.14-6.63) or subsequent composite vascular event (HR 2.77, 95% CI 1.31-5.86) compared to those without FAN.Conclusions: Retinal microvascular changes predicted subsequent vascular events after ischemic stroke, independent of traditional risk factors and stroke subtype. Thus, retinal imaging has a potential role in predicting the risk of recurrent vascular events after ischemic stroke and in understanding novel vascular risk factors. Neurology (R) 2011;77:896-903