Biological Factors for Age-Related Macular Degeneration

（2003年4月8日修订） 视网膜相关性黄斑变性（AMD）是老年人中不可逆视力丧失的主要原因。只有一小部分新生血管型AMD患者可以接受治疗，并且尚未确定预测性全身因素。已显示可保护或增加其他年龄相关疾病风险的全身性生物标志物在眼睛和/或视网膜中发挥一定作用，或者基于现有证据，其作用具有很强的生物相容性。我们将测试的假设，某些生物因素显示与氧化过程，炎症和/或血管疾病与AMD相关。总体假设是AMD的临床表现与局部和全身生物因素有关，这些生物因素可能受到可改变的环境和/或遗传因素的影响。我们建议在912名受试者（59%女性，41%男性）中使用可用的测定法检查这些生物标志物：5%的无AMD受试者，25%的轻度AMD受试者，45%的中度AMD受试者和25%的仅单眼晚期AMD受试者，所有受试者均在1996年（超过90%）或1997年提供了空腹血液标本。将对受试者进行至少7年的前瞻性随访。这项研究是AMD相关眼病研究（AREDS）的一项已获批准的辅助研究，该研究旨在评估AMD和白内障的发病率、进展和风险因素，并包括一项随机试验，以评估抗氧化维生素和矿物质对这些疾病的影响。AREDS提供了一个独特的机会来有效地和前瞻性地测试这些关联。这可能是最大的可用的患有不同阶段AMD的患者队列，这些患者在AMD和其他潜在风险因素方面得到了很好的表征。长期目标是深入了解AMD的发病机制，并确定可改变的风险或保护因素，这些因素可能导致预防措施和改善老年人视力丧失的常见原因的治疗。

(Revised 4/8/03) Age-related macular degeneration (AMD) is the leading cause of irreversible visual loss among elderly individuals. Treatment is available for only a small percentage of patients with the neovascular form of AMD and predictive systemic factors have not been identified. Systemic biomarkers shown to protect or increase risk in other age-related disorders have been shown either to play some role in the eye and/or retina, or there is strong biologic plausibility of a role based on available evidence. We will test the hypotheses that certain biological factors shown to be associated with oxidative processes, inflammation and/or vascular disease are associated with AMD. The overall hypothesis is that clinical manifestations of AMD are related to local and systemic biological factors, which may be influenced by modifiable environmental and/or genetic factors. We propose to examine these biomarkers with available assays in 912 subjects (59% female, 41% male): 5% of subjects with no AMD, 25% of subjects with mild AMD, 45 % of subjects with moderate AMD and 25% of subjects with advanced AMD in one eye only, all of whom provided a fasting blood specimen in 1996 (over 90%) or 1997. Subjects will be followed prospectively for at least seven years. This study is an approved ancillary investigation of the Age-Related Eye Disease Study (AREDS), which is designed to assess the incidence, progression and risk factors for AMD and cataract and includes a randomized trial to assess the effects of antioxidant vitamins and minerals on these diseases. AREDS provides a unique opportunity to test these associations efficiently and prospectively. This is likely the largest available cohort of patients with various stages of AMD who have been well characterized in terms of AMD and other potential risk factors. The long-term goal is to provide insight into the pathogenesis of AMD and to identify modifiable risk or protective factors that may lead to preventive measures and improved therapies for this common cause of visual loss in the elderly.