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

doi:10.3969/j.issn.1006-7795.2025.01.004

首都医科大学学报 ›› 2025, Vol. 46 ›› Issue (1): 15-21.doi: 10.3969/j.issn.1006-7795.2025.01.004

• 国家卫生健康委加强脑卒中防治工作减少百万新发残疾工程 • 上一篇下一篇

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

亚•娜仁^1,2, 刘闫³, 周霞¹, 朱德坤², 陈枫², 马争飞³, 李传辉⁴, 孙中武^1*

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

收稿日期:2024-11-15 出版日期:2025-02-21 发布日期:2025-02-24
通讯作者: 孙中武 E-mail:sunzhwu@126.com
基金资助:
国家自然科学基金项目（81771154）。

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

Ya• Naren^1,2, Liu Yan³, Zhou Xia¹, Zhu Dekun², Chen Feng², Ma Zhengfei³, Li Chuanhui⁴, Sun Zhongwu^1*

1.Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei 230000, China; 2. Department of Neurology, Shihezi City People's Hospital, Shihezi 832000, Xinjiang Uygur Autonomous Region, China; 3. Department of Neurology, The Affiliated Suzhou Hospital of Anhui Medical University, Suzhou 234000, Anhui Province, China; 4. Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100730, China

Received:2024-11-15 Online:2025-02-21 Published:2025-02-24
Supported by:
This study was supported by National Natural Science Foundation of China (8177154).

摘要/Abstract

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。

关键词: 视网膜中央动脉阻塞, 脑血管造影, 预后

Abstract: 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: 1.08 － 5.35, P=0.031), and the absence of stenosis in the ophthalmic artery (OR=1.33, 95% CI: 1.02 － 3.41, P=0.026) were independent predictors of prognosis for CRAO patients. Conclusions The degree of stenosis in the ophthalmic artery is significantly correlated with the degree of stenosis in the carotid artery in CRAO patients. Time from symptom onset to hospital admission, OHM grading, IVT, and the absence of stenosis in the ophthalmic artery are independent factors influencing the prognosis of CRAO patients.

Key words: central retinal artery occlusion, cerebral angiography, prognosis

中图分类号:

R743

亚•娜仁, 刘闫, 周霞, 朱德坤, 陈枫, 马争飞, 李传辉, 孙中武. 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[J]. 首都医科大学学报, 2025, 46(1): 15-21.

Ya• Naren, Liu Yan, Zhou Xia, Zhu Dekun, Chen Feng, Ma Zhengfei, Li Chuanhui, Sun Zhongwu. Cerebral angiographic features and prognostic study in patients with central retinal artery occlusion[J]. Journal of Capital Medical University, 2025, 46(1): 15-21.

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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

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