■颈动脉狭窄(CAS)是高血压最常见的大血管并发症之一。眼动脉来自颈内动脉;然而,在高血压患者中,CAS对眼微循环的影响尚未量化.这项研究旨在量化CAS(HCAS)高血压患者的眼部微循环指标,并探讨高血压微血管病和大血管病之间的关系。
■所有参与者(基于社区)都接受了详细的评估,包括颈动脉超声检查,光学相干断层扫描血管造影(OCTA),和增强深度成像(EDI)-OCT。颈动脉超声诊断为CAS。视网膜微循环指标,包括血管密度(VD),骨架密度(SD),分形维数(FD),和中央凹无血管区(FAZ),使用OCTA和ImageJ软件进行定量。脉络膜微循环指标,包括中央凹下脉络膜厚度(SFCT),管腔面积(LA),脉络膜血管分布指数(CVI),使用EDI-OCT和ImageJ进行定量。视网膜血管口径指标,包括视网膜中央动脉当量(CRAE),视网膜中央静脉当量(CRVE),和动脉/静脉比(AVR),使用修订后的公式计算。以上指标在HCAS组之间进行了比较,无CAS的高血压(HNCAS)组,健康对照组。使用回归分析评估了眼部指标与CAS之间的相互影响。
■在比较HCAS与HNCAS团体,包括VD在内的视网膜指标,SD,FD,和脉络膜指标,包括CVI和LA,在HCAS组显著降低(均p<0.05);然而,FAZ,SFCT,和视网膜血管口径指标,包括CRAE,CRVE,两组间AVR具有可比性(均p>0.05)。在HNCAS和健康对照组的比较中,VD,SD,和CRAE显示HNCAS组AVR显著降低(均p<0.05);两组间脉络膜指标具有可比性(均P>0.05).线性回归分析显示,高血压患者的内膜中层厚度(IMT)(p=0.01)和收缩期峰值速度(PSV)(p=0.002)与视网膜VD呈负相关。Logistic回归分析显示,年龄较大(p<0.001),吸烟史(p=0.002),较低的VD(p=0.04),SD(p=0.02),和CVI(p<0.001)与高血压患者中CAS的存在有关。
■高血压引起的视网膜和脉络膜微循环的低灌注和降低的视网膜VD和脉络膜CVI与高血压患者的CAS存在显著相关,提示高血压大血管病变和微血管病变是相互影响的,并且具有共同的病理生理学。此外,OCT可能是一种有用的工具,用于以非侵入性方式评估高血压患者的CAS风险概况。
UNASSIGNED: Carotid artery stenosis (CAS) is one of the most common macrovascular complications of hypertension. The ophthalmic artery springs from the internal carotid artery; however, the effect of CAS on ocular microcirculation has not been quantified in hypertension patients. This study aimed to quantify ocular microcirculation metrics in hypertension with CAS (HCAS) patients and to explore the relationship between micro- and macroangiopathy in hypertension.
UNASSIGNED: All participants (community-based) underwent detailed assessments, including carotid ultrasonography, optical coherence tomography angiography (OCTA), and enhanced depth imaging (EDI)-OCT. CAS was diagnosed using carotid ultrasonography. Retinal microcirculation metrics, including vessel density (VD), skeleton density (SD), fractal dimension (FD), and foveal avascular zone (FAZ), were quantified using OCTA and ImageJ software. Choroidal microcirculation metrics, including subfoveal choroidal thickness (SFCT), luminal area (LA), and choroidal vascularity index (CVI), were quantified using EDI-OCT and ImageJ. Retinal vessel caliber metrics, including central retinal artery equivalent (CRAE), central retinal vein equivalent (CRVE), and artery/vein ratio (AVR), were calculated using revised formulas. The above metrics were compared among the HCAS group, hypertension with no CAS (HNCAS) group, and healthy control group. The mutual effects between ocular metrics and CAS were evaluated using regression analyses.
UNASSIGNED: In a comparison of the HCAS vs. HNCAS groups, retinal metrics including VD, SD, FD, and choroidal metrics including CVI and LA were significantly decreased in the HCAS group (all p < 0.05); however, FAZ, SFCT, and retinal vessel caliber metrics including CRAE, CRVE, and AVR were comparable between groups (all p > 0.05). In a comparison of HNCAS and the healthy control group, VD, SD, and CRAE showed that AVR was significantly decreased in the HNCAS group (all p < 0.05); meanwhile, choroidal metrics were comparable between groups (all p > 0.05). Linear regression analyses showed that intima-media thickness (IMT) (p = 0.01) and peak systolic velocity (PSV) (p = 0.002) were negatively related to retinal VD in hypertension patients. Logistic regression analyses disclosed that older age (p < 0.001), smoking history (p = 0.002), lower VD (p = 0.04), SD (p = 0.02), and CVI (p < 0.001) were related to the presence of CAS in hypertension patients.
UNASSIGNED: CAS in hypertension-induced hypoperfusion in retinal and choroidal microcirculation and the decreased retinal VD and choroidal CVI were significantly associated with the presence of CAS in patients with hypertension, suggesting that hypertension macro- and microangiopathy were mutually affected and share the common pathophysiology. Furthermore, OCT could be a useful tool to assess hypertension patient\'s CAS risk profiles in a non-invasive way.