Relation Between Retinal Vessel Abnormalities And Leukoaraiosis

Background and PurposeCerebral small vessel include small artery,small vein and arteriole.Now researchers presume that the definition of Cerebral small vessel disease is the abnormality of the artery,whose diameter is below 400um.It contain cerebral lacune infarction,cerebral hemorrhage,Binswanger's disease.The pathogenesis of LA is still unclear completely.In usual opinion,it is caused by chronic infarction of cerebral arteriolosclerosis which have association of aging,cerebral vessel disease.The appearances of LA are cognitive impairment,gait abnormalities and urinary incontinence.They influence patients' livelihood.Up to now,there are no valid methords to cure LA.So precaution and prevetion its progression is very important.Though we can find LA sensitivitily using cerebral MRI,there are some defects in observing the development in clinical reseach.One is that using Magnetic Resonance Angiography(MRA) we can only find the abnormalities of cerebral large artery.The other is the high cost.Using retinal observation we can find abnormity clearly.It can provide unique direct visualization opportunities to study cerebral small vessel disease.Cerebral small vessel and retinal circulation share similar embryology anatomy and physiology.It is deserved to view whether retinal vessel abnormity can prognose incidence rate and progression.There were lots of research doing relationship between retinal vessel abnormity and cerebral vessel disease.But there are some flaws.First,outcome of the research are not same.Second,in reseach the parameter is semi-quantitation or qualitation. The last one,number of research ablout follow-up is small.There is not one article about whether retinal vessel abmormity can estimate incident of LA in normal person.In our research,we will do some work.Comprehend the relationship between retinal vessel abnormity and LA.Quantitate the tortuous of retinal vessel.Do ranking for hard exudates on the basis of its size and location.Our research will be foundation for future work,such as mortality of the follow-up.MaterialsRecuite patients,who were in Neurology wards of Nan Fang Hospital.Delete the samples with liver function failure,renal failure,heart failure,serious infection, malignant tumour,systemic lupus erythematosus(SLE),MS,eye's inflammation such as Uveitis,eye surgery taking in 6 months such as cataract extraction and laser,narrowing of anterior chamber angle,can't get up because of serious symptom and diseases influence LA and atrophy of corpus callosum(cc) like Alzhermer's disease.180 patients were recruited.Methods1,Basic data,Physical examination and biochemical examination would be done with every subject.2,Using software photoshop to measuring diameters of artery,vein and caculating arteriole-to-venule ratio(AVR).Quantitate the tortuous of retinal vessel. Do ranking for hard exudates on the basis of its size and location.And evaluate the retinopathy.3,Evey patients will have cerebral MRI or CT and retinal photography.Changes in subcortical(SWML) and periventricular(PWML) white matter lesions were rated with Fazakas scale.Using software autocad to calculate CCR.4,SPSS13.0 was used as statistic software.Data was showed as(?)±s and rate. One-way ANOVA,Bonferroni in multiple comparison,pared-Sampales t test, Independent-Sampales t test are used in group comparison.Pearson or spearman is used in correlation.Analyze Mutiple factors using binary logistic.All tests were two-tailed and a P-value of＜0.05 was considered significant.Results1.One patient lack rentinal photos.Use pared-Sampales t test to analysizing the difference between two eyes.There are no significant difference between the parameters of two eyes.But we find 17 patients of obviously difference between two eyes.4 of 17 person didn't have imaging data.Cerebral imaging display symmetry on 4 patients.AVR of disease side is smaller than that of normal side on 7 patients. Among these,MRA of 2 patients find the narrow of disease side of cerebral middle artery.Cerbral MRI of 2 patients exist opposite results.Between the two,disease of one is cerebral hemorrhage.2.4 patients lack basic data.Analyze the relationship between parameters of rentinal vessel disease and vessel risk factors.AVR average is significant correlate of history of smoking,drinking,family's hypertension or vessel disese.Correlation coefficient by turns is -0.034,-0.161.CRAE average is significant correlate of age, history of vessel disease and IMT of carotid artery.Correlation coefficient by turns is -0.299,-0.212,-0.217,-0.288.Controlling age,CRAE average is not significant correlate of IMT of carotid artery any more.CRVE average is significant correlate of age.Correlation coefficient is -0.224.AVN(arteriovenous nicking) is significant correlate of history of family's hypertension or vessel disese,CHOL,LDL.And correlation coefficient in order is -0.172,-0.163,-0.192.copper or silver change is significant correlate of age,history of vessel disease,TG,hsCRP.Correlation coefficient is -0.351,-0.196,0.194,0.286.Ranking of retinal artery tortuous is significant correlate of VLDL and HCY with correlation coefficient -0.195,0.311. After quantitate the tortuous of retinal vessel,artery tortuous is significant correlate of male.Vein tortuous is significant correlate of diastolic pressure and systolic pressure. correlation coefficient is -0.167,-0.155.To reduce error,patients with normal tortuous is excluded,the result don't change.Hemorrhage or microaneurysm is significant correlate of diabetes mellitus,VLDL,hsCRP.Correlation coefficient is 0.197,0.194,0.182.Hard exude is significant correlate of gender,diastolic pressure and systolic pressure.Correlation coefficient is -0.153,0.184,0.220.Cotton exude is significant correlate of diabetes mellitus.Correlation coefficient is 0.180.Ranking of retinal vessel disease is significant correlate of history of vessel disease,diastolic pressure and systolic pressure.3.Analyze the relationship between ITM of carotid artery and vessel risk factors. ITM of carotid artery is significant correlate of age,gender,hypertension,HCY, diastolic pressure and systolic pressure.4.Analyze the difference of vessel risk factors between absence and presense of LA.Age,hypertension,systolic pressure,and IMT of carotid artery are significance different.5.Using Spearman coefficient correlation,PWML is significant correlation of age,hypertension,diabetes and IMT of carotid artery.SWML is significant correlation of age,hypertension,diabetes,IMT of carotid artery,systolic pressure and HCY.6.Logistic analysis found that age and hypertension are significantly correlated with LA.7.Analyze the difference of vessel risk factors between cerebral small vessel disease(CSVD) group and cerebral infarction(CI) group.Between two group,age, hypertension,IMT of carotid artery,and HCY are significance different.8.Ranking of PWML is correlate with AVR,AVN,hemorrhage and rank of retinal vessel disease.Ranking of SWML is correlate with CRAE.After controlling age, gender,hypertension,ranking of PWML is not correlate with AVR.But the remain results are not change.9.In ervey rank of retinal vessel disease,we find one trend,in stage 3 of retinal vessel disease,rate of serious LA is higher.10.LA is significant negatively correlation with CCR.After correction for patients' age,hypertension,history of cardiovascular disease and IMT,there is weak but significant correlation between subcortical LA and CCR remained,and so is perivantricular LA and CCR.11,There is significant but weak correlation between CCR and diameter of retinal artery and vein.After correction for age,hypertension,history of cardiovascular disease and IMT,the diameter of retinal artery and vein is not correlation with CCR any more.Conclusion1.LA is negatively correlation with CCR after corrected for patients' age, hypertension,history of cardiovascular disease and IMT.2.Ranking of PWML is correlate with AVR,AVN,hemorrhage and rank of retinal vessel disease.Ranking of SWML is correlate with CRAE.After controlling age, gender,hypertension,ranking of PWML is not correlate with AVR.But the remain results are not change.3.CCR is correlate with CRAE and CRVE.After controlling age and hypertension,there is not correlation between them.LA and CC are infected by vessel risk factors.4.Throuh visualize the retinal vessel disease,we can know information of LA and CC.But a lot of reseach should be done to proof this result.