Correlation Between Retinal Abnormalities And Acute Ischemic Stroke

Background and purposeMicrovascular abnormalities are closely related to the pathogenesis of stroke.The retinal vascular system is the only part of the human body available for direct in vivo inspection,so the retina provides an opportunistic "window" to view the microcirculation.We qualitatively evaluated the degree of fundus lesions in stroke patients,studied the relationship between fundus lesions and recurrent ischemic stroke,and discussed the application value of fundus examination in the prevention and treatment of recurrent cerebral infarction.MethodsA case-control study was conducted on 196 patients aged 40 to 70 with acute ischemic stroke admitted to the neurology department of the Third People's Hospital of Luohe from December 2018 to November 2019.According to the medical history and cranial magnetic resonance imaging data,the patients were divided into the first-ever group(126 cases)and the recurrent group(70 cases).Fundus images were obtained by fundus photography,and the fundus was graded by the Wong-Mitchell classification method of hypertensive retinopathy.According to the distribution type of variables,independent sample t test,Pearson chi-square test,Fisher's exact probability test,and Mann-Whitney U test were used to compare the clinical data of the two groups.The Mantel-Haenszel chi-square test compares the linear relationship between two levels of data.Univariate Logistic regression was used to analyze the difference of fundus lesions between the group with initial onset of cerebral infarction and the group with recurrence.Variables including gender,age,history of hypertension,history of diabetes,history of coronary heart disease,history of smoking,severity of stroke and degree of fundus lesions were included in the multivariate binary logistic regression analysis to explore the independent risk factors for recurrence of stroke.Establish the prediction model of cerebral infarction recurrence and draw the ROC curve.ResultsClinical data were collected and analyzed in 196 patients with acute ischemic stroke.There were 126 cases of first-ever cerebral infarction and 70 cases of recurrent cerebral infarction.The prevalence of coronary heart disease(P=0.009),the prevalence of atrial fibrillation(P=0.044)and the admission NIHSS score(P<0.001)were higher in the recurrent group than in the first-ever group.The level of low-density lipoprotein in the recurrent group was lower than that in the first-ever group(P=0.037).There were significant differences in age distribution(P=0.028),infarction severity distribution(P<0.001),etiology distribution(P=0.016),and the degree of fundus lesions(P<0.001)between the two groups.There was a moderately positive correlation between fundus abnormalities and admission blood pressure(R=0.553,P<0.001).There was a weak positive correlation between the degree of fundus lesions and the severity of cerebral infarction(R=0.302,P<0.001).History of coronary heart disease(OR=2.677;95%Cl,1.079?6.640),and moderate fundus lesions(OR=5.588;95%CI,1.835?17.019)were independent risk factors for cerebral infarction recurrence.Moderate stroke(6 ? NIHSS score ?15)had marginal significance(P=0.052).There was no significant difference between the two groups in gender,age,smoking history,hypertension history and diabetes history.We developed a predictive model for recurrent cerebral infarction,include of history of coronary heart disease,stroke severity,three factors fundus lesion degree.The area under the receiver-operating characteristic curve was 0.711(95%CI,0.630?0.792),with a moderate potential ability to predict cerebral infarction recurrence.The Youden index corresponding to the optimal critical point is 0.390.The corresponding sensitivity and specificity were 55.7%and 83.3%respectively.Conclusions1.There was a positive correlation between fundus lesions and the degree of blood pressure on admission and the severity of ischemic stroke.2.Moderate retinopathy and a history of coronary heart disease are independent risk factors for recurrent cerebral infarction in the middle-aged and elderly people.3.Fundus assessment is helpful for clinicians to detect patients earlier who have a propensity to recur.Our study provides a theoretical basis for the application of fundus examination in secondary prevention of recurrent ischemic stroke.