スペクトル領域光コヒーレンス断層撮影法に基づく高血圧性網膜症の慢性期の診断．

Diagnosis of chronic stage of hypertensive retinopathy based on spectral domain optical coherence tomography.

• Xue Feng
• Haiwei Wang
• Yuanyuan Kong
• Junyan Zhang
• Jingfang He
• Bozheng Zhang
• Jianqiang Zhang
• Hong Qi
• Yanling Wang

抄録

高血圧性網膜症とは、全身性動脈性高血圧に伴う網膜血管の変化を指す。高血圧性網膜症は慢性期と急性期に分けられる。慢性高血圧性網膜症の診断のための網膜血管径の測定方法を、スペクトル領域光コヒーレンス断層撮影法（SD-OCT）に基づいて検討するために、横断的な研究を行った。網膜中心動脈径（CRAD），網膜中心静脈径（CRVD），動脈対静脈比（AVR）を測定した．高血圧群に56人の56眼、正常血圧群に63人の63眼の計119人を対象とした。CRAD(t=-2.14、P=.04)とAVR(t=-2.59、P=.01)で両群間に有意差があった。カットオフポイント0.75は、受信機操作特性（ROC）曲線（曲線下面積、AUC 0.786；95％信頼区間、95％CI 0.70-0.87）により決定した。多変量ロジスティック回帰分析では、AVRが0.75以下になる確率は、収縮期血圧が高い患者ほど高く（オッズ比OR 4.39; P=0.048）、男性ほど高く（OR 4.15; P=0.004）、喫煙者ほど高く（OR 5.80; P=0.01）なった。Bland-Altmanプロットは、CRAD、CRVD、AVRの2人の技術者の測定値の間に小さな平均バイアスを示した。要約すると、SD-OCTの適用は、網膜血管の直径を測定するための正確で、再現性があり、便利な方法である。高血圧性網膜症の慢性期の診断に価値があります。

Hypertensive retinopathy refers to the retinal vascular changes associated with systemic arterial hypertension. Hypertensive retinopathy can be divided into chronic and acute phases. A cross-sectional study was performed to explore a method of measurement in the diameters of retinal vessels for diagnosis of chronic hypertensive retinopathy based on spectral domain optical coherence tomography (SD-OCT). The central retinal artery diameter (CRAD), the central retinal vein diameter (CRVD), and the artery-to-vein ratio (AVR) were measured. A total of 119 subjects with 119 eyes were included in this study, in which 56 subjects with 56 eyes were included in hypertensive group and 63 subjects with 63 eyes were included in normotensive group. There were significant differences between the two groups in the CRAD (t = -2.14, P = .04) and the AVR (t = -2.59, P = .01). The cutoff point of 0.75 was determined by receiver operating characteristic (ROC) curve (area under the curve, AUC 0.786; 95% confidence interval, 95% CI 0.70-0.87). Multivariate logistic regression analysis showed the probability of AVR below to 0.75 was more in patients with high systolic blood pressure (odds ratio OR 4.39; P = .048), more in male (OR 4.15; P = .004) and more in smokers (OR 5.80; P = .01). Bland-Altman plots showed small mean bias between the measurements of the two technicians in the CRAD, the CRVD, and the AVR. In summary, application of SD-OCT is an accurate, reproducible, convenient method for measuring the diameters of retinal vessels. It is valuable for the diagnosis of chronic stage of hypertensive retinopathy.

© 2020 The Authors. The Journal of Clinical Hypertension published by Wiley Periodicals LLC.