Differing associations of white matter lesions and lacunar infarction with retinal microvascular signs

作者：Liew Gerald; Baker Michelle L; Wong Tien Y; Hand Peter J; Wang Jie Jin^*; Mitchell Paul; De Silva Deidre A; Wong Meng Cheong; Rochtchina Elena; Lindley Richard I; Wardlaw Joanna M; Hankey Graeme J

来源：International Journal of Stroke, 2014, 9(7): 921-925.

DOI：10.1111/j.1747-4949.2012.00865.x

• blood brain barrier
• cerebral lacunes
• retinal microvascular signs
• retinopathy
• white matter lesions

Background White matter lesions (WML) and lacunar infarcts (LI) are believed to have microvascular etiologies but the exact microvascular changes occurring in each is unclear. %26lt;br%26gt;Aim Using the retina as a proxy, we assessed retinal microvascular changes in WML and LI. %26lt;br%26gt;Methods We prospectively recruited 1211 acute stroke patients. Four subgroups were identified from neuroimaging: WML alone, LI alone, both WML and LI, neither WML nor LI. Masked retinal photographs identified retinopathy and retinal arteriolar wall signs and measured retinal vascular caliber. %26lt;br%26gt;Results Compared with 448 controls with neither WML nor LI, 384 patients with only WML were more likely to have retinopathy [odds ratio (OR) 15, 95% confidence interval (CI) 11 to 21] and enhanced arteriolar light reflex (OR 16, 95% CI 11 to 23); 200 patients with only LI were more likely to have arteriolar narrowing (OR 16, 95% CI 11 to 23) and enhanced arteriolar light reflex (OR 16, 95% CI 10 to 24); and 179 patients with both WML and LI were more likely to have arteriovenous nicking (OR 17, 95% CI 11 to 26), enhanced arteriolar light reflex (OR 20, 95% CI 13 to 32) and wider venules (OR 23, 95% CI 14 to 36). All analyses were adjusted for age, gender, study site and cardiovascular risk factors. %26lt;br%26gt;Conclusion Both WML and LI were associated with retinal microvascular signs, supporting a microvascular etiology. Differing patterns of association suggest different mechanisms may predominate, e.g. greater endothelial permeability in WML, and ischemia associated with arteriolar wall disease in LI.

• 出版日期2014-10