무증상 경동맥협착에서 관찰되는 망막신경섬유층의 두께 감소
Decreased Retinal Nerve Fiber Thickness in Asymptomatic Carotid Stenosis
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목적: 망막신경섬유층의 두께와 경동맥의 죽상경화성 협착과의 연관성에 대해 알아보고자 하였다. 대상과 방법: 빛간섭단층촬영을 이용한 망막신경섬유층의 측정 및 경동맥초음파검사를 1년 이내 시행한 106명을 대상으로 망막신경섬유층을 4분면으로 구분하여 각각의 두께 및 총 평균 두께와 경동맥의 내막두께, 플라크의 유무 및 협착 정도를 비교하였다. 또한, 망막신경섬유층의 총 두께와 경동맥의 죽상경화성 협착과의 상관관계를 확인하기 위해 나이, 총콜레스테롤 수치를 통제한 다중회귀분석(multiple regression analysis)을 실시하였다. 결과: 망막신경섬유층의 총 두께의 감소가 총경동맥플라크의 유무와 유의한 연관성을 보였으며(p=0.039), 총경동맥플라크 유무에 따른 두 군은 경동맥내막두께, 콜레스테롤 수치를 제외한 나이 및 혈관질환의 위험인자 간의 차이는 없었다. 선형회귀분석(linear univariate regression analysis)을 통하여 망막신경섬유층의 두께와 나이, 총 콜레스테롤 수치와의 관련성을 확인하였다. 또한, 다중회귀분석(linear multivariate regression analysis) 결과, 나이와 총 콜레스테롤 수치를 통제한 상황에서 총경동맥플라크의 유무와 망막신경섬유층 총 두께의 유의한 상관관계를 확인하였다(p=0.026). 결론: 빛간섭단층촬영을 이용한 망막신경섬유층의 측정을 통하여 안과적 질환을 배제한 망막신경섬유층의 두께 감소가 있을 경우 경동맥검사의 필요성을 고려해 볼 수 있다.
Abstract
Purpose: To investigate the relationship between retinal nerve fiber layer (RNFL) thickness and carotid artery stenosis (CAS). Methods: We retrospectively reviewed the medical records of 106 patients who underwent both optical coherence tomography to determine RNFL and carotid artery sonography within 1 year. The RNFL was divided into four quadrants, and each quadrant’s RNFL thickness and average thickness were compared with the artery endothelial thickness, the presence of plaque, and the degree of CAS. A multiple regression analysis was performed to assess the relationship between RNFL and CAS. Results: The presence of carotid artery plaque had a significant association with a decrease in the average RNFL thickness (p = 0.039). There was no statistically significant difference in age or risk factors associated with vascular disease, with the exception of carotid endothelial thickness and the total cholesterol level in the two groups, depending on the presence of total carotid plaque. RNFL thickness was confirmed to be related to age and total cholesterol levels using linear univariate regression analysis. In a multivariable linear regression analysis, with age and total cholesterol levels controlled, the presence of carotid artery plaque was significantly associated with a decrease in average RNFL thickness (p = 0.026). Conclusions: Asymptomatic CAS may be associated with a decrease in average RNFL thickness. In patients with decreased RNFL thickness without any ophthalmic diseases, carotid artery examination should be considered.
참고문헌 (16)
- Crouse JR, "Risk factors for extracranial carotid artery atherosclerosis", Stroke, 18, pp.990~996 (1987)
- GBD 2015 Neurological Disorders Collaborator Group, "Global, regional, and national burden of neurological disorders during 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015", Lancet Neurol, 16, pp.877~897 (2017)
- Norris JW, "Vascular risks of asymptomatic carotid stenosis", Stroke, 22, pp.1485~1490 (1991)
- Man BL, "Concurrent stenoses : a common etiology of stroke in Asians", World J Clin Cases, 2, pp.201~205 (2014)
- Quigley HA, "Optic nerve damage in human glaucoma. III. Quantitative correlation of nerve fiber loss and visual field defect in glaucoma, ischemic neuropathy, papilledema, and toxic neuropathy", Arch Ophthalmol, 100, pp.135~146 (1982)
- Wollstein G, "Retinal nerve fibre layer and visual function loss in glaucoma : the tipping point", Br J Ophthalmol, 96, pp.47~52 (2012)
- Wheat JL, "Correlating RNFL thickness by OCT with perimetric sensitivity in glaucoma patients", J Glaucoma, 21, pp.95~101 (2012)
- Lee J, "Characteristics of patients with a localized retinal nerve fiber layer defect and normal optic disc appearance", Eye(Lond), 26, pp.1473~1478 (2012)
- Sayin N, "A quantitative evaluation of the posterior segment of the eye using spectral-domain optical coherence tomography in carotid artery stenosis : a pilot study", Ophthalmic Surg Lasers Imaging Retina, 46, pp.180~185 (2015)
- Sehi M, "Retinal nerve fiber layer atrophy is associated with visual field loss over time in glaucoma suspect and glaucomatous eyes", Am J Ophthalmol, 155, pp.73~82 (2013)
- Wang D, "Asymptomatic carotid artery stenosis and retinal nerve fiber layer thickness. A community-based, observational study", PLoS One, 12, pp.e0177277~ (2017)
- Wang D, "Localized retinal nerve fiber layer defects and stroke", Stroke, 45, pp.1651~1656 (2014)
- Kim M, "Retinal nerve fiber layer defect and cerebral small vessel disease", Invest Ophthalmol Vis Sci, 52, pp.6882~6886 (2011)
- Mitchell P, "Prevalence of asymptomatic retinal emboli in an Australian urban community", Stroke, 28, pp.63~66 (1997)
- Yang JY, "Carotid atherosclerosis, cerebrospinal fluid pressure, and retinal vessel diameters : the asymptomatic polyvascular abnormalities in community study", PLoS One, 11, pp.e0166993~ (2016)
- Tachibana H, "Retinal vascular autoregulation in normal subjects", Stroke, 13, pp.149~155 (1982)