眼科影像检查可辨识心血管风险因素


  【24drs.com】根据发表于2012年世界眼科研讨会的研究,德国的一个远距医疗计画有助于内科医师和眼科医师之间的互动,使用视网膜的检查资料而帮助确认心血管事件风险增加的病患。
  
  德国Erlangen大学Georg Michelson医师发表研究时表示,眼睛反映出血管和神经退化疾病,特别的是,视网膜微血管病变和某些全身性疾病有关,例如动脉性高血压、中风、糖尿病;举例而言,中风患者的视网膜血管壁厚度增加,而这可以用免散瞳眼底照相机检查得知。
  
  Michelson医师指出,其团队之前的研究显示,出现棉絮状斑者的中风风险增加6.35倍,微小动脉瘤风险则是增加4.71倍;斑点状出血者的中风风险增加4.25倍。
  
  这些实证关联促使Michelson医师发展了他的TalkingEyes计画,包括了31名开业内科医师,这些医师使用携带式免散瞳眼底照相机在诊间拍摄病患视网膜的数码相片,将这些视网膜影像上传到网络上的病患病历,由眼科医师进行评估,之后在病患的电子化病历上加注报告。
  
  Michelson医师解释,如果我们可以利用远距医疗网络连结内科医师和眼科医师,将可改善病患照护。
  
  这篇研究中,6,999病患在一般开业医师诊间进行了视网膜检查,这些病患的年龄中位数是54岁、身体质量指数中位数是27.6 kg/m2,40%表示有动脉高血压病史、11.1%有第2型糖尿病。
  
  检查时,医师们拍摄了视网膜的45°相片、抽血、量血压;之后使用PROCAM指标计算心血管风险值,一名眼科医师在远端分析眼底影像。
  
  Michelson医师报告指出,9%研究对象之视网膜血管有相关的型态改变,例如动静脉交错、视网膜出血、微血管瘤、微小梗塞。
  
  根据PROCAM指标,只有2%的病患被发现心血管事件风险高,不过,55名病患(0.8%)未被发现有风险,他报告指出,我们发现相关的视网膜微血管病变变化。
  
  Michelson医师表示,我们在约60,000名病患进行此计划,相信检视这些独特的风险因素对于治疗有所影响。
  
  他认为这些变化的发生可能有两个面向,第一,接受筛检者对于整体的健康风险有比较大的警觉性,所以他们较常有动机就医而受检查,其次,医师对提高的风险迹证有所反应。
  
  大约20%的案例中,治疗决策是根据这些结果而定。
  
  资料来源:http://www.24drs.com/professional/list/content.asp?x_logon=W&x_idno=6741&x_classno=0

Eye Imaging Identifies Cardiovascular Risk Factors

By Neil Canavan
Medscape Medical News

February 28, 2012 (Abu Dhabi, United Arab Emirates) — A telemedicine program in Germany facilitates interaction between internists and ophthalmologists and helps to identify patients at increased risk for cardiovascular events using information from the retina, according to a study presented here at the World Ophthalmology Congress 2012.

"The eye mirrors vascular and neurodegenerative diseases," said study presenter Georg Michelson, MD, from the University of Erlangen in Germany. "In particular, retinal microangiopathy correlates with certain systemic diseases such as arterial hypertension, stroke, and diabetes." For instance, retinal vessel-wall thickness, which is increased in stroke, can be seen using a nonmydriatic fundus camera.

Dr. Michelson described previous research done by his team, which showed that stroke risk increased 6.35-fold when cotton-wool spots were observed, and increased 4.71-fold with microaneurysms; stroke risk was 4.25-fold higher with blot hemorrhages.

These proven associations led Dr. Michelson to develop his TalkingEyes program, consisting of a network of 31 internists in private practice. The physicians use a mobile nonmydriatic fundus camera to take digital photographs of the retina in the office. These retinal images are uploaded to a Web-based patient chart, where they are evaluated by an ophthalmologist, who then adds a report to the patient's e-chart.

"If we can connect ophthalmologists to internists with a telemedicine network, this could improve patient care," Dr. Michelson explained.

In this study, 6999 patients had retinal exams performed in the general practitioner's office. Median patient age was 54 years, median body mass index was 27.6 kg/m2, 40% reported a history of arterial hypertension, and 11.1% had type 2 diabetes.

During the examination, physicians took 45° photographs of the retina, obtained blood samples, and measured blood pressure. They then calculated cardiovascular risk using the PROCAM index. An ophthalmologist analyzed the fundus images remotely.

Dr. Michelson reported that 9% of the cohort had relevant morphologic changes in retinal vessels, such as arteriovenous crossings, retinal bleeding, microaneurysms, and microinfarcts.

Using the PROCAM index, only 2% of patients were found to be at high risk for a cardiovascular event. However, in 55 patients (0.8%) where no risk was indicated, "we found relevant retinal microangiopathic changes," he reported.

"We have now performed this in about 60,000 patients, and we believe that identifying these unique risk factors is having an impact on therapy," said Dr. Michelson.

He believes changes are occurring in 2 ways. "First, individuals who were screened gained a greater awareness of their risk factors overall, so they are motivated to go to the doctor more often for observation." Second, physicians are responding to evidence of elevated risk.

"In about 20% of cases, we see that therapeutic decisions are being made based on these findings."

Dr. Michelson has disclosed no relevant financial relationships.

World Ophthalmology Congress (WOC) 2012: Abstract IS-TEL-FR 65. Presented February 17, 2012.

    
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