中青年视网膜分支静脉阻塞患者相关发病因素与黄斑结构变化的临床研究

doi:10.3877/cma.j.issn.2095-2007.2025.05.003

目的

探讨不同年龄对视网膜分支静脉阻塞(BRVO)患者患病风险以及抗血管内皮生长因子(VEGF)治疗后视网膜与脉络膜结构修复的影响。

方法

选取2022年1月至2025年1月于江南大学附属中心医院眼科确诊的连续BRVO患者253例(257只眼)和同期于眼科门诊就诊且通过检查排除BRVO的连续性对照病例271例(271只眼)。其中，男性263例(267只眼)，女性261例(261只眼)；年龄20~89岁，平均年龄(54.5±14.3)岁。按照发病时年龄，分为中青年组(≤ 50岁)和老年组(> 50岁)。同时，按照BRVO组年龄的不同基线配对对照组。收集对照组性别、年龄、高血压及糖尿病病史等临床资料。记录BRVO患者基线、抗VEGF治疗后1个、治疗后6个及治疗后12个月的黄斑中心凹视网膜厚度(CMT)、椭圆体带(EZ)断裂发生率、外界膜(ELM)断裂发生率、中心凹下脉络膜厚度(SFCT)、脉络膜血管指数(CVI)及神经节细胞层-内丛状层复合体(GCIPL)平均厚度。采用Shapiro-Wilk检验，年龄、SFCT、CVI及GCIPL平均厚度符合正态分布以±s表示，采用重复测量方差分析；CMT符合非正态分布资料以中位数(四分位间距)M(Q1，Q3)表示，采用广义线性混合模型进行分析。EZ和ELM断裂率以百分比表示，采用广义估算方程进行分析。高血压和糖尿病病史以例数和百分比描述，采用Logistic回归分析评估其对BRVO风险的影响。

结果

中青年BRVO患者121例(125只眼)，平均年龄(43.27±5.99)岁；合并高血压和糖尿病者分别有65例(68只眼)和11例(11只眼)，分别占53.72%和9.09%。老年BRVO患者132例(132只眼)，平均年龄为(65.06±8.39)岁；合并高血压患者分别有78例(78只眼)和18例(18只眼)，分别占59.09%和13.64%。中青年对照组128例(128只眼)，平均年龄为(42.46±6.46)岁；合并高血压和糖尿病者分别有11例(11只眼)和4例(4只眼)，分别占8.59%和3.13%。老年对照组143例(143只眼)，平均年龄为(66.15±8.53)岁；合并高血压和糖尿病者分别66例(66只眼)和20例(20只眼)，分别占46.15%和13.99%。Logistic回归分析显示，高血压显著增加中青年及老年人群患BRVO的风险(OR＝12.219，4.485，95%CI：5.876~25.410，2.221~9.060；P<0.05)。中青年BRVO组和老年BRVO组患者治疗前、治疗后1个月、治疗后6个月及治疗后1年CMT分别为638.00(390.50，815.00)μm、566.50(395.25，710.25)μm、191.00(167.00，240.50)μm、201.00(197.25，220.50)μm、208.00(172.50，264.50)μm、256.00(214.00，444.00)μm、211.00(199.50，267.00)μm及221.00(201.75，240.50)μm。两组间治疗后6个月CMT比较差异有统计学意义(F＝6.795，P<0.05)。中青年BRVO组和老年BRVO组患者各时间点CMT总体比较差异有统计学意义(F＝42.531，56.664；P<0.05)。中青年BRVO组和老年BRVO组患者治疗前、治疗后1个月、治疗后6个月及治疗后1年EZ断裂发生率分别为40.6%、58.1%、19.7%、43.9%、15.9%、36.8%、15.6%及31.0%。两组治疗前、治疗后1个月、治疗后6个月EZ断裂发生率比较差异有统计学意义(χ²＝7.383，14.259，8.105；P<0.05)。中青年BRVO组和老年BRVO组患者治疗前、治疗后1个月、治疗后6个月及治疗后1年ELM断裂发生率分别为40.6%、56.2%、18.2%、41.8%、15.9%、36.8%、15.6%及28.6%。两组治疗前、治疗后1个月及治疗后6个月ELM断裂发生率比较差异有统计学意义(χ²＝5.945，15.626，8.628；P<0.05)。中青年BRVO组和老年BRVO组患者不同时间点EZ断裂发生率的总体比较差异有统计学意义(χ²＝20.882，16.702；P<0.05)。中青年BRVO组和老年BRVO组患者不同时间点ELM断裂发生率的总体比较差异有统计学意义(χ²＝25.609，14.324；P<0.05)。中青年BRVO组和老年BRVO组患者治疗前、治疗后1个月、治疗后6个月及治疗后1年SFCT分别为(367.02±127.05)μm、(337.54±128.88)μm、(359.01±252.95)μm、(305.77±123.10)μm、(329.37±117.19)μm、(301.90±115.01)μm、(340.70±129.01)μm及(317.41±126.62)μm。两组治疗前、治疗后1个月、治疗后6个月及治疗后1年SFCT比较差异无统计学意义(F＝0.307，0.968，0.047，0.785；P>0.05)。中青年BRVO组不同时间点SFCT的总体比较差异有统计学意义(F＝6.079，P<0.05)。老年BRVO组患者不同时间点SFCT的总体差异无统计学意义(F＝2.691，P>0.05)。中青年BRVO组和老年BRVO组患者治疗前、治疗后1个月、治疗后6个月及治疗后1年CVI分别为(0.34±0.08)、(0.33±0.07)、(0.37±0.06)、(0.35±0.05)、(0.37±0.05)、(0.35±0.04)、(0.40±0.07)及(0.39±0.20)。两组治疗后6个月CVI比较差异有统计学意义(F＝6.354，P<0.05)。中青年BRVO组不同时间点CVI的总体比较差异有统计学意义(F＝6.033，P<0.05)。老年BRVO组不同时间点CVI的总体比较差异无统计学意义(F＝0.813，P>0.05)。中青年BRVO组和老年BRVO组患者治疗前、治疗后1个月、治疗后6个月及治疗后1年GCIPL平均厚度分别为(81.62±12.05)μm、(81.48±11.56)μm、(78.38±9.18)μm、(79.96±28.83)μm、(74.77±10.36)μm、(76.10±10.54)μm、(69.69±10.84)μm及(76.15±12.01)μm。两组治疗后1年GCIPL平均厚度比较差异有统计学意义(F＝5.978，P<0.05)。中青年BRVO组和老年BRVO组患者不同时间点GCIPL平均厚度的总体比较差异有统计学意义(F＝4.706，4.432；P<0.05)。

结论

中青年与老年BRVO患者在治疗后不同随访时间点OCT参数的恢复程度不同，中青年者的预后不一定具有优势。因此，对年轻患者也应当进行积极的干预和密切随访。

关键词: 视网膜分支静脉阻塞, 年龄, 血管内皮生长因子, 光学相干断层扫描

Objective

The aim of this study is to investigate the influence of age on the distribution of risk factors in patients with branch retinal vein occlusion (BRVO) and its impact on the restoration of retinal and choroidal structures following anti-vascular endothelial growth factor (VEGF) therapy.

Methods

A total of 253 consecutive BRVO patients (257 eyes) diagnosed in the Department of Ophthalmology at the Affiliated Central Hospital of Jiangnan University from January 2022 to January 2025 were enrolled, along with 271 consecutive control subjects (271 eyes) who attended the Ophthalmology Department of Jiangnan University Medical Center during the same period and were confirmed not to have BRVO through examinations. Among them, there were included 263 males (267 eyes) and 261 females (261 eyes), with a mean age of ( 54.5±14.3) years (ranging from 20 to 89 years). The clinical data such as gender, age, history of hypertension and diabetes was used only to collect for the control group. Baseline data and post-treatment parametersafter in BRVO patients anti-VEGF treatment for 1 month, 6 months and 12 months were recorded, including central macular thickness (CMT), incidence of ellipsoid zone (EZ) disruption, incidence of external limiting membrane (ELM) disruption, subfoveal choroidal thickness (SFCT), choroidal vascular index (CVI), and mean ganglion cell layer-inner plexiform layer complex (GCIPL) thickness. Patients were divided into a young and middle-aged group (≤ 50 years) and an elderly group (> 50 years) based on age at onset. Simultaneously, control subjects were paired based on different age baselines of the BRVO groups. After the Shapiro-Wilk test, age, SFCT, CVI, and mean GCIPL thickness were conformed to normal distribution and presented as ±s and analyzed using repeated measures ANOVA. Non-normally distributed data, such as CMT, were presented as median (interquartile range) [M (Q1, Q3)] and analyzed using a generalized linear mixed model. The absence percentage of EZ and ELM disruption was expressed as percentages and analyzed using generalized estimating equations. The history of hypertension and diabetes was described by case and percentage, and used by Logistic regression analysis to evaluate the impact of hypertension and diabetes on the risk of BRVO.

Results

There were 121 young and middle-aged BRVO patients (125 eyes), with a mean age of (43.27±5.99) years; among them, 65 cases (68 eyes) had hypertension and 11 (11 eyes) had diabetes, accounting for 53.72% and 9.09%, respectively. There were 132 elderly BRVO patients (132 eyes) with a mean age of (65.06±8.39) years; among them, 78 (78 eyes) had hypertension and 18 (18 eyes) had diabetes, accounting for 59.09% and 13.64%, respectively. The young and middle-aged control group comprised 128 subjects (128 eyes), with a mean age of (42.46±6.46) years; 11 subjects (11 eyes) had hypertension and 4 subjects (4 eyes) had diabetes, accounting for 8.59% and 3.13%, respectively. The elderly control group comprised 143 subjects (143 eyes), with a mean age of (66.15±8.53) years; 66 subjects (66 eyes) had hypertension and 20 subjects (20 eyes) had diabetes, accounting for 46.15% and 13.99%, respectively. Logistic regression analysis showed that hypertension significantly increased the risk of BRVO in both young and middle-aged and elderly populations (OR=12.219, 4.485; 95%CI: 5.876 to 25.410, 2.221 to 9.060; P<0.05). The CMT values for the young and middle-aged BRVO group and the elderly BRVO group before treatment and at 1 month, 6 months, and 1 year after treatment were 638.00 (390.50, 815.00) μm, 566.50 (395.25, 710.25) μm, 191.00 (167.00, 240.50) μm, 201.00 (197.25, 220.50) μm, 208.00 (172.50, 264.50) μm, 256.00 (214.00, 444.00) μm, 211.00 (199.50, 267.00) μm and 221.00 (201.75, 240.50) μm, respectively. The difference in CMT between the two groups at 6 months after treatment was statistically significant (F=6.795, P<0.05). The overall comparison of CMT at different time points showed statistically significant differences within both the young and middle-aged BRVO group and the elderly BRVO group (F=42.531, 56.664; P<0.05). The incidence rates of EZ disruption in the young and middle-aged BRVO group and the elderly BRVO group before treatment and at 1 month, 6 months, and 1 year after treatment were 40.6%, 58.1%, 19.7%, 43.9%, 15.9%, 36.8%, 15.6% and 31.0%, respectively. The differences in the incidence of EZ disruption between the two groups before treatment and at 1 month and 6 months after treatment were statistically significant (χ²=7.383, 14.259, 8.105; P<0.05). The incidence rates of ELM disruption in the young and middle-aged BRVO group and the elderly BRVO group before treatment and at 1 month, 6 months, and 1 year after treatment were 40.6%, 56.2%, 18.2%, 41.8%, 15.9%, 36.8%, 15.6% and 28.6%, respectively. The differences in the incidence of ELM disruption between the two groups before treatment and at 1 month and 6 months after treatment were statistically significant (χ²=5.945, 15.626, 8.628; P<0.05). The overall differences in the incidence of EZ disruption at different time points were statistically significant within both the young and middle-aged BRVO group and the elderly BRVO group (χ²=20.882, 16.702; P<0.05). The overall differences in the incidence of ELM disruption at different time points were statistically significant within both the young and middle-aged BRVO group and the elderly BRVO group (χ²=25.609, 14.324; P<0.05). The SFCT values for the young and middle-aged BRVO group and the elderly BRVO group before treatment and at 1 month, 6 months, and 1 year after treatment were (367.02±127.05) μm, (337.54±128.88) μm, (359.01±252.95) μm, (305.77±123.10) μm, (329.37±117.19) μm, (301.90±115.01) μm, (340.70±129.01) μm and (317.41±126.62) μm, respectively. There were no statistically significant differences in SFCT between the two groups before treatment and at 1 month, 6 months, and 1 year after treatment (F=0.307, 0.968, 0.047, 0.785; P>0.05). The overall comparison of SFCT at different time points was statistically significant within the young and middle-aged BRVO group (F=6.079, P<0.05). The CVI values for the young and middle-aged BRVO group and the elderly BRVO group before treatment and at 1 month, 6 months, and 1 year after treatment were (0.34±0.08), (0.33±0.07), (0.37±0.06), (0.35±0.05), (0.37±0.05), (0.35±0.04), (0.40±0.07) and (0.39±0.20), respectively. The difference in CVI between the two groups at 6 months after treatment was statistically significant (F=6.354, P<0.05). The overall difference in CVI at different time points was statistically significant within the young and middle-aged BRVO group (F=6.033, P<0.05). The mean GCIPL thickness for the young and middle-aged BRVO group and the elderly BRVO group before treatment and at 1 month, 6 months, and 1 year after treatment were (81.62±12.05) μm, (81.48±11.56) μm, (78.38±9.18) μm, (79.96±28.83) μm, (74.77±10.36) μm, (76.10±10.54) μm, (69.69±10.84) μm and (76.15±12.01) μm, respectively. The difference in mean GCIPL thickness between the two groups at 1 year after treatment was statistically significant (F=5.978, P<0.05). The overall comparisons of mean GCIPL thickness at different time points were statistically significant within both the young and middle-aged BRVO group and the elderly BRVO group (F=4.706, 4.432; P<0.05).

Conclusions

Differences exist in the degree of recovery of OCT parameters at various follow-up time points after treatment between young and middle-aged and elderly patients with BRVO. Younger age does not consistently confer a prognostic advantage. Therefore, active intervention and close follow-up are also warranted for younger patients.

Key words: Branch retinal vein occlusion, Age, Vascular endothelial growth factor, Optical coherence tomography

表1 危险因素单因素Logistic回归分析的结果

组别	疾病	例数(眼数)	β	SE	Wald χ²	P值	OR	95%CI
组别	疾病	例数(眼数)	β	SE	Wald χ²	P值	OR	下限	上限
中青年组	高血压	65(68)	2.503	0.374	44.898	< 0.05	12.219	5.876	25.410
中青年组	糖尿病	11(11)	0.415	0.706	0.345	> 0.05	1.515	0.379	6.049
老年组	高血压	78(78)	1.501	0.359	17.506	< 0.05	4.485	2.221	9.060
老年组	糖尿病	18(18)	-0.298	0.388	0.589	> 0.05	0.742	0.347	1.589

表1 危险因素单因素Logistic回归分析的结果

组别	疾病	例数(眼数)	β	SE	Wald χ²	P值	OR	95%CI
组别	疾病	例数(眼数)	β	SE	Wald χ²	P值	OR	下限	上限
中青年组	高血压	65(68)	2.503	0.374	44.898	< 0.05	12.219	5.876	25.410
中青年组	糖尿病	11(11)	0.415	0.706	0.345	> 0.05	1.515	0.379	6.049
老年组	高血压	78(78)	1.501	0.359	17.506	< 0.05	4.485	2.221	9.060
老年组	糖尿病	18(18)	-0.298	0.388	0.589	> 0.05	0.742	0.347	1.589

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Analysis of related pathogenic factors and macular structural changes in young and middle-aged patients with branch retinal vein occlusion

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Analysis of related pathogenic factors and macular structural changes in young and middle-aged patients with branch retinal vein occlusion