Состояние сосудов сетчатки, световой чувствительности зрительной системы и их связь со структурными изменениями в головном мозге у пациентов с артериальной гипертензией

2017 том 1, №1

А.И. Кубарко, Е.А. Бур, Ю.А. Кубарко, Л.Л. Авдей

УО «Белорусский государственный медицинский университет»,УЗ «Минский консультационно-диагностический центр», УЗ «Минский консультационно диагностический центр»

У пациентов с АГ выявлены более высокие ПСЧ и большее отклонение их величины от возрастной нормы, чем отклонение ПСЧ (р<0,05) у пациентов группы сравнения. Относительная площадь сосудов (венозных и венозных вместе с артериальными), а также количество сосудов (венозных и венозных вместе с артериальными) у пациентов с АГ были меньше, чем соответствующие значения у пациентов группы сравнения.
Абсолютный и скорректированный объём желудочков, ширина 3-го желудочка были большими у пациентов с АГ, чем у пациентов группы сравнения.
Обнаружена обратная корреляционная связь средней силы между объёмом желудочков и скорректированными объёмами вещества головного мозга и полушарий (г от -0,37 до -0,54, p<0,05), а также обратная корреляционная связь средней силы между морфологическими изменениями сосудов глазного дна (относительная площадь сосудов, количество артериальных сосудов) и изменениями объёма желудочков головного мозга (г от -0,28 до -0,47, p<0,05).

ключевые слова: артериальная гипертензия, атрофия мозга, болезнь малых сосудов, диаметр сосудов сетчатки, магнитно-резонансная томография, пороги световой чувствительности.

для цитирования: Кубарко А.И., Бур Е.А., Кубарко ЮА, Авдей Л.Л. Состояние сосудов сетчатки, световой чувствительности зрительной системы и их связь со структурными изменениями в головном мозге у пациентов с артериальной гипертензией. Неотложная кардиология и кардиооваскулярные риски, 2017, Т. 1, №1, С. 89-98.

State of Retina Vessels,Light Sensitivity of the Visual System and their Correlation with Brain Structural Changes in Patients with Arterial Hypertension

A.I. Kubarko, E.A. Bur, Y.A. Kubarko, L.L. Avdei

Thresholds of light sensitivity and their deviation were higher (р<0,05) in patients with arterial hypertension, than in patients from the comparison group. The relative vessel area (arterial, arterial and venous) and the number of vessels (arterial, arterial and venous) in patients with arterial hyperten¬sion were lower than in patients from the comparison group (р<0,05).
The total and corrected brain ventricle volume and the width of the 3rd ventricle in patients with arterial hypertension were larger than in patients from the comparison group.
The inverse correlation between ventricle volume and total and cor¬rected volume of brain and hemispheres was found (r from -0,37 till -0,54, p<0,05). The reverse correlation was also found between morphological parameters of the retina vessels (relative area, number of arterial vessels) and the volume of brain ventricles (r from -0,28 till -0,47, p<0,05).
The larger volume of brain ventricles was associated with the diminished relative area of vessels, especially in the subgroup of patients with arterial hypertension. The enlarged ventricles indicate the processes of brain atrophy, that can be found in patients with arterial hypertension, as well as decreased area of vessels, caused by their remodeling. The larger volume of ventricles was also associated with the decreased light sensitivity of the visual system. Taking into account the fact that more than 30 areas in the brain are responsible for the vision, the processes of brain atrophy could lead to the decrease in this parameter.

keywords: arterial hypertension, brain atrophy, small vessel disease, retina vessels caliber, magnetic-resonance tomography, thresholds of light sensitivity.

for references: Kubarko A.I., Bur E.A., Kubarko Y.A., Avdei L.L. State of Retina Vessels, Light Sensitivity of the Visual System and their Correlation With Brain Structural Changes in Patients With Arterial Hypertension. Neotlozhnaya kardiologiya i kardioovaskulyarnye riski [Emergency cardiology and cardiovascular risks], 2017, vol. 1, no. 1, pp. 90-99.

1.Amenta F., DiTullioM.A., Tomassoni D. Arterial hypertension and brain damage-evidence from animal models (review). Clin Exp Hypertens, 2003, vol. 25, no. 6, pp. 359-380.
2.Gasecki D., Kwarciany M., Nyka W., Narkiewicz K. Hypertension, Brain Damage and Cognitive Decline. Curr Hypertens Repo, 2013, vol. 15, no. 6, pp. 547-558.
3.Tzourio, Ch., Debette S. Is Hypertension Associated With an Accelerated Aging of the Brain? Hypertension, 2014, vol. 63, pp. 894-903.
4.Whitmer, R.A.,Sidney S.,Selby J., Johnston S. C., Yaffe K. Midlife cardiovascular risk factors and risk of dementia in late life. Neurology, 2005, vol. 64, no. 2, pp. 277-281.
5.Napoli, С. Lerman L. O., de Nigris F., Gossl M., Balestrieri M. L., Lerman A. Rethinking Primary Prevention of Atherosclerosis Related Diseases. Circulation, 2006, vol. 114, no. 23, pp. 2517-2527.
6.Doubal F. N., MacGillivray T.J., Patton N., Dhillon B., Dennis M. S., Wardlaw J. M. Fractal analysis of retinal vessels suggests that a distinct vasculopathy causes lacunar stroke. Neurology, 2010, vol. 74, no. 14, pp. 1102-1107.
7.Ding J., Patton N., Deary I. J., Strachan M. W., Fowkes F. G., Mitchell R. J., Price J. F. Retinal microvascular abnormalities and cognitive dysfunction: a systematic review. Br J Ophthalmol, 2008, vol. 92, no. 8, pp. 1017-1025.
8.Wong T. Y., Klein R., Klein B. E., Tielsch J. M., Hubbard L., Nieto F. J. Retinal microvscular abnormalities and they relationship with hypertension? Cardiovascular diseases and mortality. Surv Ophthalmol. 2001, vol. 46, no. 1, pp. 59-80.
9.Wong T. Y., Klein R., Sharrett A. R., Couper.D.J., Klein B. E., Liao D. P., Hubbard L. D., Mosley T. H. Cerebral white matter lesion? Retinopathy and risk of clinical stroke: the Atherosclerosis Risk in Communities Study. JAMA, 2002, vol. 288, no. 1, pp. 67-74.
10.McGeechan K., Liew G., Macaskill P., Irwig L., Klein R., Klein B. E., Wang J. J., Mitchell P., Vingerling J. R., Dejong P. T., Witteman J. C., Breteler M. M., Shaw J., Zimmet P., Wong T. Y. Meta-analysis: retinal vessel caliber and risk for coronary heart disease. Ann Intern Med, 2009, vol. 151, no. 6, pp. 404-413.
11.Grosso A., Veglio F., Porta M., Grignolo F. M., Wong T. Y. Hypertensive retinopathy revisited: some answers, more questions. Br J Ophthalmol, 2005, vol. 89, no. 12, pp. 1646-1654.
12.Feihl F., Liaudet L., Levy B. I., Waeber B. Hypertension and microvascular remodelling. Cardiovasc Res, 2008, vol. 78, no.2, pp. 274-285.
13.Cheung, C. Y., Ikram M. I., Chen C., Wong T. Y. Imaging retina to study dementia and stroke. Prog Retin Eye Res, 2017, vol. 57, pp. 89-107.
14.Kubarko A. I., Kubarko Yu.A., Aleksandrov D. A. [et al.] Izmeneniya pokazateley zritel'nych funkziykaksledstvieimarkernarusheniygemodinamikivsosudachmozga [Changes in the indices of visual functions as a consequence and a marker of hemodynamic disorders in the vessels of the brain]. Sbornik nauchnych trudov, posvyaschennyy 10-letnemu yubileyu sotrudnichestva mezhdu BGMU, intervenzionnymi kardiologami universiteta Zapadnogo Ontario (Kanada) i kardiologami RB. Minsk: Knigazbor, 2010.- S. 148-157. (in Russian).
15.Patton N., Aslam T., Macgillivray T., Pattie A., Deary I. J., Dhillon B. Retinal vascular image analysis as potential screening tool for cerebrovascular disease: a rationale based on homology between cerebral and retinal microvasculatures. JAnat, 2005, vol. 206, no. 4, pp. 319-348.
16.Mutlu U., Cremers L. G., de Groot M., Hofman A., Niessen W. J., van der Lugt A., Klaver C. C., Ikram M. A., Vernooij M. W., Ikram M. K. Retinal microvasculature and white matter microstructure: The Rotterdam Studyl. Neurology, 2016, vol. 87, no. 10, pp. 1003-1010.
17.Kubarko A. I., Kubarko N. P., Kubarko Yu.A., Buben E. A., Bur E. A. Sostoyaniesosudov setchatki, svetovoy i kontrastno-zvetovoy chuvstvitel'nosti u pazientov s arterial'noy gipertenziey [The state of the vessels of the retina, light and contrast-color sensitivity in patients with arterial hypertension]. Oftal'mologiya. Vostochnaya Evropa, 2014, no. 4(23), S. 223-231. (in Russian).
18.Wong T. Y., Klein R., Sharrett A. R., Nieto F. J., Boland L. L., Couper D. J., Mosley T. H., Klein B. E., Hubbard L. D., Szklo M. Retinal microvascular abnormalities and cognitive impairment in middle-aged persons: the Atherosclerosis Risk in Communities Study. Stroke, 2002, vol. 33, no. 6, pp. 1487-1492.
19.Cooper L. S., Wong T. Y., Klein R., Sharrett A. R., Bryan R. N., Hubbard L. D., Couper D. J., Heiss G., Sorlie P. D. Retinal microvascular abnormalities and MRI-defined subclinical cerebral infarction: the Atherosclerosis Risk in Communities Study. Stroke, 2006, vol. 37, no. 1, pp. 82-86.
20.Hughes A. D., Falaschetti E., Witt N., Wijetunge S., Thom S. A., Tillin T., Aldington S. J., Chaturvedi N. Association of Retinopathy and Retinal Microvascular Abnormalities With Stroke and Cerebrovascular Disease. Stroke, 2016, vol. 47, 11, pp. 2862-2864.
21.Liew G., Baker M. L., Wong T. Y., Hand P. J., Wang J. J., Mitchell P., De Silva D. A., Wong M. C., Rochtchina E., Lindley R. I., Wardlaw J. M., Hankey G. J. Differing Associations of White Matter Lesions and Lacunar Infarction with Retinal Microvascular Signs. Int J Stroke, 2014, vol. 9, no. 7, pp. 921-925.
22.Baker M. L., Hand P. J., Wang J. J., Wong T. Y. Retinal signs and stroke revisiting the link between the eye and brain. Stroke, 2008, vol. 39, no. 4, pp. 1371-1379.
23.Kawasaki R., Xie J., Cheung N., Lamoureux E., Klein R., Klein B. E., Cotch M. F., Sharrett A. R., Shea S., Wong T. Y. Retinal microvascular signs and risk of stroke: the Multi-Ethnic Study of Atherosclerosis (MESA). Stroke, 2012, vol. 43, no. 12, pp. 3245-3251.
24.Cheung C. Y., Tay W. T., Ikram M. K., Ong Y. T., De Silva D. A., Chow K. Y., Wong T. Y. Retinal microvascular changes and risk of stroke: the Singapore Malay Eye Study. Stroke, 2013, vol. 44, no. 9, pp. 2402-2408.
25.Patton N., Pattie A., MacGillivray T., Aslam T., Dhillon B., Gow A., Starr J. M., Whalley L. J., Deary I. J. The association between retinal vascular network geometry and cognitive ability in an elderly population. Invest Ophthalmol Vis. Sc, 2007, vol. 48, no. 5, pp. 1995-2000.
26.Cheung C. Y., Ikram M. K., Sabanayagam C., Wong T. Y. Retinal microvasculature as a model to study the manifestations of hypertension. Hypertension, 2012, vol. 60, no. 5, pp. 1094-1103.
27.Nguen T. T., Wang J. J., Wong T. Y. Retinal Vascular Changes in Pre-Diabetes and Prehypertension. New findings and their research and clinical implications. Diabetes care, 2007, vol. 30, no. 10, pp. 2708-2715.
28.Aleksandrov D. A., Kubarko A. I. Izmenenie porogov svetovoy chuvstvitel'nosti zritel'noy sistemy v usloviyach lokal'nogo temperaturnogo vozd eystviya i ee zavisimost' ot sostoyaniya sistemnogo krovotoka [Change in thresholds of light sensitivity of the visual system under conditions of local temperature influence and its dependence on the state of the systemic blood flow]. Med. zhurnal, 2008, no. 1, S. 18-21 (in Russian).
29.Ascaso F. J., Cruz N., Modrego P. J., Lopez-Anton R., Santabarbara J., Pascual L. F., Lobo A., Cristobal J. A. Retinal alterations in mild cognitive impairment and Alzheimer's disease: an optical coherence tomography study. J. Neurol, 2014, vol. 261, no. 8, pp. 1522-1530.
30.Heringa S. M., Bouvy W. H., van den Berg E., Moll A. C., Kappelle L. J., Biessels G. J. Associations between retinal microvascular changes and dementia, cognitive functioning, and brain imaging abnormalities: a systematic review. J Cereb Blood Flow Metab, 2013, vol. 33, no. 7, pp. 983-995.
31.O'Rourke M. F. Safar M. E. Relationship Between Aortic Stiffening and Microvascular Disease in Brain and Kidney. Cause and Logic of Therapy. Hypertension, 2005, vol. 46, pp. 200-204.
32.Ponomareva, M. N. Diagnostika i medikamentoznaya korrekziya narusheniy gemodinamiki pri ishemicheskoy neyropatii zriteknogo nerva u bolnych s serdechno-sosudistymi zabolevaniyaml [Diagnosis and drug correction of hemodynamic disorders in ischemic neuropathy of the optic nerve in patients with cardiovascular diseases]: Diss. dokt. med. nauk: 14.01.07. M., 2010, 235 s. (in Russian).
33.Diker S., Has A. C., Kurne A., Gogmen R., Oguz K. K., Karabudak R. The association of cognitive impairment with gray matter atrophy and cortical lesion load in clinically isolated syndrome. MultSclerRelatDiscard, 2016, vol. 10, pp. 14-21.
34.van der Veen P. H., Geerlings M. I., Visseren F. L., Nathoe H. M., Mali W. P., van der Graaf Y., Muller M. Hypertensive Target Organ Damage and Longitudinal Changes in Brain Structure and Function The Second Manifestations of Arterial Disease - Magnetic Resonance Study. Hypertension, 2015, vol. 66, no. 6, pp. 1152-1158.
35.Wardlaw J. M., Smith E. E., Biessels G. J., Cordonnier C., Fazekas F., Frayne R., Lindley R. I., O'Brien J.T., Barkhof F., Benavente O. R., Black S. E., Brayne C., Breteler M., Chabriat H., Decarli C., de Leeuw F. E. [et al.] Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration. Lancet Neurol, 2013, vol. 12, no. 8, pp. 822-838.
36.Hayreh, S. S. Blood Flow in the Optic Nerve Head and Factors that may Influence it. Prog Retin Eye Res, 2001, vol. 20, no. 5, pp. 595-624.
37.Feihl F., Liaudet L., Waeber B., Levy B. I. Hypertension, a disease of the microcirculation? Hypertension, 2006, vol. 48, no. 6, pp. 1012-1017.
38.Wong T. Y., Islam F. M., Klein R., Klein B. E., Cotch M. F., Castro C., Sharrett A. R., Shahar E. Retinal Vascular Caliber, Cardiovascular risk factors and Inflammation: The Multi-Ethnic Study of Atherosclerosis (MESA). Invest Ophthalmol Vis Sci, 2006, vol. 47, no. 6, pp. 2341-2350.
39.Sivak, J. M. The Aging Eye: Common Degenerative Mechanisms Between the Alzheimer's Brain and Retinal Disease. Invest Ophthalmoo Vis Sci, 2013, vol. 54, no. 1, pp. 871-880.
40.Ikram M. K., de Jong F. J., Vernooij M. W., Hofman A., Niessen W. J., van der Lugt A., Klaver C. C., Ikram M. A. Retinal Vascular Calibers Associate Differentially With Cerebral Gray Matter and White Matter Atrophy. Alzheimer Dis Assoc Disord, 2013, vol. 27, no. 4, pp. 351-355.
41.Pires P. W., Dams Ramos C. M., Matin N., Dorrance A. M. The effects of hypertension on the cerebral circulation. Am J Physiol Heart Circ Physiol, 2013, vol. 304, no. 12, pp. 1598¬1614.
42.Ferri C. P., Prince M., Brayne C., Brodaty H., Fratiglioni L., Ganguli M., Hall K., Hasegawa K., Hendrie H., Huang Y., Jorm A., Mathers C., Menezes P. R., Rimmer E., Scazufca M. Global prevalence of dementia: a Delphi consensus study. Lancet, 2005, vol. 366, no. 9503, pp. 2112-2117.
43.Kantarci K. Magnetic resonance markers for early diagnosis and progression of Alzheimer's disease. Expert Rev. Neurother, 2005, vol. 5, no. 5, pp. 663-670.
44.Jennings J. R., Mendelson D. N., Muldoon M. F., Ryan C. M., Gianaros P. J., Raz N., Aizenstein H. Regional grey matter shrinks in hypertensive individuals despite successful lowering of blood pressure. J Hum Hypertens, 2012, vol. 26, no. 5, pp. 295-305.
45.Pantoni L., Garcia J. H. Pathogenesis of leukoaraiosis: a review. Stroke, 1997, vol. 28, no. 3, pp. 652-659.

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