李涛+范卫华+吴震��

【摘要】目的分析高血压患者发生眼底改变的影响因素，为高血压性眼底改变的防治提供临床参考。

方法收集511例原发性高血压患者，根据是否存在眼底病变分为眼底病变组357例和无眼底病变组154例。比较两组患者收缩压、血总胆固醇、甘油三酯、同型半胱氨酸浓度及尿蛋白水平，并对眼底病变程度与相关影响因素的关系进行分析。

结果眼底病变组收缩压≥140 mmHg、总胆固醇>5.17 mmol/L、同型半胱氨酸>15 μmol/L及伴有蛋白尿的比例明显高于无眼底病变组（P<0.05）。眼底病变程度随收缩压、总胆固醇、同型半胱氨酸、蛋白尿浓度的升高而加重，两者呈正相关。

结论影响高血压患者眼底改变的因素较多，收缩压、血总胆固醇、同型半胱氨酸及蛋白尿浓度是眼底改变较为显著的影响因素，它们可能参与了高血压患者眼底改变过程，高血压早期密切监测有利于预防眼底病变或减轻眼底病变程度。

【关键词】高血压；眼底改变；小动脉痉挛；动脉粥样硬化

中图分类号：R773.4；R544.1文献标识码：ADOI：10.3969/j.issn.10031383.2017.02.025

【Abstract】ObjectiveTo analyze influencing factors of ocular fundus changes in patients with essential hypertension， so as to provide clinical reference for the prevention and treatment of hypertension.

Methods511 patients with essential hypertension were collected，according to presence of fundus lesions，they were divided into fundus lesion group（357 cases） and non fundus lesion group（154 cases）.And then，systolic blood pressure，serum total cholesterol，triglyceride，homocysteine and urinary protein levels were compared between the two groups.And the relation between the degree of fundus diseases and the related factors was analyzed.

ResultsThe proportion of systolic blood pressure≥140 mmHg，total cholesterol>5.17 mmol/L，homocysteine>15 μmol/L，combined with proteinuria in the fundus lesions group were significantly higher than those in the non fundus lesion group（P<0.05）.The degree of fundus lesions aggravated with the increase of systolic blood pressure，total cholesterol，homocysteine and protein urine concentration，which showed a positive correlation.

ConclusionThere are many factors affecting fundus changes in patients with hypertension，and patients systolic blood pressure，serum total cholesterol，homocysteine and urine protein concentration are the significant ones，they may involve in the process of fundus changes.Early monitoring of hypertension is beneficial to the prevention of ocular fundus diseases or alleviate the degree of ocular fundus diseases.

【Key words】hypertension；fundus changes；small artery spasm；atherosclerosis

高血壓的发病早期可致全身小动脉病变，随着病情的进展，血管管径、管壁会出现各种病理改变，终致动脉粥样硬化（AS）形成。高血压早期可引起眼底小动脉痉挛和收缩，严重时可致视网膜水肿、渗血，甚至可造成高血压性视神经病变，影响患者视力[1]。因此，对高血压患者发生眼底改变的危险因素进行分析，在疾病早期进行干预显得格外重要。本研究对511例原发性高血压患者的临床资料进行回顾性分析，以探讨高血压患者发生眼底改变的危险因素，为此类患者的治疗提供参考。……