Title Utjecaj protoka krvi arterijama karotidnog sustava na razvoj starosne degeneracije žute pjege : doktorski rad Author Tea Čaljkušić-Mance Mentor Damir Kovačević (mentor)Committee member Nikica Gabrić (predsjednik povjerenstva)Committee member Slava Podobnik-Šarkanji (član povjerenstva)Committee member Alen Ružić (član povjerenstva)305670006 Granter University of Rijeka Defense date and country 2012-01-01, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Universal decimal classificationUDC ) 617 - Surgery. Orthopaedics. Ophthalmology Abstract Uvod: Starosna degeneracija žute pjege (ARMD) vodeći je uzrok ozbiljnih poremećaja vida i
legalne sljepoće kod starijih osoba (preko 50 god.) u razvijenim zemljama. ARMD je
multifaktorijalna bolest koja uključuje kompleksnu interakciju genetskih i faktora okoliša te
metaboličkih i funkcionalnih promjena. Premda je patogeneza bolesti djelomično poznata
neka istraživanja napominju mogućnost vaskularnog etiopatogenetskog mehanizma.
Cilj: Analizirati pojavu makroangiopatija ili mikroangiopatija u arterijama karotidnog sustava,
kod pacijenata s ARMD te povezanost rizik faktora za kardiovaskularni sustav sa ARMD kao i
omjera omega-6/omega-3 u organizmu s pojavom i progresijom ARMD.
Ispitanici i metode: Analizirali smo 125 osoba kojima je pregledom u oftalmološkoj
ambulanti Klinike za oftalmologiju KBC Rijeka u toku 2009., 2010. i 2011. godine
dijagnosticirana ARMD. Podijeljeni u 5 skupina po 25 pacijenata prema CARMS-ovom
sistemu (Clinical Age-Related Maculopathy Staging System) . Kontrolnu skupinu činio je 51
ispitanik slične dobne skupine bez ARMD. Učinjen je oftalmološki pregled (vidna oštrina
prema Snellenovim tablicama, mjerenje očnog tlaka te fundoskopija). Razvrstani su prema
dobi i spolu. Ultrazvučnimaparatomutvrdio se protok krvi krozunutarnju karotidnu arteriju
(u formi postotka stenoze), protok kroz oftalmičku arteriju iprocjena IMT-parametra (u
mm). IMT (engl. intima-media thickness) označavazadebljanje slojevaarterijskestijenke, a
ukazuje napojavu i težinu ateroskleroze. Izračunaose perfuzijski tlak oka.Horioidalno
punjenje imrežnične kapilare analizirani sufluoresceinskomangiografijom.Izmjereni su
krvni tlaki koncentracije kolesterola i triglicerida u krvi. Posebni upitnici korišteni su za
utvrđivanje pušačkog statusa i omega-6/omega-3 omjera.
Rezultati: Ukupan broj pregledanih pacijenata bio je 176, 125 sa ARMD i 51 u kontrolnoj
skupini. Između ovih skupina ispitanici se statistički značajno razlikuju u dobi (P<0,001).
Najveće su razlike između kontrolne skupine i stadija 3,4 i 5.Raspodjela ispitanika s obzirom na spol nije statistički značajno
različita (P=0,992). Protok krvi kroz karotidu ne razlikuje se s
obzirom na stadij ARMD (P=0,933)niti prema kontroli(p=0,202). Broj ispitanika koji imaju
zadebljenje karotidne stijenke ne razlikuje se s obzirom na stadij ARMD (p=0,074).Broj
ispitanika koji imaju zadebljenje karotidne stijenke > 1mm je značajno veći u ispitanika koji
imaju ARMD uusporedbi s ispitanicima iz kontrolne skupine(p=0,029).Protok krvi kroz a.
oftalmiku ne razlikuje se značajno s obzirom na stadij ARMD (p=0,970) nitina kontrolu
(p=0,198).Vrijeme koroidalnog punjenja je statistički značajno kraće u ispitanika iz kontrolne
skupine u odnosu na ispitanike iz stadija 5 (p<0,001), stadija 4 (p<0,001) i stadija 3
(P=0,002). Normalne vrijednosti omjera Choroid/Disc su statistički značajno manje
zastupljene u ispitanika koji imaju ARMD stadija 4i 5 u odnosu na broj ispitanika u
kontrolnoj skupini (oba p<0,05). Broj ishemičnih kapilara razlikuje se statistički značajno s
obzirom na stadij ARMD (p=0,049) i raste s težinom bolesti. Kolesterol i trigliceridi ne
razlikuju se statistički značajno s obzirom na stadij ARMD međusobno i u odnosu na
kontrolu(p=0,545 i p=0,162).Broj ispitanika koji nisu nikad pušili je značajno veći u
ispitanika iz kontrolne skupine u usporedbi s ispitanicima koji imaju ARMD
(P=0,004).Neovaskularna ARMD ima statistički značajno povišen omega-6/omega-3 omjer u
odnosu na sve ostale skupine (p=0,000020), a GA čak blago niži.
Zaključak: Insuficijencija koroidalne cirkulacije povezana je s razvojem i progresijom ARMD.
Potrebno je dalje istražiti pitanje da li su promjene u koroidalnoj cirkulaciji uzrok ili
posljedica promjena fotoreceptora i RPE. U vezi s ARMD nisu stenoza karotide i oftalmike, a
jesu pušenje, povećan IMT, povišen broj retinalnih ishemičnih kapilara i povišen
omega-6/omega-3 omjer.
Abstract (english) Introduction: Age-related macular degeneration (ARMD) is a leading cause of visual
impairments and legal blindness in patients over 50 years in developed countries. ARMD is
multifactorial disease including complex interaction between genetic and enviromental risk
factors and metabolic and functional changes. Pathogenesis of ARMD is particullary known,
but some researchers think about vascular etiopathogenetic mechanism.
Aim: To investigate if patients with ARMD have macroangiopathy and/or microangiopathy in
carotid artery system, to analyse if risk factors for cardiovascular disease have influence on
ARMD development and progression.
Participants and methods: We examined 125 patients diagnosed with ARMD during
2009., 2010. and 2011. and divided into 5 groups of 25 patients according to CARMS (Clinical
Age-Related MaculopathyStaging System). Control group consists of 51 patients with similar
ages, without ARMD. We excluded patients with glaucoma or diabetic retinopathy.All of
participants underwent Snellen test of visual acuity, stereobiomicroscopy, tonometry,
fundus photography andfluorescein angiography. Participants were divided according to age
and sex. Carotid artery blood flow was notified as degree of stiffness by ultrasound. Also, it
wasused for analysing IMT and ophtalmic artery. IMT is thickness of carotid artery wall and
signof atherosclerosis being increased. Ocular perfussion pressure was counted. Choroidal
fillingtime was determined by fluorescein angiography. Retinal capillaries were analysed on
fluorescein angiogram. Systemic blood pressure was measured once and we noticed data
about using antihypertensive therapy. Concentracions of blood cholesterol and triglicerids
were measured. Special questionairres were used for analysing smoking status and
omega-6/omega-3 ratio.
Results: Total number of examined patients was 176, 125 diagnosed with ARMD and 51 in
control group. There was statistically significant difference in ages according to groups (p<0,001). The greatest difference
were among control group and stages 3, 4 i 5. Distribution
according to sex was not statistically significant different (p=0.992). Carotid artery blood flow
was not statistically significant different between groups (p=0,933)and comparing to control
(p=0,202). The number of participants with increased IMT was not different according to
stages of ARMD (p=0,074). The number of participants with IMT>1 mm was statistically
significant different in ARMD patients compared to control (p=0,029). Ophtalmic artery
blood flow was not different between stages (p=0,970) or compared to control (p=0,198).
Choroidal filling time was statistically significant shorter in control compared to stage 5
(p<0,001), stage 4 (p<0,001) and stage 3 (p=0,002). Normal values of choroid/disc ratio were
statistically significant less present in stages 4 and 5 compared tocontrol (p<0,05). The
number of ishaemic capillaries was statistically significant differentbetween stages of
ARMD (p=0,049) and raised with severity of disease. Cholesterol andtriglicerids were not
statistically significant different between stages of ARMD (p=0,545)and compared to
control (p=0,162). The number of participants who was non smokers wasstatistically
significant greater in control compared with ARMD patients (p=0,004). Neovascular ARMD
had statistically significant greater omega-6/omega-3 ratio compared with all other groups
(p=0,000020) and GA mild lower.
Conclusion: Insufficient choroidal circulation is connected with development and
progression of ARMD. We need further evaluation to detect if choroidal circulation changes
are cause or secondary changes to RPE and photoreceptors atrophy. ARMD is not connected
with carotid artery stiffness and ophtalmic artery stiffness. ARMD is connected with
smoking, increased IMT, increased number of ishaemic capillaries and increased
omega-6/omega-3 ratio.
Keywords
Degeneracija žute pjege - starosna
Fluoresceinska angiografija
Karotidne arterije
Protok krvi
Retinalna arterija
Ultrasonografija - Color Doppler
Keywords (english)
Blood Circulation
Carotid Arteries
Fluorescein Angiography
Macular Degeneration - Age-Related
Retinal Artery
Ultrasonography - Color Doppler
Language croatian URN:NBN urn:nbn:hr:188:661747 Study programme Title: Biomedicine Postgraduate (doctoral) study programme Catalog URL http://libraries.uniri.hr/cgi-bin/ucat/unilib.cgi?form=D1130104017 Type of resource Text Extent 96 str; 30 cm File origin Born digital Access conditions Closed access Terms of use Created on 2017-01-19 18:02:29
