美国全国数据库中镰状细胞病与大血管视网膜血管闭塞风险的回顾性队列研究。

IF 4.4 Q1 OPHTHALMOLOGY Ophthalmology. Retina Pub Date : 2025-01-01 DOI:10.1016/j.oret.2024.07.013

Gabriel T. Kaufmann MD , Matthew Russell MD , Priya Shukla BS , Rishi P. Singh MD , Katherine E. Talcott MD

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引用次数: 0

摘要

目的：确定镰状细胞患者发生大血管视网膜血管闭塞的风险是否存在差异：确定镰状细胞患者发生大血管视网膜血管闭塞的风险是否存在差异：设计：回顾性队列研究：由眼科医生评估的镰状细胞疾病或特质患者与同样由眼科医生评估的无镰状细胞疾病或特质的匹配对照组进行比较：这项研究使用了国家数据库（2006-2024 年）中的去身份化数据，使用国际疾病分类 10 代码来选择视网膜血管闭塞患者。对年龄、性别、种族、民族、吸烟、高血压、糖尿病、血脂异常和肥胖等因素进行倾向得分匹配，得出 HbSS、HbSC 和镰状细胞特质（SCT）队列和匹配的对照队列：视网膜血管闭塞诊断的风险比和 95% 置信区间 (CI)，包括视网膜中央动脉闭塞 (CRAO)、视网膜分支动脉闭塞 (BRAO)、视网膜中央静脉闭塞 (CRVO)、视网膜分支静脉闭塞 (BRVO)，以及作为阴性对照的角膜营养不良：经过倾向评分匹配后，HbSS（人数=10802，平均±标准差年龄为 38.6 ± 20.6 岁）、HbSC（人数=4296，34.3 ± 17.8 岁）和 SCT（人数=15249，39.8±23.7岁）队列与对照队列（分别为10,802人，38.7±20.7岁；4,296人，34.6±18.0岁；15,249人，39.9±23.8岁）进行了比较。与匹配的对照组相比，镰状细胞病（HbSS）患者发生任何视网膜血管闭塞（RR 2.33；95% CI 1.82-3.00）、CRAO（RR 2.71；95% CI 1.65-4.47）和BRAO（RR 4.90；95% CI 2.48-9.67）的风险较高。与无镰状细胞病的匹配对照组相比，HbSC 患者发生视网膜血管闭塞的风险更高（RR 3.14；95% CI 1.95-5.06）。镰状细胞性状患者发生视网膜血管闭塞的风险（RR 1.01；95% CI 0.81-1.26）并不比匹配对照组高：在一项回顾性队列研究中，与非镰状细胞病患者相比，HbSS 型镰状细胞病患者发生视网膜血管闭塞的风险更高，尤其是 CRAO 和 BRAO。

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Retrospective Cohort Study of Sickle Cell Disease and Large Vessel Retinal Vascular Occlusion Risk in a National United States Database

Objective

To determine if differences exist in the risk of developing large vessel retinal vascular occlusions in patients with sickle cell states.

Design

Retrospective cohort study.

Participants

Patients with sickle cell disease (SCD) or trait evaluated by an ophthalmologist were compared with matched controls without SCD or sickle cell trait (SCT) also evaluated by an ophthalmologist.

Methods

This study used deidentified data from a national database (2006–2024), using International Classification of Diseases 10 codes to select for retinal vascular occlusions. Propensity score matching was performed with respect to age, sex, race, ethnicity, smoking, hypertension, diabetes, dyslipidemias, and obesity, resulting in hemoglobin SS (HbSS), hemoglobin SC (HbSC), and SCT cohorts and matched control cohorts.

Main Outcome Measures

Risk ratios (RRs) and 95% confidence intervals (CIs) of retinal vascular occlusion diagnosis, including central retinal artery occlusion (CRAO), branch retinal artery occlusion (BRAO), central retinal vein occlusion, branch retinal vein occlusion, and corneal dystrophy as a negative control, given SCD or SCT.

Results

After propensity score matching, HbSS (n = 10 802; mean age ± standard deviation, 38.6 ± 20.6 years), HbSC (n = 4296, 34.3 ± 17.8 years), and SCT (n = 15 249, 39.8 ± 23.7 years) cohorts were compared with control cohorts (n = 10 802, 38.7 ± 20.7 years; n = 4296, 34.6 ± 18.0 years; n = 15 249, 39.9 ± 23.8 years, respectively).

Patients with SCD (HbSS) had higher risk of developing any retinal vascular occlusion (RR, 2.33; 95% CI, 1.82–3.00), CRAO (RR, 2.71; 95% CI, 1.65–4.47), and BRAO (RR, 4.90; 95% CI, 2.48–9.67) than matched controls. Patients with HbSC disease had higher risk (RR, 3.14; 95% CI, 1.95–5.06) of developing any retinal vascular occlusion than matched controls without SCD. Patients with SCT did not have higher risk of developing retinal vascular occlusions (RR, 1.01; 95% CI, 0.81–1.26) than matched controls.

Conclusions

In a retrospective cohort study, patients with HbSS SCD have an increased risk of developing retinal vascular occlusions, and more specifically CRAO and BRAO, compared with patients without SCD.