aterosklerozАтеросклерозAteroscleroz2078-256X2949-3633НИИТПМ-филиал ИЦиГ СО РАН10.15372/ATER20200205ateroskleroz-376Research ArticleОБЗОРЫREVIEWSПатологические изменения сетчатки глаза при сердечно-сосудистых заболеваниях и сахарном диабетеPathological changes of the eye retina at cardiovascular disease and diabetes mellitushttps://orcid.org/0000-0003-3801-6844ДиреевА. О.DireevA. O.

Диреев Артем Олегович – аспирант очного обучения кафедры терапии, гематологии и трансфузиологии ФПК и ППВ

630091, г. Новосибирск, Красный просп., 52, 

630089, г. Новосибирск, ул. Бориса Богаткова, 175/1

630091, Novosibirsk, Krasnyy av., 52, 

630089, Novosibirsk, Boris Bogatkov str., 175/1

dr.direev@gmail.comhttps://orcid.org/0000-0003-4908-3946МунцИ. В.MuntsI. V.

Мунц Инна Викторовна – аспирант очного обучения кафедры терапии, гематологии и трансфузиологии ФПК и ППВ

630091, г. Новосибирск, Красный просп., 52

630091, Novosibirsk, Krasnyy av., 52

healy@mail.ruКулешоваО. Н.KuleshovaO. N.

Кулешова Ольга Николаевна – доктор медицинских наук, профессор кафедры офтальмологии

 

https://orcid.org/0000-0003-0415-6478МаздороваЕ. В.MazdorovaE. V.

Маздорова Екатерина Викторовна – кандидат медицинских наук, научный сотрудник лаборатории этиопатогенеза и клиники внутренних заболеваний

630089, г. Новосибирск, ул. Бориса Богаткова, 175/1

630089, Novosibirsk, Boris Bogatkov str., 175/1

mazdorova@mail.ruhttps://orcid.org/0000-0001-9868-855XРябиковА. Н.RyabikovA. N.

Рябиков Андрей Николаевич – доктор медицинских наук, профессор, главный научный сотрудник лаборатории этиопатогенеза и клиники внутренних заболеваний

630091, г. Новосибирск, Красный просп., 52, 

630089, г. Новосибирск, ул. Бориса Богаткова, 175/1

WoS: J-4565-2018

630091, Novosibirsk, Krasnyy av., 52, 

630089, Novosibirsk, Boris Bogatkov str., 175/1

a_ryabikov@hotmail.comhttps://orcid.org/0000-0001-6539-0466МалютинаС. К.MalyutinaS. K.

Малютина Софья Константиновна – доктор медицинских наук, профессор, заведующий лаборатерией этипатогенеза и клиники внутренних заболеваний, НИИТПМ – филиал ФГБНУ ФИЦ ИЦИГ СО РАН; профессор кафедры терапии, профессор гематологии и трансфузиологии ФПК и ППВ ФГБОУ ВПО НГМУ Минздрава России

630091, г. Новосибирск, Красный просп., 52, 

630089, г. Новосибирск, ул. Бориса Богаткова, 175/1

eLibrary SPIN: 6780-9141

WoS: J-1651-2018

630091, Novosibirsk, Krasnyy av., 52, 

630089, Novosibirsk, Boris Bogatkov str., 175/1

smalyutina@hotmail.comФГБОУ ВПО Новосибирский государственный медицинский университет Минздрава России; НИИ терапии и профилактической медицины – филиал ФГБНУ ФИЦ Институт цитологии и генетики СО РАНNovosibirsk State Medical University of Minzdrav of Russia; Research Institute of Internal and Preventive Medicine – Branch of Federal Research Center Institute of Cytology and Genetics of SB RASФГБОУ ВПО Новосибирский государственный медицинский университет Минздрава РоссииNovosibirsk State Medical University of Minzdrav of RussiaНИИ терапии и профилактической медицины – филиал ФГБНУ ФИЦ Институт цитологии и генетики СО РАНResearch Institute of Internal and Preventive Medicine – Branch of Federal Research Center Institute of Cytology and Genetics of SB RAS2020240720201624962Copyright © Диреев А.О., Мунц И.В., Кулешова О.Н., Маздорова Е.В., Рябиков А.Н., Малютина С.К., 20202020Диреев А.О., Мунц И.В., Кулешова О.Н., Маздорова Е.В., Рябиков А.Н., Малютина С.К.Direev A.O., Munts I.V., Kuleshova O.N., Mazdorova E.V., Ryabikov A.N., Malyutina S.K.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://ateroskleroz.elpub.ru/jour/article/view/376Цель

Цель. В работе анализируются данные современной литературы (опубликованные с 2005 по 2020 г.) о поражении сетчатки при сердечно-сосудистых заболеваниях (ССЗ) и сахарном диабете. Повреждения сосудистого русла сетчатки и зрительного нерва в современном мире представляют актуальную проблему ввиду существенной распространенности, тяжести необратимых повреждений сетчатки, приводящих к инвалидизации, и в связи с коморбидностью с ССЗ.

Методы

Методы. Выполнен поиск исследований по тематике работы с 2005 по 2020 г. Использовались электронные базы данных Академии Google (https://scholar.google.ru/), PubMed (https://www.ncbi.nlm.nih.gov/pubmed/), eLIBRARY.ru (https://www.elibrary.ru/) и зарубежных и отечественных журналов, посвященных кардиологии, терапии и офтальмологии.

Результаты

Результаты. Анализ литературы показал, что атеросклеротическое поражение микрососудистого русла сетчатки является достоверным фактором риска острого коронарного синдрома, инфаркта миокарда и мозгового инсульта (МИ). Однако вопрос о тождественности атеросклеротических процессов, протекающих в сосудистом русле сетчатки и в периферических артериях, остается открытым. Гипертензивная ретинопатия (ГР) имеет убедительную связь с МИ, хронической сердечной недостаточностью (ХСН) и смертностью от ишемической болезни сердца (ИБС), подтвержденную в крупных популяционных исследованиях ARIC и Rotterdam Study. Дискутабельным остается вопрос о прогностической значимости ГР в зависимости от ее степени. Имеются последовательные данные о связи ГР с ИБС и ХСН. Диабетическая ретинопатия (ДР) является нейроваскулярным осложнением сахарного диабета. В преимущественно клинических работах представлены свидетельства значения ДР как маркера риска МИ, диабетической периферической нейропатии, кардиальной автономной нейропатии, утолщения комплекса «интима–медия» каротидных артерий, микроальбуминурии. Ряд других крупных клинических работ не показал достоверной ассоциации ДР с МИ. Существенным недостатком изучения связи ДР с ССЗ является дефицит популяционных исследований по данной тематике.

Заключение

Заключение. Несмотря на современные методы диагностики и достаточно большое количество исследований сосудистого русла глаза и сетчатки, сведения об их связи с ССЗ остаются недостаточными и противоречивыми, что обусловлено ограниченным объемом выборок, вариабельностью оценок и сложностью патогенеза атеросклероза и ССЗ. Исследование ассоциаций ССЗ с патологией сетчатки в российской популяции с применением автоматических систем оценок микрососудистого русла предоставляет уникальную возможность преодоления ряда противоречивых аспектов и получения новых данных.

Objective

Objective. In this work we analyzed the current literature data about the retinal damage in cardiovascular diseases and diabetes mellitus (published from 2005 to 2020). The damage of retinal vascular bed and optic nerve represents a relevant problem in the modern world in view of the significant prevalence, severity of retinal irreversible damage leading to disability, and in relation to comorbidity with cardiovascular diseases (CVD).

Methods

Methods. Publications on selected topic were analyzed from 2005 to 2020. The search was carried out using the electronic databases of the Google Academy (https://scholar.google.com/), PubMed (https://www.ncbi.nlm.nih.gov/pubmed/), eLIBRARY.ru (https: //www.elibrary.ru/) and foreign and national journals devoted to cardiology, therapy and ophthalmology.

Results

Results. The analysis of literature showed that atherosclerotic lesion of the microvascular retinal bed is a significant risk factor for acute coronary syndrome myocardial infarction (MI) and stroke. However, the identity of atherosclerotic processes occurring in the retinal vascular bed and in the peripheral arteries remains open. A strong association was shown between hypertensive retinopathy (HR) has with MI, congestive heart failure (CHF) and CHD mortality in large-scale population-based studies such as ARIC and Rotterdam Study. The question of the predictive significance of GR, depending on its degree, remains debatable. There are consistent evidence on the association between HR and CHD and CHF. Diabetic retinopathy (DR) represents a neurovascular complication of diabetes. In predominantly clinical work, there is evidence of the significance of DR as a risk marker for Stroke, diabetics peripheral neuropathy, autonomic cardiac neuropathy, thickness of carotid intima-media, micro albuminuria. A number of other major clinical works has not shown a significant association between DR and stroke. A significant drawback of investigation of the relationship between DR and CVD is a lack of population studies on this topic.

Conclusions

Conclusions. Despite the use of modern diagnostic methods and a fairly large number of studies of the eye vascular bed and retina, the data about their relationship with CVD remain scare and contradictory, which is largely due to the limited size of the studied samples, the variability of the estimates, and a complexity of the pathway of atherosclerosis and CVD. The study of association between CVD and retinal pathology in the Russian population with using of automatic assessment of the microvascular bed provides a unique opportunity to solve some contradictory aspects and obtain new data.

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The authors declare that there are no conflicts of interest present.