Prävalenz erhöhter Lipoprotein(a)-Spiegel bei unter 60-jährigen Patienten mit venösen retinalen Gefäßverschlüssen

Zusammenfassung

Hintergrund: Die Bedeutung einer Lipoprotein(a)-Erhöhung [Lp(a)] im Hinblick auf Alter und andere Risikofaktoren für die Entstehung venöser retinaler Gefäßverschlüsse wurde bisher wenig untersucht.

Patienten und Methoden: In einer retrospektiven Fall-Kontroll-Studie verglichen wir die Ergebnisse eines umfassenden Thrombophiliescreenings von 106 jungen Patienten mit venösen retinalen Gefäßverschlüssen (< 60 Jahre zum Zeitpunkt der Erkrankung oder eines früheren thromboembolischen Ereignisses) mit denen von 76 gesunden Probanden.

Ergebnisse: 31 der 106 (29,2 %) Patienten wiesen eine Lp(a)-Erhöhung auf verglichen mit 7 der 76 (9,2 %) gesunden Probanden (p = 0,0009). Die durchschnittlich gemessenen Lp(a)-Spiegel waren in der Patientengruppe signifikant höher als in der gesunden Vergleichsgruppe (p = 0,012). Innerhalb der Patientengruppe beobachteten wir eine signifikante Assoziation von Lp(a) mit einer auffälligen Eigen- oder Familienanamnese hinsichtlich thromboembolischer Ereignisse (p = 0,03). Darüber hinaus zeigte sich innerhalb der Patientengruppe eine Lp(a)-Erhöhung signifikant häufiger in Kombination mit zusätzlichen thrombophilen Risikofaktoren als in der Vergleichsgruppe (p = 0,005). Die logistische Regression mit Abbau bestätigte Lp(a) als unabhängigen Risikofaktor für die Entstehung venöser retinaler Gefäßverschlüsse (p = 0,003).

Schlussfolgerung: Unsere Ergebnisse weisen darauf hin, dass erhöhten Lp(a)-Spiegeln bei jungen Patienten mit venösen retinalen Gefäßverschlüssen eine pathogenetische Bedeutung zukommt. Eine positive Eigen- oder Familienanamnese hinsichtlich thromboembolischer Ereignisse weist signifikant häufiger auf diesen genetisch determinierten Parameter hin.

Abstract

Background: The potential impact of elevated Lipoprotein (a) [Lp(a)] levels on retinal venous occlusive (RVO) diseases with regard to age and various risk factors has not been studied extensively.

Patients and Methods: In a retrospective case-control study, thrombophilia data of 106 young patients (< 60 years at the time of the RVO or a previous thromboembolic event) with RVO and 76 healthy subjects were evaluated.

Results: Elevated Lp(a) plasma levels were significantly more prevalent among RVO patients (29.2 %) than among controls (9.2 %; p = 0.0009). Lp(a) levels were found to be significantly (p = 0.012) different between patients and controls. Moreover, we found that an unusual personal or family history of thromboembolism was a strong predictor of elevated Lp(a) (p = 0.03). We observed a significant correlation between elevated Lp(a) and other coagulation disorders (p = 0.005). Multivariate analysis showed that elevated lipoprotein(a) levels (OR: 3.5; p = 0.003) were an independent risk factor for the development of RVO.

Conclusions: Elevated plasma levels of Lp(a) are associated with the development of RVO. Selective screening of young patients and subjects with a personal or family history of thromboembolism may be helpful in identifying RVO patients with elevated Lp(a).

Schlüsselwörter

venöse retinale Gefäßverschlüsse - Zentralvenenverschluss - Venenastverschluss - Lipoprotein(a) - Thrombophilie

Key words

retinal vein occlusion - central retinal vein occlusion - branch retinal vein occlusion - lipoprotein(a) - thrombophilia

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