Zusammenfassung
Hintergrund: Retinale Gefäßverschlüsse werden relativ häufig bei älteren Patienten gesehen. Gelegentlich
kommen sie aber auch bei jüngeren Patienten ohne Arteriosklerose vor. Wir vermuten
in diesen Fällen eine zugrunde liegende vaskuläre Dysregulation. Patienten und Methoden: In einer prospektiven Studie analysierten wir sechs Patienten unter 55 Jahren: drei
Männer mit venösen retinalen Verschlüssen und drei Frauen mit arteriellen retinalen
Verschlüssen. Wir suchten nach Zeichen einer vaskulären Dysregulation und bestimmten
den Endothelin-1-(ET-1-) Plasmaspiegel. Ergebnisse: Bei allen untersuchten Patienten war der ET-1-Plasmaspiegel deutlich erhöht. Der
Mittelwert lag mit 3,72 ± 0,8 pg/ml signifikant (p < 0,001) über dem in dieser Altersgruppe
zu erwartenden Wert (1,52 ± 0,24 pg/ml). Alle Fälle zeigten in der Kapillarmikroskopie
eine vaskuläre Dysregulation. In der Anamnese wurden von allen Patienten gehäuft kalte
Extremitäten und von vier Patienten eine Migräne angegeben. Hingegen wurden weder
Veränderungen der Gefäße im Carotis- und Ophthalmica-Gebiet noch Störungen der Hämostase
und Fibrinolyse gefunden. Schlussfolgerungen: Alle sechs untersuchten Patienten unter 55 Jahren mit retinalen Gefäßverschlüssen
hatten eine vaskuläre Dysregulation und erhöhte ET-1-Plasmaspiegel. Ein Zusammenhang
zwischen der vaskulären Dysregulation und den Gefäßverschlüssen ist deshalb wahrscheinlich.
Abstract
Background: Vascular occlusive diseases are usually seen in the elderly but can occur even in
younger patients without arteriosclerosis. We assume a vascular dysregulation as a
underlying pathogenetic mechanism. Patients and methods: In a prospective study we analysed the clinical findings of six patients under 55
years of age, three men with retinal vein occlusions and three women with branch retinal
arterial obstructions. They were examined for signs of a vascular dysregulation and
the endothelin-1 (ET-1) plasma level was measured. Results: In all patients the ET-1 plasma level was markedly elevated. The mean value (3.72
± 0.8 pg/ml) was significantly increased compared to normal values for that age (1.52
± 0.24 pg/ml; p < 0.001). In all cases an increased tendency for vascular dysregulation
could be demonstrated in nailfold capillaroscopy. Furthermore, frequent coldness of
the extremities was mentioned by every patient and migraine was mentioned by four
patients whereas neither changes of the vessels in carotis and ophthalmica region
nor disturbances in the haemostasis and fibrinolysis could be found. Conclusions: All six patients with vascular occlusive diseases occurring before the age of 55
had a vascular dysregulation and increased ET-1 plasma levels. A relationship between
the vascular dysregulation and the vascular occlusive diseases is therefore likely.
Schlüsselwörter
Endothelin-1 - retinale Gefäßverschlüsse - vaskuläre Dysregulation
Key words
Endothelin-1 - retinal vascular occlusive diseases - vascular dysregulation
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J. Flammer, M.D.
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