The current prevalence of hypertension is increasing year by year, and its ocular complication, hypertensive retinopathy, is also receiving increasing attention. However, little attention has been paid to neuronal damage in hypertensive retinopathy.

To investigate the application and value of optical coherence tomography as a screening tool in the evaluation of neuronal damage in hypertensive retinopathy.

A total of 102 patients with hypertension who were admitted to Hospital Clínico Quirúrgico "Hermanos Ameijeiras" (HHA Hospital) from March 2019 to July 2020 were included as study subjects, as well as 45 healthy subjects as the control group to monitor 24-h ambulatory blood pressure. The average arterial blood pressure of 24-h diastolic and systolic blood pressure were taken, intraocular pressure (IOP) was measured and ocular perfusion pressure was calculated. The thickness of retinal nerve fiber layer (RNFL) and ganglion cell complex layer (GCC) in macular region were measured. The patients were divided into the control group (n=51) and uncontrolled group (n=51) according to their blood pressure control, with 45 healthy subjects as the control group. Pearson correlation analysis or Spearman rank correlation analysis were used to explore the correlation of blood pressure, ocular perfusion pressure, retinopathy and GCC thickness with blood pressure, as well as ocular perfusion pressure with retinopathy, and mediation analysis was performed using R 3.5.3 software.

There were significant differences in race, systolic blood pressure, diastolic blood pressure, average arterial pressure, IOP, ocular perfusion pressure and retinopathy among the three groups (P<0.05) . The average RNFL thickness in the uncontrolled blood pressure group was lower than that in the control group (P<0.05) , the average GCC thickness in the control group and uncontrolled blood pressure group was lower than that in the control group, and the minimum GCC thickness in the uncontrolled blood pressure group was lower than that in the control group (P<0.05) . Correlation analysis results showed that average GCC thickness, superior temporal GCC thickness and inferior temporal CCG thickness were negatively correlated with systolic blood pressure, diastolic blood pressure, ocular perfusion pressure and retinopathy (P<0.05) , while superior temporal GCC thickness was negatively correlated with systolic blood pressure, diastolic blood pressure and ocular perfusion pressure (P<0.05) ; inferior temporal CCG thickness was negatively correlated with diastolic blood pressure (P<0.05) , retinopathy was positively correlated with systolic blood pressure, diastolic blood pressure and ocular perfusion pressure (P<0.05) . The mediating effect showed a significant effect of "systolic blood pressure→average GCC thickness→hypertensive retinopathy" , with systolic blood pressure positively correlated with average GCC thickness, average GCC thickness positively correlated with hypertensive retinopathy (P<0.05) . Systolic blood pressure had a direct effect on the risk of hypertensive retinopathy (β=0.013, 95%CI=0.007-0.020, P<0.001) , and the average GCC thickness partially mediated the effect of systolic blood pressure on the risk of hypertensive retinopathy (β=0.117, 95%CI=0.014-0.360, P=0.04) , the mediating effect accounted for 11.7% of the total effect.

Optical coherence tomography is a non-invasive ophthalmological test that can detect hypertensive retinal neuronal damage superior to normal fundus examination, provide early prevention and warning of irreversible blindness and hypertensive target organ damage in hypertension-induced optic neuronal damage.

当前高血压的患病率呈逐年增长趋势，其眼部并发症高血压视网膜病也日益受到关注。然而目前对于高血压性视网膜病变中神经元损伤的研究尚少。

本研究以光学相干断层成像检查为检查手段，探究其在高血压性视网膜病变中神经元损伤评估中的应用和重要价值。

纳入2019年3月—2020年7月于Hospital Clínico Quirúrgico"Hermanos Ameijeiras"（HHA医院）就诊的102例高血压患者为研究对象，同时纳入45名健康受试者，监测24 h动态血压，取24 h舒张压和收缩压的平均动脉血压值，测量眼压，计算眼灌注压。检测视盘区视网膜神经纤维（RNFL）厚度和黄斑区神经节细胞复合层（GCC）厚度。依据血压控制情况将患者分为血压控制组（n=51）和血压未控制组（n=51），45名健康受试者为对照组。采用Pearson相关性分析或Spearman秩相关分析探究血压、眼灌注压、视网膜病变与GCC厚度和血压、眼灌注压与视网膜病变的相关性，采用R 3.5.3软件进行中介作用分析。

3组研究对象人种、收缩压、舒张压、平均动脉压、眼压、眼灌注压、视网膜病变比较，差异有统计学意义（P<0.05）。血压未控制组平均RNFL厚度低于对照组（P<0.05），血压控制组、血压未控制组GCC平均厚度低于对照组，血压未控制组GCC最小值低于对照组（P<0.05）。相关性分析结果显示，GCC平均厚度、上方GCC厚度、颞下方CCG厚度与收缩压、舒张压、眼灌注压、视网膜病变呈负相关（P<0.05），颞上方GCC厚度与收缩压、舒张压、眼灌注压呈负相关（P<0.05），下方GCC厚度与舒张压呈负相关（P<0.05），视网膜病变与收缩压、舒张压、眼灌注压呈正相关（P<0.05）。中介效应结果显示，"收缩压→GCC平均厚度→高血压性视网膜病变"效应显著，收缩压与GCC平均厚度呈正相关，GCC平均厚度与高血压性视网膜病变呈正相关（P<0.05）。收缩压对高血压性视网膜病变发生风险具有直接影响（β=0.013，95%CI=0.007~0.020，P<0.001），GCC平均厚度部分介导了收缩压对高血压性视网膜病变发生风险的影响（β=0.117，95%CI=0.014~0.360，P=0.04），中介效应占总效应的11.7%。

光学相干断层成像检查是一种无创的眼科检查方法，可优于普通眼底检查提前发现高血压性视网膜神经元受损情况，对高血压导致视神经受损的不可逆盲和高血压靶器官受损进行早期预防和预警。