WO2001030235A1

WO2001030235A1 - A device for detecting arteriosclerosis, and method of use thereof

Info

Publication number: WO2001030235A1
Application number: PCT/JP2000/007273
Authority: WO
Inventors: Reiji Kawada
Original assignee: Bml, Inc.
Priority date: 1999-10-22
Filing date: 2000-10-19
Publication date: 2001-05-03
Also published as: AU7949600A

Abstract

A device for detecting arteriosclerosis comprises means for detecting an electrocardiography signal, means for recognizing a specific pattern of the electrocardiography signal, and means for detecting an eyeground image synchronized with the recognized specific pattern of the electrocardiogram signal. This device provides simple and sensitive detection of arteriosclerosis.

Description

FIELD OF THE INVENTION

The present invention relates to an apparatus for detecting arteriosclerosis and a method for using the same. Background art

In an aging society, how to care for the elderly is a common issue in many countries. It is clear that the more elderly people who become bedridden, the greater the social costs, as well as the burden on themselves and their families. Therefore, recently, there has been an increasing movement to guide the elderly to better QOL (qualitative of life) and promote independence.

In order for elderly people to become independent, it is essential to have a preventive medical approach that prevents the onset of various diseases, as well as their own mental awareness.

Cardiovascular disease is a typical disease that is more likely to occur in elderly people and is likely to be directly linked to bedridden life. It is well known that cardiovascular diseases, along with cancer, which will cast the most serious shadows in an aging society, are largely due to arteriosclerosis. In most cases, ischemic heart disease such as angina pectoris and myocardial infarction, and stroke such as cerebral infarction, cerebral hemorrhage, and subarachnoid hemorrhage are related to arteriosclerosis as a cause.

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It is unavoidable that arteriosclerosis develops with aging to some extent, but it is possible to some extent to slow the progress. In other words, according to the state of the artery, it is possible to avoid catastrophic damage by diet, exercise, non-smoking and other lifestyle guidance, drug therapy, and possibly surgery.

However, in practice, it is not easy to grasp the state of the artery simply and accurately. At present, angiography is the most accurate means of grasping the state of arteries.However, this is the method that should be used for patients with very invasive subjects and imminent cardiovascular disease. It is. In other words, angiography is It may be used to a person who is not observed objective symptoms, regardless of the _c angiography not be the detection means of arteriosclerosis, artery, in particular, as a means to grasp the status of cerebrovascular arteries, photographing of the eye bottom photos That is, fundus diagnosis. At the time of photographing the fundus, there is almost no invasion of the subject, and it is considered to be convenient and widely used for medical examination. Nevertheless, fundus diagnosis is not widely used as a means of diagnosing arteriosclerosis.

This may be due to the fact that the criteria used for fundus photography are very complex and this requires considerable clinical experience. On the other hand, the pursuit of simplicity impairs the sensitivity of detecting arteriosclerosis. At present, the conditions of the 1969 Ministry of Education's Hypertension Research Group, K-W Classification, Seheie Classification, etc. are used to judge arteriosclerosis using fundus photographs, which are gradually simplified. Despite this, it is undeniable that they are still tended to be shunned in clinical practice.

The problem to be solved by the present invention is to provide a simple and sensitive means for detecting arteriosclerosis. Disclosure of the invention

The present inventor has considered that the fact that the fundus photograph is taken arbitrarily at any time is one of the causes that hinders the accurate evaluation of the progression of arteriosclerosis. In other words, in actual blood vessels, there is a time lag due to the Widkessel phenomenon of pulsation starting from the heart beat so that blood can be efficiently sent to the periphery. Therefore, in a fundus photograph taken arbitrarily at any time, the phase of the diastole and the systole of the heart due to the Widkessel phenomenon differ from one photographing to another, which is indispensable for the above-mentioned criteria of arteriosclerosis determination based on the fundus photograph. The present invention has been completed by noting that it is difficult to accurately measure the diameters of the fundus artery and the fundus vein.

The present invention provides an electrocardiogram signal detection means capable of detecting an electrocardiogram signal, an electrocardiogram signal detection means for detecting a specific pattern of the electrocardiogram signal, and a specific electrocardiogram signal detected thereby. It is an invention to provide an arteriosclerosis detection device (hereinafter, also referred to as the detection device of the present invention) provided with a fundus image detection means capable of detecting a fundus image in synchronization with a pattern. The means for detecting the electrocardiogram signal is not particularly limited as long as it can accurately detect the electrocardiogram signal.For example, the means for detecting the electrocardiogram signal is derived by attaching an electrode sensor composed of a piezoelectric element to the chest or other body part of the subject. Means that can detect an electrocardiogram signal. Typically, a mechanism provided by an existing electrocardiograph can be used as a means for detecting an electrocardiogram signal.

The electrocardiogram signal sensing means is means for sensing the detected electrocardiogram signal, extracting a specific pattern signal as an electric signal from the sensed electrocardiogram signal, and transmitting it to the fundus image detecting means. The specific pattern signal may be subjected to a process suitable for use in the fundus image detecting means, for example, an amplification process, if necessary. As an electrocardiogram signal sensing means, for example, an output terminal that detects only a specific electrocardiogram signal such as an R wave of an existing electrocardiograph and transmits the signal to the outside can be _{used.c The} specific electrocardiogram signal is an electrocardiogram. The signal is not particularly limited as long as it is a signal that can be grasped as the above established pattern, and any of the P, Q, R, S or T wave patterns can be selected. from stage to discharge toward the body butter - that the force ⁵ to select the R-wave is down signal 'it is preferable and practical. In addition, a lead method for obtaining an electrocardiogram signal from the subject is not particularly limited, and can be selected from so-called “standard 12 lead” and the like. The criterion for selecting the lead method is preferably the type of the specific ECG signal to be selected. In other words, force detecting specific ECG ^signal?, It is good preferable to select an easy induction way possible. When an R wave is selected as a specific electrocardiogram signal, it is preferable to select lead II, lead I, lead L, or the like, which detects a potential difference between the left hand and the right hand of the subject.

As described above, the fundus image detecting means is a means capable of detecting the fundus image in synchronization with a specific pattern of an electrocardiogram signal such as an R wave detected by the electrocardiogram signal detecting means.

In the present invention, “synchronizing” means that the fundus image detecting means responds to a specific pattern of an electrocardiogram signal at a fixed timing. For example, when an R wave is selected as a specific pattern of an electrocardiogram signal, a method of detecting a fundus image at a certain time from any time point in the R wave, for example, a rising time point. Activating the stage. This timing is kept constant and is shorter than the timing when the same pattern of the electrocardiogram signal occurs again (for example, in the case of an R wave, the time when the next R wave occurs). If so, there is no particular limitation. As described above, by detecting the fundus image in synchronization with the specific pattern of the electrocardiogram, information on the fundus blood vessels, specifically, the blood vessel diameter indispensable for obtaining an index for arteriosclerosis in the present invention is obtained. Information can be obtained accurately. That is, as described above, it was difficult to accurately evaluate the fundus vascular diameter, which changes in response to the expansion and contraction of the heart, in the fundus photograph taken arbitrarily at any time, due to the Widkessel phenomenon. However, if the fundus image is detected in synchronization with a specific pattern on the electrocardiogram, it is possible to obtain a fundus blood vessel image at a certain pulsation timing, and it is possible to accurately evaluate the fundus blood vessel diameter. Become.

As a means for detecting a fundus image, typically, a camera having a mechanism capable of photographing the fundus (specifically, a so-called fundus camera: an analog camera or a digital camera may be used) In this case, the shutter is set so as to be synchronized with a specific pattern of the electrocardiogram signal.

As described above, it is possible to obtain a blood vessel image of the fundus at a constant pulsation timing by the detection device of the present invention. By associating the information obtained from the fundus blood vessel image with the progress of the arteriosclerosis of the subject, the arteriosclerosis of the subject can be detected. The specific means of this association is not particularly limited, but the information on the fundus blood vessel diameter is particularly effective information for detecting the arteriosclerosis of the subject. The information about the fundus blood vessel diameter is used as a conventional criterion for arteriosclerosis, such as the aforementioned conditions of the 1969 Ministry of Education Hypertension Research Group, K-W Classification, Seheie Classification, etc. In this case, the arteriosclerosis of the subject can be detected.

The present inventor has reported that a fundus artery and a fundus vein (in the present invention, the “fundus artery” means “retinal artery” in medical terms, and “fundus vein” means “retinal vein” in medical terms. It has been found that the degree of stenosis of the fundus vein in the vicinity of the intersection can be a very useful index that can be associated with the development of arteriosclerosis. The detection device of the present invention, which can obtain a fundus blood vessel image at a certain pulsation timing, is very useful for obtaining this index. The degree of the stenosis of the fundus vein can also be detected by directly observing the fundus image obtained by the detection device of the present invention visually. Further, the above-described fundus image detecting means may be provided with a fundus vein stenosis detecting means capable of detecting the fundus vein stenosis, and this process may be automated. As means for detecting the stenosis of the fundus vein, for example, a means for detecting the above-mentioned fundus image data converted into electronic information by being captured by a scanner or the like is programmed. Software (for example, means for detecting the intersection of the fundus vein and the fundus artery and means for grasping and calculating the degree of stenosis of the fundus vein near the intersection or Z or the like). By processing the above-described image of the fundus image with such software, a desired stenosis of the fundus vein can be detected simply and reliably.

Here, an index of stenosis of the fundus vein useful for detecting the progress of arteriosclerosis, which is found by the present inventors, will be described.

At the intersection of the fundus artery and the fundus vein, it is known that these fundus blood vessels share the adventitia. When arteriosclerosis is observed at the intersection, the inside of the fundus artery is hardened, and the "pulling force" due to the hardening of the intima of the artery causes the fundus vein to move near the intersection. Causes stenosis. This indicates that the more severe the stenosis is, the more the arterial stiffness is developed near the intersection.

The present inventor has found that the ratio of the original outer diameter of the fundus vein to the outer diameter of the fundus vein near the intersection of the fundus artery and the fundus vein (hereinafter also referred to as the V ratio) is defined as the fundus vein showing arteriosclerosis. It was found to be extremely useful as an index of stenosis in the vicinity of the crossing point. Specifically, the V ratio is calculated as follows.

FIG. 1 is a schematic diagram of a fundus vein and a fundus vein in which stenosis of the fundus vein is observed, wherein the fundus vein 20 crosses the lower side of the fundus artery 10, and in the vicinity of the crossover part 30, The intima of the fundus artery 10 is hardened (not shown), and stenosis near the crossing portion 30 of the fundus vein 20 is recognized by the pulling force due to the hardening.

Assuming that the outer diameter of the fundus artery 10 is ΦA, confirm a site about 3 X ΦA away from the intersection 30 on the distal side of the fundus vein 20 and determine the outer diameter of the fundus vein 20 at that position. , Intersection Assuming the outer diameter of the fundus vein when no pulling stenosis is observed at 30-this is defined as V 2 and the right side of the fundus artery 10 at the intersection 30 (for example, from the intersection 30 The outside diameter of the fundus vein 20 at a distance of about 1/10 X Φ A) is defined as V 1.

In this case, the ratio between VI and V2 (usually V1ZV2) is calculated as the V ratio. As V ratio (V 1 ZV 2) is small, at the intersecting portion 30 near, indicates that the curing of the retinal arteries 1 0 is progressing, _c second diagram representing an increased risk of arteriosclerosis, FIG. 4 is a schematic diagram showing a case where the stiffness of the intima of the fundus artery 11 spreads in a direction slightly displaced from the intersection 31 (hardened portions: 11 1 and 11 2). 21 shows that the fundus vein 2 1 is displaced near the intersection 31 as a result of the pulling force acting alternately in the vicinity of the intersection 31 in c. Therefore, it is necessary to slightly correct the V ratio (V 1 ZV 2) described above. Specifically, a vector line (2 1 1) force connecting the center of the left and right outer diameters of the fundus vein 21 with the fundus artery 11 interposed at the intersection 31 1 is the outer diameter of the fundus vein 2 1 In the case where the deviation is 0.5 to 1.0 times of the above, a correction value obtained by subtracting 0.1 from the value of the above-mentioned V ratio is used as the V ratio to be used for detecting arteriosclerosis. If the outer diameter is more than 1.0 times the outer diameter of the fundus vein 21, the correction value obtained by subtracting 0.2 from the above-mentioned V ratio is used as the atherosclerosis. V ratio to be used for detection of

Preferably, the average value of the V ratio at a plurality of (about three) intersections of the fundus artery and the fundus vein at least one nipple diameter away from the nipple is calculated, and this is used as the V ratio of the subject. It can be used as a detection index of arteriosclerosis.

Standardization information obtained by standardizing the degree of stenosis of the fundus vein near the intersection of the fundus artery and the fundus vein, determined by the V ratio, etc., according to the ages of a plurality of subjects; It is also possible to detect the degree of arterial aging (vascular age) of each subject by associating it with the degree of stenosis in each subject. BRIEF DESCRIPTION OF THE FIGURES

Fig. 1 is a schematic diagram of the fundus artery and vein, where the stenosis of the fundus vein is observed, and Fig. 2 shows that the stiffness of the intima of the fundus artery is slightly shifted from the intersection. FIG. 3 is a schematic diagram showing a case where the detection device is expanded in the horizontal direction. FIG. 3 is a block diagram showing a configuration of the detection device of the present invention.

BEST MODE FOR CARRYING OUT THE INVENTION

Hereinafter, embodiments of the present invention will be described.

FIG. 3 is a block diagram showing a configuration of the detection device of the present invention.

In FIG. 3, the detection device 40 of the present invention includes an electrocardiogram signal detection section 41, an electrocardiogram signal detection section 42, and a fundus image detection section 43.

Further, the electrocardiogram signal detecting section 41 is composed of an electrode sensor 411 and an amplifying section 412. The sensing unit 42 includes a waveform analysis processing unit 421 and an output unit 422. Further, the fundus image detection unit 43 includes an input unit 431, a waveform signal sensing and transmission unit 4332, a shutter mechanism 4333, an imaging unit 4334, a photoelectric conversion unit 4353, and an output unit. It consists of 4 3 6 and analysis section 4 3 7.

In the electrocardiogram signal detection section 41, the electrode sensor 411 is a mechanism that is made of, for example, a piezoelectric element, is attached to the chest or other body part of the subject, and detects the derived electrocardiogram signal. The amplifying unit 412 is a mechanism for amplifying the electrocardiogram signal detected by the electrode sensor 411.

In the sensing section 42, the waveform analysis processing section 4 21 is a mechanism for performing a pulse wave selection processing required in the present invention on the electrocardiogram signal amplified in the amplification section 4 12. For example, when a pulse wave signal for the R wave is used at a specific timing as a signal to the shutter mechanism 433 described later, a specific timing in the R wave (for example, after a certain time from the rising of the R wave) ) Is a mechanism that performs specific selection processing. Specifically, the waveform analysis processing unit 4 21 can be provided with a selective amplification unit such as a filter amplifier for specifically amplifying a pulse wave signal at a specific timing of a specific electrocardiogram signal. . If necessary, an AZD conversion mechanism for digitizing the electrocardiogram signal (analog signal) selectively amplified by the selective amplification means can be provided in the waveform analysis processing unit.

The output unit 422 is a mechanism (for example, an output terminal or the like) for outputting the electrocardiogram signal selectively amplified by the waveform analysis processing unit 421 to the fundus image detection unit 43. It is.

In the fundus image detecting unit 43, the input unit 431 is provided with a mechanism for inputting the selectively amplified electrocardiogram signal output from the output unit 4222 to the detecting unit (for example, an input terminal or the like). ). The waveform signal sensing / transmitting section 432 is a mechanism that detects the electrocardiogram signal input from the input section 431 and transmits it to the shutter mechanism 433 as an appropriate ON / OFF signal. The shutter mechanism 433 senses the ON signal of the ONZOFF signal (eg, a pulse signal corresponding to a specific electrocardiogram signal), activates the imaging unit 434, and outputs the same “OFF” signal (described above). For conditions other than the pulse signal, etc.), there is provided a means for suppressing the operation of the imaging unit 434. In other words, the imaging unit 434 operates only at timing synchronized with a specific electrocardiogram signal, and can image the fundus of the subject. Note that the imaging unit 433 includes a mechanism for imaging the fundus of the subject, such as an eyepiece, a light source, an alignment mechanism, and an angle-of-view adjustment mechanism, which are provided in a normal fundus optics. Of course, they are provided as necessary.

The optical information of the fundus image captured in synchronization with the specific electrocardiogram signal in the imaging unit 434 is converted into electrical information in the photoelectric conversion unit 435 (even analog information is digital information. The electrical information is output at the output unit 436 (for example, a monitor image or a printer image), and the fundus image at the time of imaging is provided to the measurer. In addition, by appropriately analyzing the electrical information in the analysis unit 437, the information on the fundus image can be converted into more useful information. The useful information includes, for example, the above-mentioned V ratio of the subject and the age of the blood vessel. The analysis unit 437 includes appropriate software, for example, software for selecting an appropriate intersection between a fundus artery and a fundus vein, software for calculating a V ratio from the intersection, and the V Software for calculating the vascular age from the ratio can be used.

Thus, in the detection device 40 of the present invention, the electrocardiogram signal detected from the subject in the electrocardiogram signal detection unit 41 is converted into a specific pulse wave such as an R wave by the electrocardiogram signal detection unit 42. The electric signal based on this specific timing is synchronized with the fundus image detecting means. As a result, the Widkessel phenomenon It is possible to obtain a stable fundus image that is not affected by the fundus image detection unit 43. Information related to arteriosclerosis of the subject can be obtained from information obtained from the stable fundus image and subjected to appropriate arithmetic processing as needed. Industrial applicability

According to the present invention, a simple and sensitive means for detecting arteriosclerosis is provided.

Claims

The scope of the claims

1. An electrocardiogram signal detecting means capable of detecting an electrocardiogram signal, an electrocardiogram signal detecting means for detecting a specific pattern of the electrocardiogram signal, and synchronizing with a specific pattern of the detected electrocardiogram signal. An arterial stiffness detection device, comprising: a fundus image detection means capable of detecting a fundus image.

2. The fundus vein stenosis detecting means, which is capable of detecting fundus vein stenosis in the vicinity of the intersection of the fundus artery and the fundus vein, is provided in the fundus image detecting means. Detection device.

3. The arteriosclerosis detecting device according to claim 1 or 2, wherein the specific pattern of the electrocardiogram signal is an R wave of the electrocardiogram signal.

4. Detect arteriosclerosis by using the degree of stenosis of the fundus vein near the intersection of the fundus artery and the fundus vein, which is detected in the fundus image detected by the fundus image detection means, as an index of arteriosclerosis. A method of using the apparatus for detecting arterial sclerosis according to any one of claims 1 to 3.

5. Obtain the degree of stenosis of the fundus vein near the intersection of the fundus artery and the fundus vein, which is detected by using the arteriosclerosis detection device, by performing standardization processing according to the age of multiple subjects. The artery according to any one of claims 1 to 3, wherein the degree of aging of the artery of each subject is detected by associating the standardization information with the degree of the stenosis in each subject. How to use the cure detection device.