目的：比较不同年龄组视网膜动脉阻塞(RAO)患者在病因学、危险因素、性别分布及急性期临床表现方面的差异，揭示年龄相关的异质性特征。

方法：本研究采用回顾性比较队列设计，纳入RAO患者并根据年龄分为<50岁组与≥50岁组。依据改良TOAST标准进行病因分型，比较两组在危险因素、病因构成及性别分布上的差异； 同时在急性中央视网膜动脉阻塞(CRAO)病例中进一步评估其眼底特征与视力预后。

结果：本研究共纳入145例RAO患者，分为<50岁组(女15例，男13例，平均年龄36.64±9.72岁)与≥50岁组(女38例，男79例，平均年龄63.50±9.54岁)。其中<50岁组高血压(46.4% vs 85.5%)及糖尿病(3.6% vs 27.4%)的患病率均显著低于≥50岁组(均P<0.001)。病因构成方面，<50岁组以其他确定病因(SOE)为主(35.7% vs 2.6%，P<0.001)，而≥50岁组则以小动脉闭塞(SAO，35.9%)和大动脉粥样硬化(LAA，31.6%)占主导，两者在≥50岁组的发生率均显著高于<50岁组(均P<0.001)。<50岁组女性比例更高(53.6% vs 32.5%，P=0.039)。多变量分析显示，LAA与高龄独立相关，而SOE与年轻独立相关。Boxcarring征仅见于≥50岁组患者\〖39.5%(17/43)vs 0，P=0.011\〗。

结论：<50岁组RAO患者以非动脉粥样硬化性病因为主，且女性占比更高； 而≥50岁组患者则主要由动脉粥样硬化相关病因驱动，并表现出血管代偿能力减退的征象。上述发现提示，在制定RAO的病因评估策略及管理方案时，应充分考虑年龄相关的差异。

METHODS:This retrospective comparative cohort study enrolled patients with RAO. Patients were divided into <50 y group and ≥50 y group. Etiological classification was based on modified TOAST criteria. Comparisons assessed the prevalence of risk factors, etiological distribution, sex ratio, and, in cases of acute central retinal artery occlusion(CRAO), fundus characteristics and visual outcomes.

RESULTS:This study included a total of 145 RAO patients,which were divided into two groups based on age: <50 y group(15 females and 13 males)with the mean age of 36.64±9.72 y, and ≥50 y group(38 females and 79 males)with the mean age of 63.50±9.54 y. Hypertension(46.4% vs 85.5%)and diabetes(3.6% vs 27.4%)were less prevalent in <50 y group(both P<0.001). The <50 y group was characterized predominantly by stroke of other determined etiology(SOE, 35.7% vs 2.6%, P<0.001), whereas the ≥50 y group was dominated by small artery occlusion(SAO, 35.9%)and large artery atherosclerosis(LAA, 31.6%), the incidence rates were significantly higher in the ≥50 y group than in the <50 y group(both P<0.001). Females were more frequently represented in <50 y group(53.6% vs 32.5%, P=0.039). Multivariable analysis demonstrated that LAA was independently linked to older age and SOE to younger age. Boxcarring occurred exclusively in ≥50 y patients\〖39.5%(17/43)vs 0, P=0.011\〗.

CONCLUSION:The RAO patients<50 y predominantly present with non-atherosclerotic causes and a higher proportion of females, whereas patients≥50 y are mainly affected by atherosclerosis driven etiologies and show signs of reduced vascular compensatory capacity. These findings indicate that age-related differences in RAO should be taken into account when determining etiologic evaluation and management strategies.