Hubbard L D, Brothers R J, King W N, Clegg L X, Klein R, Cooper L S, Sharrett A R, Davis M D, Cai J
ARIC Retinal Reading Center, Department of Ophthalmology & Visual Sciences, University of Wisconsin-Madison, 53705-2397, USA.
Ophthalmology. 1999 Dec;106(12):2269-80. doi: 10.1016/s0161-6420(99)90525-0.
To develop protocols to photograph and evaluate retinal vascular abnormalities in the Atherosclerosis Risk in Communities (ARIC) Study; to test reproducibility of the grading system; and to explore the relationship of these microvascular changes with blood pressure.
Population-based, cross-sectional study.
Among 4 examination centers, 11,114 participants (48-73 years of age) at their third triennial examination, after excluding persons with diabetes from this analysis.
One eye of each participant was photographed by technicians with nonmydriatic fundus cameras. Reading center graders evaluated focal arteriolar narrowing, arteriovenous (AV) nicking, and retinopathy by examining slides on a light box and measured diameters of all vessels in a zone surrounding the optic disc on enhanced digitized images. To gauge generalized narrowing, vessel diameters were combined into central arteriolar and venular equivalents with formulas adjusting for branching, and the ratio of equivalents (A/V ratio) was calculated.
Retinal vascular abnormalities, mean arteriolar blood pressure (MABP).
Among 11,114 participants, photographs were obtained of 99%, with quality sufficient to perform retinal evaluations in 81%. In the 9040 subjects with usable photographs, A/V ratio (lower values indicate generalized arteriolar narrowing) ranged from 0.57 to 1.22 (median = 0.84, interquartile range = 0.10), focal arteriolar narrowing was found in 7%, AV nicking in 6%, and retinopathy in 4%. Because of attrition of subjects and limitation of methods, prevalence of abnormality was likely underestimated. Controlling for gender, race, age, and smoking status, these retinal changes were associated with higher blood pressure. For every 10-mmHg increase in MABP, A/V ratio decreased by 0.02 unit (P < 0.0001), focal arteriolar narrowing had an odds ratio (OR) of 2.00 (95% confidence interval [CI] = 1.87-2.14), AV nicking had an OR of 1.25 (95% CI = 1.16-1.34), and retinopathy had an OR of 1.25 (95% CI = 1.15-1.37). For any degree of generalized narrowing, individuals with focal narrowing had MABP approximately 8 mmHg higher than those without (P < 0.0001). Masked replicate assessment of a sample found the following reproducibility: for A/V ratio, correlation coefficient = 0.79 and median absolute difference = 0.03; for focal arteriolar narrowing, kappa = 0.45; for AV nicking, kappa = 0.61; and for retinopathy, kappa = 0.89.
Protocols have been developed for nonmydriatic fundus photography and for evaluation of retinal vascular abnormalities. Several microvascular changes were significantly associated with higher blood pressure; follow-up will show whether these are predictive of later cerebrovascular or cardiovascular disease independently of other known risk factors.
制定在社区动脉粥样硬化风险（ARIC）研究中拍摄和评估视网膜血管异常的方案；测试分级系统的可重复性；并探讨这些微血管变化与血压的关系。
基于人群的横断面研究。
在4个检查中心，11114名参与者（年龄48 - 73岁）在其第三次三年期检查时，本分析排除了糖尿病患者。
技术人员使用免散瞳眼底相机拍摄每位参与者的一只眼睛。阅片中心的分级人员通过在灯箱上检查幻灯片来评估局灶性小动脉狭窄、动静脉交叉压迹和视网膜病变，并在增强的数字化图像上测量视盘周围区域所有血管的直径。为了评估全身性狭窄，将血管直径通过调整分支的公式合并为中央小动脉和小静脉等效值，并计算等效值之比（A/V比）。
视网膜血管异常、平均小动脉血压（MABP）。
在11114名参与者中，99%获得了照片，其中81%的照片质量足以进行视网膜评估。在9040名有可用照片的受试者中，A/V比（较低值表示全身性小动脉狭窄）范围为0.57至1.22（中位数 = 0.84，四分位间距 = 0.10），7%发现有局灶性小动脉狭窄，6%有动静脉交叉压迹，4%有视网膜病变。由于受试者流失和方法的局限性，异常患病率可能被低估。在控制性别、种族、年龄和吸烟状况后，这些视网膜变化与较高的血压相关。MABP每升高10 mmHg，A/V比降低0.02单位（P < 0.0001），局灶性小动脉狭窄的比值比（OR）为2.00（95%置信区间[CI] = 1.87 - 2.14），动静脉交叉压迹的OR为1.25（95% CI = 1.16 - 1.34），视网膜病变的OR为1.25（95% CI = 1.15 - 1.37）。对于任何程度的全身性狭窄，有局灶性狭窄的个体的MABP比没有的个体高约8 mmHg（P < 0.0001）。对一个样本进行的盲法重复评估发现了以下可重复性：对于A/V比，相关系数 = 0.79，中位数绝对差 = 0.03；对于局灶性小动脉狭窄，kappa = 0.45；对于动静脉交叉压迹，kappa = 0.61；对于视网膜病变，kappa = 0.89。
已制定了免散瞳眼底摄影和评估视网膜血管异常的方案。几种微血管变化与较高的血压显著相关；随访将显示这些变化是否独立于其他已知危险因素预测后期的脑血管或心血管疾病。
