视网膜血管直径与年龄相关性黄斑病变的发病风险：鹿特丹研究

Retinal vessel diameters and the risk of incident age-related macular disease: the Rotterdam Study.

作者信息

Ikram M Kamran, van Leeuwen Redmer, Vingerling Johannes R, Hofman Albert, de Jong Paulus T V M

机构信息

Department of Epidemiology and Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands.

出版信息

Ophthalmology. 2005 Apr;112(4):548-52. doi: 10.1016/j.ophtha.2004.10.038.

DOI:10.1016/j.ophtha.2004.10.038

PMID:15808242

Abstract

PURPOSE

To study the relationship between retinal vessel diameters and incident age-related macular disease (iAMD).

DESIGN

Prospective population-based cohort study.

PARTICIPANTS

Persons (55 years and older) from the Rotterdam Study, who participated at the baseline (1990-1993) and 1 of 2 follow-up examinations (1993-1994 and 1997-1999).

METHODS

In the current analysis, 4345 participants who were free of AMD at baseline and had gradable macular transparencies at both baseline and follow-up examination were included. Also, arteriolar and venular diameters were measured on digitized baseline images. Stereoscopic transparencies of the macular region were graded according to the International Classification and Grading System for AMD. Incidence of AMD was defined as the development of soft distinct drusen with pigmentary changes or indistinct or reticular drusen with or without pigmentary changes (early iAMD) or atrophic or neovascular AMD (late iAMD). Logistic regression models were used to assess these associations, adjusting for age, gender, and follow-up time and, additionally, for smoking, body mass index, intima-media thickness, systolic blood pressure, and total and high-density lipoprotein cholesterol levels.

MAIN OUTCOME MEASURE

Incidence of AMD.

RESULTS

After a mean follow-up time of 5.2 years, a total of 374 persons developed early and late iAMD. Neither arteriolar nor venular diameters were related to the risk of iAMD. The odds ratio (OR) per standard deviation (SD) decrease in arteriolar diameter was 1.03 (95% confidence interval [CI], 0.93-1.15), and the OR per SD increase in venular diameter was 1.04 (95% CI, 0.93-1.16). After categorizing the retinal vessel diameters into quintiles, there was no trend. After stratifying on age, only persons 75 years and older with smaller arteriolar diameters were at a borderline significant increased risk of iAMD: OR/SD decrease in arteriolar diameters adjusted for age, gender, follow-up time, and other cardiovascular risk factors, 1.24 (95% CI, 0.94-1.63).

CONCLUSION

Overall retinal vessel diameters were not related to the risk of iAMD in this general elderly population.

摘要

目的

研究视网膜血管直径与年龄相关性黄斑疾病（iAMD）发病之间的关系。

设计

基于人群的前瞻性队列研究。

参与者

来自鹿特丹研究的55岁及以上人群，他们参加了基线检查（1990 - 1993年）以及两次随访检查中的一次（1993 - 1994年和1997 - 1999年）。

方法

在当前分析中，纳入了4345名在基线时无AMD且在基线和随访检查时黄斑透明度可分级的参与者。此外，在数字化的基线图像上测量小动脉和小静脉直径。黄斑区的立体透明度根据AMD国际分类和分级系统进行分级。AMD的发病定义为出现伴有色素改变的软性明显玻璃膜疣或伴有或不伴有色素改变的不明显或网状玻璃膜疣（早期iAMD）或萎缩性或新生血管性AMD（晚期iAMD）。使用逻辑回归模型评估这些关联，并对年龄、性别和随访时间进行调整，另外还对吸烟、体重指数、内膜中层厚度、收缩压以及总胆固醇和高密度脂蛋白胆固醇水平进行调整。

主要观察指标

AMD的发病率。

结果

平均随访5.2年后，共有374人发生了早期和晚期iAMD。小动脉和小静脉直径均与iAMD风险无关。小动脉直径每减少一个标准差（SD）的比值比（OR）为1.03（95%置信区间[CI]，0.93 - 1.15），小静脉直径每增加一个SD的OR为1.04（95%CI，0.93 - 1.16）。将视网膜血管直径分为五分位数后，没有发现趋势。按年龄分层后，仅75岁及以上且小动脉直径较小的人群患iAMD的风险有边缘性显著增加：在对年龄、性别、随访时间和其他心血管危险因素进行调整后，小动脉直径每减少一个SD的OR为1.24（95%CI，0.94 - 1.63）。