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类风湿关节炎患者的视网膜血管口径发生改变:疾病活动和心血管风险的生物标志物?

Retinal vascular calibre is altered in patients with rheumatoid arthritis: a biomarker of disease activity and cardiovascular risk?

机构信息

Department of Medicine (RMH/WH), University of Melbourne, 4th Floor Clinical Sciences Building, Royal Melbourne Hospital, Parkville Vic 3050, Melbourne, Australia.

出版信息

Rheumatology (Oxford). 2011 May;50(5):939-43. doi: 10.1093/rheumatology/keq428. Epub 2010 Dec 20.

Abstract

OBJECTIVES

Alterations in retinal vascular calibre, particularly wider venular calibre, have been independently associated with elevated markers of inflammation and cardiovascular risk in the general population. We hypothesized that retinal vascular calibre would be altered in patients with RA, who are known to have both elevated cardiovascular risk and chronic, systemic inflammation.

METHODS

Retinal vascular calibre was measured from digital retinal photographs using computerized methods in 51 RA patients and 51 age- and gender-matched controls. Retinal vascular calibre was compared between RA and control patients with adjustment for relevant variables including cardiovascular risk factors and companion vessel calibre. The relationship between retinal venular calibre and inflammation was assessed by comparing controls and RA patients with high and lower disease activity.

RESULTS

Retinal venular calibre [mean (s.d.)] was significantly wider in RA patients than in controls [235.9 (24.6) vs. 211.6 (21.0) µm, P < 0.001]. After adjustment for all relevant variables, mean venular calibre remained 20.3 µm (95% CI 10.4, 30.3) wider in RA patients compared with controls. Retinal venular calibre [mean (s.d.)] also increased with increasing levels of systemic inflammation: 211.6 (21.0) µm in controls, 232.3 (22.4) µm in RA patients with moderate or lower disease activity and 255.5 (28.3) µm in RA patients with high disease activity (P for trend < 0.0001).

CONCLUSIONS

This study demonstrates that RA patients have dilated retinal venular calibre, reflecting systemic inflammation and possibly increased cardiovascular risk. Longitudinal studies correlating retinal vascular calibre with subsequent cardiovascular events will clarify the clinical utility of this test in patients with RA.

摘要

目的

视网膜血管口径的改变,特别是静脉口径增宽,与一般人群中炎症和心血管风险标志物的升高独立相关。我们假设,类风湿关节炎(RA)患者的视网膜血管口径会发生改变,因为他们既有较高的心血管风险,又有慢性、全身性炎症。

方法

使用计算机化方法从数字视网膜照片中测量 51 例 RA 患者和 51 例年龄和性别匹配的对照者的视网膜血管口径。在调整了心血管危险因素和伴行血管口径等相关变量后,比较了 RA 和对照组患者的视网膜血管口径。通过比较高疾病活动度和低疾病活动度的对照组和 RA 患者,评估视网膜静脉口径与炎症之间的关系。

结果

RA 患者的视网膜静脉口径[平均值(标准差)]明显宽于对照组[235.9(24.6)比 211.6(21.0)µm,P<0.001]。在调整了所有相关变量后,RA 患者的平均静脉口径仍比对照组宽 20.3µm(95%置信区间 10.4,30.3)。视网膜静脉口径[平均值(标准差)]也随全身性炎症水平的升高而增加:对照组为 211.6(21.0)µm,疾病活动度中低的 RA 患者为 232.3(22.4)µm,疾病活动度高的 RA 患者为 255.5(28.3)µm(趋势 P<0.0001)。

结论

本研究表明,RA 患者的视网膜静脉口径扩张,反映了全身性炎症和可能增加的心血管风险。将视网膜血管口径与随后的心血管事件进行纵向关联的研究将阐明该检测在 RA 患者中的临床应用价值。

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