Fundus Photograph Reading Center, Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, USA.
Am J Ophthalmol. 2012 Mar;153(3):434-444.e1. doi: 10.1016/j.ajo.2011.08.028. Epub 2011 Oct 22.
To evaluate relationships between retinal vessel caliber, AIDS-related factors, and mortality.
Longitudinal, observational cohort study.
We evaluated data for participants without ocular opportunistic infections at initial examination (baseline) in the Longitudinal Studies of the Ocular Complications of AIDS (1998-2008). Semi-automated evaluation of fundus photographs (1 eye/participant) determined central retinal artery equivalent (CRAE), central retinal vein equivalent (CRVE), and arteriole-to-venule ratio (AVR) at baseline. Multiple linear regression models, using forward selection, identified independent relationships between indices and various host- and disease-related variables.
Included were 1250 participants. Mean follow-up for determination of mortality was 6.1 years. Smaller CRAE was related to increased age (P < .001) and hypertension (P < .001); larger CRAE was related to lower hematocrit (P = .002). Larger CRAE and CRVE were associated with black race (P < .001). Larger CRVE was related to smoking (P = .004); smaller CRVE was related to age (P < .001) and higher mean corpuscular volume (P = .001). We observed the following relationships with AIDS-associated factors: smaller CRAE and larger CRVE with history of highly active antiretroviral therapy (HAART; P < .001); and larger CRAE with lower CD4+ T lymphocyte count (P = .04). We did not identify independent relationships with human immunodeficiency virus RNA blood levels. There was a 12% (95% CI, 2%-21%) increase in mortality risk per quartile of decreasing AVR (P = .02).
Variations in retinal vascular caliber are associated with AIDS-specific factors and are markers for increased mortality risk. Relationships are consistent with the hypothesis that the vasculature is altered by known atherogenic effects of chronic HAART or the prolonged inflammatory state associated with AIDS.
评估视网膜血管口径、艾滋病相关因素与死亡率之间的关系。
纵向观察性队列研究。
我们评估了 1998 年至 2008 年期间眼部艾滋病机会性感染初始检查（基线）时无眼部机会性感染的参与者的数据。对眼底照片（每只眼/每位参与者）进行半自动评估，确定基线时的中央视网膜动脉当量（CRAE）、中央视网膜静脉当量（CRVE）和动静脉比（AVR）。采用逐步选择的多元线性回归模型，确定了指数与各种宿主和疾病相关变量之间的独立关系。
共纳入 1250 名参与者。死亡率确定的平均随访时间为 6.1 年。较小的 CRAE 与年龄增加（P<0.001）和高血压（P<0.001）有关；较大的 CRAE 与较低的红细胞压积（P=0.002）有关。较大的 CRAE 和 CRVE 与黑种人有关（P<0.001）。较大的 CRVE 与吸烟有关（P=0.004）；较小的 CRVE 与年龄（P<0.001）和较高的平均红细胞体积（P=0.001）有关。我们观察到与艾滋病相关因素的以下关系：有过高效抗逆转录病毒治疗（HAART）史的参与者 CRAE 较小，CRVE 较大（P<0.001）；较低的 CD4+T 淋巴细胞计数与较大的 CRAE 有关（P=0.04）。我们没有发现与人类免疫缺陷病毒 RNA 血液水平有关的独立关系。AVR 每降低一个四分位数，死亡率风险增加 12%（95%CI，2%-21%）（P=0.02）。
视网膜血管口径的变化与艾滋病特定因素有关，是增加死亡率风险的标志物。这些关系与血管结构发生改变的假设一致，这种改变是由慢性 HAART 的已知动脉粥样硬化作用或与艾滋病相关的长期炎症状态引起的。
