糖耐量受损个体的视网膜血管反应异常：一项初步研究。

Abnormal retinal vascular reactivity in individuals with impaired glucose tolerance: a preliminary study.

机构信息

Vascular Research Laboratory, Ophthalmic Research Group, School of Life and Health Sciences, Aston University, Birmingham, UK.

出版信息

Invest Ophthalmol Vis Sci. 2012 Aug 1;53(9):5102-8. doi: 10.1167/iovs.12-9512.

DOI:10.1167/iovs.12-9512

PMID:22743316

Abstract

PURPOSE

To investigate the relationship between vascular function parameters measured at the retinal and systemic level and known markers for cardiovascular risk in patients with impaired glucose tolerance (IGT).

METHODS

Sixty age- and sex-matched white European adults (30 with IGT and 30 with normal glucose tolerance [NGT]) were recruited for the study. Fasting plasma glucose, lipids, and 24-hour blood pressure (BP) were measured in all subjects. Systemic vascular and endothelial function was assessed by using carotid-artery intimal media thickness (cIMT) and flow-mediated dilation (FMD). Retinal vascular reactivity was assessed by the dynamic retinal vessel analyzer. Additionally, blood glutathione (reduced glutathione [GSH], glutathione disulfide [GSSG], and total glutathione [tGSH]) and plasma von Willebrand (vWF) factor levels were also measured.

RESULTS

Individuals with IGT demonstrated higher BP values (P < 0.001), fasting triglyceride (TG) levels and TG:high-density lipoprotein (HDL) ratios (P < 0.001) than NGT subjects. Furthermore, total:HDL-cholesterol (HDL-C) ratios and Framingham scores were raised (P = 0.010 and P < 0.001, respectively). Blood glutathione levels (GSH, GSSG, and tGSH) were lower (P < 0.001, P = 0.039, and P < 0.001, respectively) while plasma vWF was increased (P = 0.014) in IGT subjects compared to controls. IGT individuals also demonstrated higher IMT in right and left carotid arteries (P = 0.017 and P = 0.005, respectively) alongside larger brachial artery diameter (P = 0.015) and lower FMD percentage (P = 0.026) and glyceryl trinitrate-induced dilation (P = 0.012) than healthy controls. At the retinal arterial level, the IGT subjects showed higher baseline diameter fluctuations (BDFs) (P = 0.026), longer reaction time (RT) (P = 0.032), and reduced baseline-corrected flicker response (bFR) (P = 0.045). In IGT subjects, retinal BDF correlated with total:HDL (P = 0.003) and HDL-C (P = 0.004). Arterial RT also correlated with FMD (P = 0.017) in IGT but not NGT subjects.

CONCLUSIONS

In IGT individuals there is a relationship between macro- and microvascular function, as well as a direct correlation between the observed retinal microcirculatory changes and established plasma markers for cardiovascular diseases. Multifactorial preventive interventions to decrease vascular risk in these individuals should be considered.

摘要

目的

研究视网膜和全身血管功能参数与葡萄糖耐量受损（IGT）患者心血管风险已知标志物之间的关系。

方法

招募了 60 名年龄和性别匹配的白种欧洲成年人（30 名 IGT 患者和 30 名正常糖耐量[NGT]患者）进行研究。所有受试者均测量空腹血糖、血脂和 24 小时血压（BP）。通过颈动脉内中膜厚度（cIMT）和血流介导的扩张（FMD）评估全身血管和内皮功能。通过动态视网膜血管分析仪评估视网膜血管反应性。此外，还测量了血液谷胱甘肽（还原型谷胱甘肽[GSH]、谷胱甘肽二硫化物[GSSG]和总谷胱甘肽[tGSH]）和血浆血管性血友病因子（vWF）水平。

结果

与 NGT 受试者相比，IGT 患者的血压值（P < 0.001）、空腹甘油三酯（TG）水平和 TG：高密度脂蛋白（HDL）比值（P < 0.001）更高。此外，总：HDL-胆固醇（HDL-C）比值和弗雷明汉评分升高（P = 0.010 和 P < 0.001）。与对照组相比，IGT 患者的血液谷胱甘肽水平（GSH、GSSG 和 tGSH）更低（P < 0.001、P = 0.039 和 P < 0.001），而血浆 vWF 升高（P = 0.014）。与健康对照组相比，IGT 患者右侧和左侧颈动脉内中膜厚度（P = 0.017 和 P = 0.005）更大，肱动脉直径更大（P = 0.015），血流介导的扩张百分比（FMD%）更低（P = 0.026），甘油三酯诱导的扩张（P = 0.012）也更低。在视网膜动脉水平，IGT 患者的基线直径波动（BDF）更高（P = 0.026），反应时间（RT）更长（P = 0.032），基础校正闪烁反应（bFR）更低（P = 0.045）。在 IGT 患者中，视网膜 BDF 与总：HDL（P = 0.003）和 HDL-C（P = 0.004）呈正相关。动脉 RT 也与 IGT 患者的 FMD 呈正相关（P = 0.017），但在 NGT 患者中则没有。