Department of Ophtalmology, Ziv Medical Centre, Safed 13100, Israel.
Int J Environ Res Public Health. 2013 Aug 6;10(8):3409-23. doi: 10.3390/ijerph10083409.
To evaluate the relationship between retinal vascular caliber and cardiovascular disease in non-alcoholic fatty liver disease (NAFLD) patients without diabetes and hypertension.
Intention to treat study of individuals who underwent cardiac computed tomography (CT) during a two year period. Coronary artery disease (CAD) was defined as stenosis of >50% in at least one major coronary artery. Liver and spleen density were measured by abdominal (CT); intima-media thickness (IMT) by Doppler ultrasound; retinal artery and vein diameter by colored-retinal angiography; and metabolic syndrome by ATP III guidelines. Serum biomarkers of insulin resistance, inflammation, and oxidant-antioxidant status were assessed.
Compared with 22 gender and age matched controls, the 29 NAFLD patients showed higher prevalence of coronary plaques (70% vs. 30%, p < 0.001), higher prevalence of coronary stenosis (30% vs. 15%, p < 0.001), lower retinal arteriole-to-venule ratio (AVR) (0.66 ± 0.06 vs. 0.71 ± 0.02, p < 0.01), higher IMT (0.98 ± 0.3 vs. 0.83 ± 0.1, p < 0.04), higher carotid plaques (60% vs. 40%, p < 0.001), higher homeostasis model assessment of insulin resistance (HOMA) (4.0 ± 3.4 vs. 2.0 ± 1.0, p < 0.005), and higher triglyceride levels (200 ± 80 vs. 150 ± 60, p < 0.005) than controls. Multivariate analysis showed fatty liver (OR 2.5; p < 0.01), IMT (OR 2.3 p < 0.001), and retinal AVR ratio (OR 1.5, p < 0.01) to be strongly associated with CAD independent of metabolic syndrome (OR 1.2, p < 0.05).
Patients with smaller retinal AVR (<0.7) are likely to be at increased risk for CAD and carotid atherosclerosis in patients with NAFLD even without hypertension or diabetes.
评估无糖尿病和高血压的非酒精性脂肪肝 (NAFLD) 患者视网膜血管口径与心血管疾病之间的关系。
对两年期间行心脏计算机断层扫描 (CT) 的个体进行意向治疗研究。冠状动脉疾病 (CAD) 定义为至少一条主要冠状动脉狭窄 >50%。通过腹部 CT 测量肝脾密度；多普勒超声测量内膜中层厚度 (IMT)；彩色视网膜血管造影测量视网膜动脉和静脉直径；根据 ATP III 指南评估代谢综合征。评估胰岛素抵抗、炎症和氧化应激状态的血清生物标志物。
与 22 名性别和年龄匹配的对照相比，29 名 NAFLD 患者的冠状动脉斑块患病率更高（70%比 30%，p < 0.001），冠状动脉狭窄患病率更高（30%比 15%，p < 0.001），视网膜小动脉与小静脉比值 (AVR) 更低（0.66 ± 0.06 比 0.71 ± 0.02，p < 0.01），IMT 更高（0.98 ± 0.3 比 0.83 ± 0.1，p < 0.04），颈动脉斑块更多（60%比 40%，p < 0.001），稳态模型评估的胰岛素抵抗 (HOMA) 更高（4.0 ± 3.4 比 2.0 ± 1.0，p < 0.005），甘油三酯水平更高（200 ± 80 比 150 ± 60，p < 0.005）。多变量分析显示脂肪肝（OR 2.5；p < 0.01）、IMT（OR 2.3，p < 0.001）和视网膜 AVR 比值（OR 1.5，p < 0.01）与 CAD 独立于代谢综合征（OR 1.2，p < 0.05）密切相关。
即使没有高血压或糖尿病，视网膜 AVR 较小 (<0.7) 的 NAFLD 患者发生 CAD 和颈动脉粥样硬化的风险可能更高。
