Yip WanFen, Sabanayagam Charumathi, Teo Boon Wee, Tay Wan Ting, Ikram M Kamran, Tai E Shyong, Chow Khuan Yew, Wong Tien Y, Cheung Carol Y
Singapore Eye Research Institute, Singapore National Eye Center, Singapore, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore.
Singapore Eye Research Institute, Singapore National Eye Center, Singapore, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore; Office of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore, Singapore.
PLoS One. 2015 Feb 6;10(2):e0118076. doi: 10.1371/journal.pone.0118076. eCollection 2015.
Retinal microvascular signs may provide insights into the structure and function of small vessels that are associated with renal disease. We examined the relationship of retinal microvascular signs with both prevalent and incident end-stage renal disease (ESRD) in a multi-ethnic Asian population.
A total of 5763 subjects (aged ≥ 40 years) from two prospective population-based studies (the Singapore Malay Eye Study and the Singapore Prospective Study) were included for the current analysis. Retinopathy was graded using the modified Airlie House classification system. Retinal vascular parameters were measured using computer-assisted programs to quantify the retinal vessel widths (arteriolar and venular caliber) and retinal vascular network (fractal dimension). Data on ESRD was obtained by record linkage with the ESRD cases registered by National Registry of Diseases Office, Singapore. Multi-variable adjusted regression analyses were performed to assess the associations of baseline retinal vascular parameters and prevalent and incident ESRD.
At baseline, 21(0.36%) persons had prevalent ESRD. During a median follow-up of 4.3 years, 33 (0.57%) subjects developed ESRD. In our analyses, retinopathy was associated with prevalent ESRD (multi-variable adjusted odds ratio [OR], 3.21, 95% confidence interval [CI]: 1.28-8.05) and incident ESRD (multi-variable adjusted hazard ratio [HR], 2.51, 95%CI: 1.14-5.54). This association was largely seen in person with diabetes (HR, 2.60, 95%CI: 1.01-6.66) and not present in persons without diabetes (HR, 1.65, 95%CI: 0.14-18.98). Retinal arteriolar caliber, retinal venular caliber and retinal vascular fractal dimension were not associated with ESRD.
Retinopathy signs in persons with diabetes are related to an increased risk of ESRD; however, other microvascular changes in the retina are not associated with ESRD.
视网膜微血管体征可能有助于深入了解与肾脏疾病相关的小血管的结构和功能。我们在一个多民族亚洲人群中研究了视网膜微血管体征与现患和新发终末期肾病（ESRD）之间的关系。
本分析纳入了来自两项基于人群的前瞻性研究（新加坡马来人眼研究和新加坡前瞻性研究）的5763名受试者（年龄≥40岁）。使用改良的艾利屋分类系统对视网膜病变进行分级。使用计算机辅助程序测量视网膜血管参数，以量化视网膜血管宽度（小动脉和小静脉管径）和视网膜血管网络（分形维数）。通过与新加坡疾病登记处登记的ESRD病例进行记录链接来获取ESRD数据。进行多变量调整回归分析以评估基线视网膜血管参数与现患和新发ESRD之间的关联。
在基线时，21人（0.36%）患有现患ESRD。在中位随访4.3年期间，33名受试者（0.57%）发生了ESRD。在我们的分析中，视网膜病变与现患ESRD相关（多变量调整比值比[OR]，3.21，9置信区间[CI]：1.28 - 8.05）和新发ESRD相关（多变量调整风险比[HR]，2.51，95%CI：1.14 - 5.54）。这种关联主要在糖尿病患者中可见（HR，2.60，95%CI：1.01 - 6.66），而在无糖尿病患者中不存在（HR，1.65，95%CI：0.14 - 18.98）。视网膜小动脉管径、视网膜小静脉管径和视网膜血管分形维数与ESRD无关。
糖尿病患者的视网膜病变体征与ESRD风险增加有关；然而，视网膜的其他微血管变化与ESRD无关。
