McGowan Amy, Silvestri Giuliana, Moore Evelyn, Silvestri Vittorio, Patterson Christopher C, Maxwell Alexander P, McKay Gareth J
Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland.
Centre for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland; Department of Ophthalmology, Royal Victoria Hospital, Belfast, Northern Ireland.
PLoS One. 2015 Sep 1;10(9):e0136434. doi: 10.1371/journal.pone.0136434. eCollection 2015.
Chronic kidney disease (CKD) and hypertension are global public health problems associated with considerable morbidity, premature mortality and attendant healthcare costs. Previous studies have highlighted that non-invasive examination of the retinal microcirculation can detect microvascular pathology that is associated with systemic disorders of the circulatory system such as hypertension. We examined the associations between retinal vessel caliber (RVC) and fractal dimension (DF), with both hypertension and CKD in elderly Irish nuns.
Data from 1233 participants in the cross-sectional observational Irish Nun Eye Study (INES) were assessed from digital photographs with a standardized protocol using computer-assisted software. Multivariate regression analyses were used to assess associations with hypertension and CKD, with adjustment for age, body mass index (BMI), refraction, fellow eye RVC, smoking, alcohol consumption, ischemic heart disease (IHD), cerebrovascular accident (CVA), diabetes and medication use.
In total, 1122 (91%) participants (mean age: 76.3 [range: 56-100] years) had gradable retinal images of sufficient quality for blood vessel assessment. Hypertension was significantly associated with a narrower central retinal arteriolar equivalent (CRAE) in a fully adjusted analysis (P = 0.002; effect size = -2.16 μm; 95% confidence intervals [CI]: -3.51, -0.81 μm). No significant associations between other retinal vascular parameters and hypertension or between any retinal vascular parameters and CKD were found.
Individuals with hypertension have significantly narrower retinal arterioles which may afford an earlier opportunity for tailored prevention and treatment options to optimize the structure and function of the microvasculature, providing additional clinical utility. No significant associations between retinal vascular parameters and CKD were detected.
慢性肾脏病（CKD）和高血压是全球性公共卫生问题，伴有相当高的发病率、过早死亡率及随之而来的医疗费用。既往研究强调，视网膜微循环的非侵入性检查可检测出与高血压等循环系统全身性疾病相关的微血管病变。我们研究了老年爱尔兰修女视网膜血管管径（RVC）和分形维数（DF）与高血压及CKD之间的关联。
采用标准化方案，利用计算机辅助软件，从横断面观察性爱尔兰修女眼部研究（INES）的1233名参与者的数码照片中获取数据。采用多变量回归分析评估与高血压和CKD的关联，并对年龄、体重指数（BMI）、屈光不正、对侧眼RVC、吸烟、饮酒、缺血性心脏病（IHD）、脑血管意外（CVA）、糖尿病和药物使用情况进行校正。
总共1122名（91%）参与者（平均年龄：76.3岁[范围：56 - 100岁]）有质量足以进行血管评估的可分级视网膜图像。在完全校正分析中，高血压与较窄的中心视网膜动脉当量（CRAE）显著相关（P = 0.002；效应量 = -2.16μm；95%置信区间[CI]：-3.51，-0.81μm）。未发现其他视网膜血管参数与高血压之间或任何视网膜血管参数与CKD之间存在显著关联。
高血压患者的视网膜小动脉明显更窄，这可能为采取针对性预防和治疗方案提供更早的机会，以优化微血管的结构和功能，具有额外的临床应用价值。未检测到视网膜血管参数与CKD之间存在显著关联。
