Malan Leoné, Hamer Mark, von Känel Roland, Schlaich Markus P, Reimann Manja, Frasure-Smith Nancy, Lambert Gavin W, Vilser Walthard, Harvey Brian H, Steyn Faans, Malan Nico T
Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.
Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa; National Centre for Sport and Exercise Medicine, Loughborough University, Leicestershire, United Kingdom.
Nitric Oxide. 2016 May 1;55-56:10-7. doi: 10.1016/j.niox.2016.02.008. Epub 2016 Mar 2.
Depression has been associated with impaired nitric oxide (NO)-mediated vasodilation and vascular dysregulation (VD). Whether depression and NO levels will disturb retinal haemodynamics is not clear.
Associations between the retinal vasculature, diastolic ocular perfusion pressure (DOPP) as measure of hypoperfusion, NO metabolites (NOx) and depression symptoms were assessed. Chronic VD risk markers [depression symptoms (Patient Health Questionnaire/PHQ-9 ≥ 10) and 24 h pulse pressure] were determined in a bi-ethnic cohort (n = 313; 48.6 ± 9 years; 53.9% men). At 3 year follow-up, retinal vessel calibre and retinopathy signs were quantified from digital images. Salivary NOx was obtained pre- and post-flicker light-induced provocation (FLIP). DOPP was defined as diastolic blood pressure minus intraocular pressure.
Chronic VD risk was evident in Blacks opposed to acute risk in Whites (P < 0.05). At follow-up, retinopathy (Blacks 60.4%/Whites 39.6%), lower pre-FLIP (μM) and higher post-FLIP NOx (changes from baseline, %), arteriolar narrowing and wider venular calibre values were evident in Blacks compared to Whites, independent of confounders. A wider venular calibre, an index of stroke risk, was associated with chronic depression symptoms [cut point 248 MU: Area under the curve 0.61 (95% CI: 0.51, 0.72); 71% sensitivity; 55% specificity] as well as with hypoperfusion in the Blacks. In this group, arteriolar narrowing was associated with hypoperfusion; and attenuated arteriolar dilation with increased post-FLIP NOx responses.
Chronic depression symptoms may alter NO regulation and facilitate VD. NO-mediated vasoconstriction presumably impeded perfusion, retinal haemodynamics and -remodelling; potentiating stroke risk in Blacks.
抑郁症与一氧化氮（NO）介导的血管舒张功能受损和血管调节异常（VD）有关。抑郁症和NO水平是否会干扰视网膜血流动力学尚不清楚。
评估视网膜血管系统、作为灌注不足指标的舒张期眼灌注压（DOPP）、NO代谢产物（NOx）与抑郁症状之间的关联。在一个双种族队列（n = 313；48.6±9岁；53.9%为男性）中确定慢性VD风险标志物[抑郁症状（患者健康问卷/PHQ-9≥10）和24小时脉压]。在3年随访时，从数字图像中量化视网膜血管口径和视网膜病变体征。在闪烁光诱发刺激（FLIP）前后获取唾液NOx。DOPP定义为舒张压减去眼压。
黑人中存在慢性VD风险，而白人中存在急性风险（P < 0.05）。随访时，与白人相比，黑人中视网膜病变（黑人60.4%/白人39.6%）、FLIP前较低的（微摩尔）和FLIP后较高的NOx（相对于基线的变化，%）、小动脉狭窄和较宽的静脉口径值更为明显，且不受混杂因素影响。较宽的静脉口径是中风风险的一个指标，与慢性抑郁症状[切点248 MU：曲线下面积0.61（95% CI：0.51，0.72）；71%敏感性；55%特异性]以及黑人中的灌注不足有关。在该组中，小动脉狭窄与灌注不足有关；小动脉扩张减弱与FLIP后NOx反应增加有关。
慢性抑郁症状可能会改变NO调节并促进VD。NO介导的血管收缩可能阻碍灌注、视网膜血流动力学和重塑；增加黑人的中风风险。
