视网膜血管管径、视网膜神经纤维层厚度与青光眼之间的相互关系：一种中介分析方法

Inter-Relationships Between Retinal Vascular Caliber, Retinal Nerve Fiber Layer Thickness, and Glaucoma: A Mediation Analysis Approach.

作者信息

Tham Yih-Chung, Siantar Rosalynn Grace, Cheung Carol Yim-Lui, Tan Shu-Pei, Koh Victor T, Aung Tin, Wong Tien Y, Cheng Ching-Yu

机构信息

Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 2Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore.

出版信息

Invest Ophthalmol Vis Sci. 2016 Jul 1;57(8):3803-9. doi: 10.1167/iovs.15-18683.

DOI:10.1167/iovs.15-18683

PMID:27421069

Abstract

PURPOSE

The purpose of this study was to explore the interrelationships among retinal vascular caliber, retinal nerve fiber layer (RNFL), and glaucoma; in particular, whether the relationship between narrower retinal vascular caliber and glaucoma is mediated by thinning of RNFL.

METHODS

A total of 9407 participants, including 253 glaucoma and 195 primary open-angle glaucoma (POAG) cases from the Singapore Epidemiology of Eye Diseases Study were included in this study. All participants underwent standardized examinations. Glaucoma was defined according to International Society for Geographical and Epidemiologic Ophthalmology criteria. Logistic regression analyses were used to determine the total direct effects of retinal vascular calibers on glaucoma. Regression-based mediation analyses were used to evaluate the indirect effects of retinal vascular caliber on glaucoma through RNFL thinning.

RESULTS

After we adjusted for relevant covariates, narrower retinal arteriolar caliber (per standard deviation [SD], 15.1-μm decrease) was associated with glaucoma (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.06-1.38) and POAG (OR, 1.23; 95% CI, 1.06-1.43). Similarly, narrower retinal venular caliber (per SD, 21.6μm decrease) was associated with glaucoma (OR, 1.51; 95% CI, 1.32-1.73) and POAG (OR, 1.64; 95% CI, 1.41-1.91). In addition, there were significant indirect effects of retinal vascular narrowing on glaucoma through thinning of RNFL (all P < 0.001), with mediated proportion of 36.9% and 12.9% in retinal arteriole- and venule-related analysis, respectively.

CONCLUSIONS

Mediation analyses indicated that the effect of retinal vascular narrowing on glaucoma was partially the result of thinning of RNFL. These findings provide additional mechanistic insights linking retinal vascular narrowing and glaucoma.

摘要

目的

本研究旨在探讨视网膜血管管径、视网膜神经纤维层（RNFL）与青光眼之间的相互关系；特别是较窄的视网膜血管管径与青光眼之间的关系是否由RNFL变薄介导。

方法

本研究纳入了9407名参与者，其中包括来自新加坡眼病流行病学研究的253例青光眼患者和195例原发性开角型青光眼（POAG）患者。所有参与者均接受了标准化检查。青光眼根据国际地理和流行病学眼科学会标准进行定义。采用逻辑回归分析来确定视网膜血管管径对青光眼的总直接效应。基于回归的中介分析用于评估视网膜血管管径通过RNFL变薄对青光眼的间接效应。

结果

在调整相关协变量后，较窄的视网膜小动脉管径（每标准差[SD]减少15.1μm）与青光眼（优势比[OR]，1.21；95%置信区间[CI]，1.06 - 1.38）和POAG（OR，1.23；95% CI，1.06 - 1.43）相关。同样，较窄的视网膜小静脉管径（每SD减少21.6μm）与青光眼（OR，1.51；95% CI，1.32 - 1.73）和POAG（OR，1.64；95% CI，1.41 - 1.91）相关。此外，视网膜血管变窄通过RNFL变薄对青光眼有显著的间接效应（所有P < 0.001），在视网膜小动脉和小静脉相关分析中的中介比例分别为36.9%和12.9%。