Keel Stuart, Itsiopoulos Catherine, Koklanis Konstandina, Vukicevic Meri, Cameron Fergus, Brazionis Laima
a Department of Clinical Vision Sciences , Latrobe University , Melbourne , Australia.
b Department of Dietetics , Latrobe University , Melbourne , Australia.
Ophthalmic Epidemiol. 2017 Jun;24(3):204-208. doi: 10.1080/09286586.2016.1267230. Epub 2017 Mar 13.
To evaluate the relationship between retinal vascular caliber and kidney function in a cohort of Australian children and adolescents with type 1 diabetes.
This was a cross-sectional study of 483 children and adolescents with type 1 diabetes, aged 7-18 years. An audit of medical files of participants who attended the Royal Children's Hospital, Melbourne, between January 2009 and March 2014 was performed. Albumin to creatinine ratio (ACR) was acquired through spot urine samples and microalbuminuria was classified as ACR >3.5 mg/mmol in females and >2.5 mg/mmol in males. Retinal vascular caliber was measured using a standardized protocol and later summarized as central retinal arteriolar equivalent (CRAE) and central retinal venular equivalent (CRVE).
CRAE was significantly narrower in participants with microalbuminuria compared to those with normo-albuminuria in crude analysis (mean ± standard deviation 159.07 ± 9.90µm vs 164.49 ± 12.45 µm; p = 0.006). After adjustment for key confounders and known or potential mediators of microalbuminuria (age, sex, ethnicity, hemoglobin A1c, systolic blood pressure, total cholesterol, body mass index, duration of diabetes and CRVE) the association between narrower CRAE and microalbuminuria was attenuated and was no longer significant (95% confidence interval 0.94-1.02, p = 0.222). No significant associations between CRVE or arteriole-to-venule ratio and microalbuminuria were observed in univariate or multivariate models.
After adjustment for potential confounding variables, retinal vascular caliber was not significantly associated with microalbuminuria in this sample of children and adolescents with type 1 diabetes. Future prospective longitudinal research is warranted to further evaluate these findings.
评估澳大利亚1型糖尿病儿童和青少年队列中视网膜血管管径与肾功能之间的关系。
这是一项对483名7至18岁1型糖尿病儿童和青少年的横断面研究。对2009年1月至2014年3月期间在墨尔本皇家儿童医院就诊的参与者的医疗档案进行了审核。通过随机尿样获取白蛋白与肌酐比值（ACR），微量白蛋白尿被定义为女性ACR>3.5mg/mmol，男性ACR>2.5mg/mmol。使用标准化方案测量视网膜血管管径，随后汇总为视网膜中央动脉等效直径（CRAE）和视网膜中央静脉等效直径（CRVE）。
在粗分析中，微量白蛋白尿参与者的CRAE明显比正常白蛋白尿参与者窄（均值±标准差159.07±9.90µm对164.49±12.45µm；p = 0.006）。在对微量白蛋白尿的关键混杂因素以及已知或潜在中介因素（年龄、性别、种族、糖化血红蛋白、收缩压、总胆固醇、体重指数、糖尿病病程和CRVE）进行调整后，较窄的CRAE与微量白蛋白尿之间的关联减弱且不再显著（95%置信区间0.94 - 1.02，p = 0.222）。在单变量或多变量模型中，未观察到CRVE或动静脉比与微量白蛋白尿之间存在显著关联。
在对潜在混杂变量进行调整后，在这个1型糖尿病儿童和青少年样本中，视网膜血管管径与微量白蛋白尿无显著关联。未来有必要进行前瞻性纵向研究以进一步评估这些发现。
