视网膜血管指标：正常数据及其在系统性高血压中的应用：古登堡健康研究结果

Retinal vessel metrics: normative data and their use in systemic hypertension: results from the Gutenberg Health Study.

作者信息

Ponto Katharina A, Werner David J, Wiedemer Linn, Laubert-Reh Dagmar, Schuster Alexander K, Nickels Stefan, Höhn René, Schulz Andreas, Binder Harald, Beutel Manfred, Lackner Karl J, Wild Philipp S, Pfeiffer Norbert, Mirshahi Alireza

机构信息

aDepartment of Ophthalmology bDepartment of Preventive Cardiology and Preventive Medicine, Center for Cardiology I cInstitute of Medical Biostatistics, Epidemiology and Informatics, Division of Biostatistics and Bioinformatics dDepartment of Psychosomatic Medicine and Psychotherapy eInstitute of Clinical Chemistry and Laboratory Medicine fCenter for Thrombosis and Hemostasis, University Medical Center gDZHK (German Center for Cardiovascular Research), Partner Site Rhine Main, Langenbeckstr. 1, Mainz, Germany hDepartment of Ophthalmology, University Hospital Bern, Bern, Switzerland iDardenne Eye Hospital, Bonn-Bad Godesberg, Germany.

出版信息

J Hypertens. 2017 Aug;35(8):1635-1645. doi: 10.1097/HJH.0000000000001380.

DOI:10.1097/HJH.0000000000001380

PMID:28505063

Abstract

PURPOSE OF REVIEW

In-vivo measurement of retinal vascular calibers may be used as a tool to study the pathophysiology and clinical status of the microvasculature of the retina. The aim of this study was to generate normative data for retinal vessel parameters, and to evaluate the clinical relevance in systemic hypertension.

METHODS

Fundus photographs from 4309 participants of the Gutenberg Health Study were assessed using the 'retinal vessel analyzer' software (IMEDOS). We generated age and sex-specific nomograms in a disease-free subpopulation of 890 participants for determining the central retinal arteriolar equivalent (CRAE), the central retinal venular equivalent, and the arteriovenous ratio (AVR).

RESULTS

Women had higher values of CRAE, central retinal venular equivalent, and AVR than men, and the decrease in measures with increasing age was less steep in women than in men. Systemic hypertension was associated with lower values [odds ratio (OR), 95% confidence interval (CI) referring to area below the 5% percentile] of AVR (men: OR 2.41, 95% CI 1.669-3.490, P < 0.001; women: OR 3.01, 95% CI 2.126-4.268, P < 0.001) and CRAE (men: OR 2.60, 95% CI 1.563-4.326, P < 0.001, women: OR 3.00, 95% CI 2.004-4.487, P < 0.001). Both median CRAE and AVR were lower in participants with uncontrolled hypertension (172.28, range 83.05-251.04; and 0.81, range 0.56-1.04) versus those with screening-detected hypertension (175.72, range 101.23-222.09, P < 0.001; and 0.82, range 0.64-1.05, P = 0.001), and versus those with controlled (179.10, range 108.19-221.92, P < 0.001; and 0.84, range 0.60-1.08, P < 0.001) hypertension.

CONCLUSION

The study provides sex and age-specific normative data for retinal vasculature. Persons with untreated or insufficiently treated hypertension are more likely to have retinal vessel equivalents outside the reference range.

摘要

综述目的

视网膜血管管径的体内测量可作为研究视网膜微血管病理生理学和临床状况的工具。本研究的目的是生成视网膜血管参数的标准数据，并评估其在系统性高血压中的临床相关性。

方法

使用“视网膜血管分析仪”软件（IMEDOS）对古登堡健康研究中4309名参与者的眼底照片进行评估。我们在890名无疾病参与者的亚组中生成了年龄和性别特异性列线图，用于确定视网膜中央动脉等效直径（CRAE）、视网膜中央静脉等效直径和动静脉比（AVR）。

结果

女性的CRAE、视网膜中央静脉等效直径和AVR值高于男性，且随着年龄增长，女性各项测量值的下降幅度比男性小。系统性高血压与较低的AVR值[优势比（OR），95%置信区间（CI）指低于第5百分位数的区域]相关（男性：OR 2.41，95%CI 1.669 - 3.490，P<0.001；女性：OR 3.01，95%CI 2.126 - 4.268，P<0.001）以及CRAE值（男性：OR 2.60，95%CI 1.563 - 4.326，P<0.001，女性：OR 3.00，95%CI 2.004 - 4.487，P<0.001）。未控制高血压的参与者的CRAE和AVR中位数均低于筛查发现高血压的参与者（分别为172.28，范围83.05 - 251.04；以及0.81，范围0.56 - 1.04），与血压得到控制的参与者（分别为179.10，范围108.19 - 221.92，P<0.001；以及0.84，范围0.60 - 1.08，P<0.001）相比也是如此。