Boersema Jeltje, de Vos Lisanne C, Links Thera P, Mulder Douwe J, Smit Andries J, Zeebregts Clark J, Lefrandt Joop D
Division of Vascular Medicine, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Division of Vascular Medicine, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
J Vasc Surg. 2017 Dec;66(6):1696-1703.e1. doi: 10.1016/j.jvs.2017.04.037. Epub 2017 Jun 24.
Advanced glycation end products (AGEs) are implicated in the pathogenesis of cardiovascular disease. Accumulation of AGEs is driven by oxidative or glycemic stress and can be assessed by skin autofluorescence (SAF). SAF is increased in patients with peripheral artery disease (PAD) and independently associated with mortality and major adverse cardiovascular events in these patients. PAD and abdominal aortic aneurysm (AAA) share several risk factors. Inflammation is an important process in AAA formation and increases levels of oxidative stress. We therefore hypothesized that SAF would be increased in AAA patients compared with controls.
A case-control study was performed in 248 AAA patients and 124 controls without AAA or PAD matched for age and presence of diabetes mellitus. SAF was noninvasively assessed with the AGE Reader (Diagnoptics Technologies BV, Groningen, The Netherlands).
SAF was higher in AAA patients than in controls: 2.89 ± 0.63 vs 2.68 ± 0.63 arbitrary units (P = .003). PAD comorbidity was associated with increased SAF within the AAA patient group (P = .01). After correction for known factors influencing SAF (age, current smoking, hypertension, and estimated glomerular filtration rate), PAD comorbidity remained an independent determinant of SAF. Logistic regression analysis of the total cohort showed an unadjusted odds ratio (OR) of 1.74 (95% confidence interval [CI], 1.20-2.51) for the presence of AAA with each unit increase of SAF and an adjusted OR of 1.78 (95% CI, 1.22-2.60) after correction for cardiovascular comorbidity (cerebrovascular disease and coronary artery disease). After additional correction for sex, current smoking, hypertension, and use of lipid-lowering drugs, this significance was lost (adjusted OR, 1.53; 95% CI, 0.94-2.48).
Skin accumulation of AGEs, measured by SAF, is increased in patients with AAA compared with controls without AAA or PAD, independent of the presence of coronary artery disease and cerebrovascular disease. In AAA patients, SAF is closely associated with the presence of PAD and cardiovascular risk factors.
晚期糖基化终末产物（AGEs）与心血管疾病的发病机制有关。AGEs的积累由氧化应激或血糖应激驱动，可通过皮肤自发荧光（SAF）进行评估。外周动脉疾病（PAD）患者的SAF升高，且与这些患者的死亡率和主要不良心血管事件独立相关。PAD和腹主动脉瘤（AAA）有若干共同的危险因素。炎症是AAA形成过程中的一个重要环节，并会增加氧化应激水平。因此，我们推测与对照组相比，AAA患者的SAF会升高。
对248例AAA患者和124例无AAA或PAD的对照组进行了一项病例对照研究，对照组在年龄和糖尿病患病情况方面与病例组相匹配。使用AGE Reader（荷兰格罗宁根Diagnoptics Technologies BV公司）对SAF进行无创评估。
AAA患者的SAF高于对照组：分别为2.89±0.63和2.68±0.63任意单位（P = 0.003）。在AAA患者组中，PAD合并症与SAF升高相关（P = 0.01）。在校正影响SAF的已知因素（年龄、当前吸烟状况、高血压和估算肾小球滤过率）后，PAD合并症仍是SAF的独立决定因素。对整个队列进行逻辑回归分析显示，SAF每增加一个单位，AAA存在的未调整优势比（OR）为1.74（95%置信区间[CI]，1.20 - 2.51），在校正心血管合并症（脑血管疾病和冠状动脉疾病）后，调整后的OR为1.78（95%CI，1.22 - 2.60）。在进一步校正性别、当前吸烟状况、高血压和降脂药物使用情况后，这一显著性消失（调整后的OR为1.53；95%CI，0.94 - 2.48）。
与无AAA或PAD的对照组相比，通过SAF测量的AAA患者皮肤中AGEs的积累增加，且独立于冠状动脉疾病和脑血管疾病的存在。在AAA患者中，SAF与PAD的存在及心血管危险因素密切相关。
