Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia.
Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.
Microcirculation. 2019 Oct;26(7):e12557. doi: 10.1111/micc.12557. Epub 2019 Jul 10.
Intermediate phenotypes of microcirculation (retinal microvascular caliber) are associated with cardiovascular (CV) risk factors and independently predict CV events. However, the effect of microcirculation variation on the vascular system is unclear. We conducted a systematic review and meta-analysis of observational studies to quantify associations of retinal microvascular caliber (arteriolar, venular caliber, arteriole-to-venule ratio) and preclinical CV measures (large arterial function and structure).
We identified studies in MEDLINE, EMBASE, and PubMed (1946 to March 2018) studying (a) general population samples and (b) patients with cardiometabolic disease. Study-specific correlation estimates were combined into meta-analysis where possible.
Of 1294 studies identified, 26 met inclusion criteria (general population 16, patients 10), of which five studies were included in meta-analysis. Most studied middle-aged adults cross-sectionally, with one childhood study. Large arterial function and structure were predominantly assessed by pulse wave velocity and carotid intima-media thickness, respectively. Only arteriolar caliber was consistently associated with arterial function and structure, with stronger associations observed in cardiometabolic patients. Narrower (worse) arteriolar caliber was associated with faster (poorer) pulse wave velocity (correlation coefficient (r) -0.17, 95% CI -0.25 to -0.10) and greater (poorer) intima-media thickness (r -0.05, 95%CI -0.09 to -0.02) across all adult participants.
Retinal arteriolar, but not venular caliber, was modestly associated with large arterial function and weakly associated with large arterial structure, with stronger evidence in patients with cardiometabolic disease. This suggests that preclinical changes in large arteries and the microcirculation have some shared but mainly unique pathways to associate with cardiovascular disease.
微循环（视网膜微血管口径）的中间表型与心血管（CV）危险因素相关，并独立预测 CV 事件。然而，微循环变化对血管系统的影响尚不清楚。我们进行了一项系统综述和荟萃分析，以量化视网膜微血管口径（小动脉、小静脉口径，小动脉-小静脉比值）和临床前 CV 指标（大动脉功能和结构）之间的关联。
我们在 MEDLINE、EMBASE 和 PubMed（1946 年至 2018 年 3 月）中检索了研究（a）一般人群样本和（b）代谢性心血管疾病患者的研究。在可能的情况下，将研究特异性相关估计值合并到荟萃分析中。
在 1294 项研究中，有 26 项符合纳入标准（一般人群 16 项，患者 10 项），其中 5 项研究纳入荟萃分析。大多数研究为横断面研究，涉及中年成年人，有一项为儿童研究。大动脉功能和结构主要通过脉搏波速度和颈动脉内膜中层厚度来评估。只有小动脉口径与动脉功能和结构始终相关，在代谢性心血管疾病患者中观察到更强的相关性。较窄（较差）的小动脉口径与更快（较差）的脉搏波速度（相关系数（r）-0.17，95%CI-0.25 至-0.10）和更大（较差）的内膜中层厚度（r-0.05，95%CI-0.09 至-0.02）相关所有成年参与者。
视网膜小动脉，而不是小静脉口径，与大动脉功能有适度的关联，与大动脉结构有微弱的关联，在代谢性心血管疾病患者中证据更强。这表明大动脉和微循环的临床前变化与心血管疾病有一些共同但主要是独特的关联途径。
