视网膜内皮功能、体能与心血管风险：一项诊断挑战。
Retinal Endothelial Function, Physical Fitness and Cardiovascular Risk: A Diagnostic Challenge.
作者信息
Streese Lukas, Kotliar Konstantin, Deiseroth Arne, Infanger Denis, Vilser Walthard, Hanssen Henner
机构信息
Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel, Switzerland.
Department of Medical Engineering and Applied Mathematics, FH Aachen - University of Applied Sciences, Aachen, Germany.
出版信息
Front Physiol. 2019 Jul 5;10:831. doi: 10.3389/fphys.2019.00831. eCollection 2019.
INTRODUCTION
Dynamic retinal vessel analysis (DVA) is a new non-invasive method to quantify microvascular endothelial dysfunction by flicker light-induced dilatation (FID). FID has been shown to be impaired in type 2 diabetes as well as heart failure. The aim of the study was to analyze FID in healthy active versus healthy sedentary and cardiovascular (CV) risk patients in addition to corresponding static vessel diameters.
METHODS
Thirty-one healthy active (HA, mean age 60 ± 8 years), 33 healthy sedentary individuals (HS, 59 ± 7 years) and 76 sedentary patients with increased CV risk (SR, 58 ± 6 years) were included in this cross-sectional study. Group differences in CV risk factors and cardiorespiratory fitness, maximal arteriolar (ADmax) and venular (VDmax) dilatation as well as the arteriolar (AFarea) and venular (VFarea) area under the flicker curve were analyzed. The central retinal arteriolar and venular diameters were used to calculate the arteriolar-to-venular diameter ratio (AVR).
RESULTS
HS [ADmax = 3.5 (2.1)%; AFarea = 48.2 (31.9)%s] showed higher FID compared to SR [ADmax = 2.7 (1.8)%, = 0.021; AFarea = 34.5 (26.5)%s, = 0.006] and HA [AFarea = 32.8 (23.1)%s, = 0.029]. HA and SR did not significantly differ. HA had a higher AVR (0.87 ± 0.05) compared to HS (0.83 ± 0.04, < 0.001) with further deterioration in SR (0.79 ± 0.05, < 0.001). Interestingly, 28 participants had impaired FID but normal AVR and 43 participants had normal FID but impaired AVR.
DISCUSSION
FID can differentiate between sedentary low and high risk individuals. However, FID in healthy active persons (HA) seemed impaired with a concomitant higher AVR. We postulate that lower FID in HA may be explained by predilatated arterioles and a reduced dilatation reserve. We recommend combination of FID with analysis of retinal vessel diameters to differentiate functional non-responders from manifest microvascular endothelial dysfunction and, thereby, improve microvascular risk stratification in a personalized medicine approach.
CLINICAL TRIAL REGISTRATION
ClinicalTrials.gov: NCT02796976 (https://clinicaltrials.gov/ ct2/show/NCT02796976).
引言
动态视网膜血管分析（DVA）是一种通过闪烁光诱导扩张（FID）来量化微血管内皮功能障碍的新型非侵入性方法。FID已被证明在2型糖尿病以及心力衰竭中受损。本研究的目的是分析健康活跃人群与健康久坐人群以及心血管（CV）风险患者的FID，并比较相应的静态血管直径。
方法
本横断面研究纳入了31名健康活跃者（HA，平均年龄60±8岁）、33名健康久坐者（HS，59±7岁）和76名久坐的CV风险增加患者（SR，58±6岁）。分析了CV危险因素和心肺适能的组间差异、最大小动脉（ADmax）和小静脉（VDmax）扩张以及闪烁曲线下的小动脉（AFarea）和小静脉（VFarea）面积。使用视网膜中央小动脉和小静脉直径计算小动脉与小静脉直径比（AVR）。
结果
与SR [ADmax = 2.7（1.8）%，P = 0.021；AFarea = 34.5（26.5）%s，P = 0.006]和HA [AFarea = 32.8（23.1）%s，P = 0.029]相比，HS [ADmax = 3.5（2.1）%；AFarea = 48.2（31.9）%s]显示出更高的FID。HA和SR之间无显著差异。与HS（0.83±0.04，P < 0.001）相比，HA的AVR更高（0.87±0.05），SR进一步恶化（0.79±0.05，P < 0.001）。有趣的是，28名参与者FID受损但AVR正常，43名参与者FID正常但AVR受损。
讨论
FID可以区分久坐的低风险和高风险个体。然而，健康活跃人群（HA）的FID似乎受损，同时AVR更高。我们推测HA中较低的FID可能是由于小动脉预扩张和扩张储备减少所致。我们建议将FID与视网膜血管直径分析相结合，以区分功能性无反应者与明显的微血管内皮功能障碍，从而在个性化医疗方法中改善微血管风险分层。
临床试验注册
ClinicalTrials.gov：NCT02796976（https://clinicaltrials.gov/ct2/show/NCT02796976）。
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