Centre for Public Health, Institute of Clinical Science, Queen's University Belfast, Block B, Royal Hospital, Grosvenor Road, Belfast, Northern Ireland, BT12 6BA.
VAMPIRE project, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, Scotland, UK.
BMC Nephrol. 2021 Feb 25;22(1):72. doi: 10.1186/s12882-021-02273-6.
Associations between microvascular variation and chronic kidney disease (CKD) have been reported previously. Non-invasive retinal fundus imaging enables evaluation of the microvascular network and may offer insight to systemic risk associated with CKD.
Retinal microvascular parameters (fractal dimension [FD] - a measure of the complexity of the vascular network, tortuosity, and retinal arteriolar and venular calibre) were quantified from macula-centred fundus images using the Vessel Assessment and Measurement Platform for Images of the REtina (VAMPIRE) version 3.1 (VAMPIRE group, Universities of Dundee and Edinburgh, Scotland) and assessed for associations with renal damage in a case-control study nested within the multi-centre UK Biobank cohort study. Participants were designated cases or controls based on urinary albumin to creatinine ratio (ACR) thresholds. Participants with ACR ≥ 3 mg/mmol (ACR stages A2-A3) were characterised as cases, and those with an ACR < 3 mg/mmol (ACR stage A1) were categorised as controls. Participants were matched on age, sex and ethnic background.
Lower FD (less extensive microvascular branching) was associated with a small increase in odds of albuminuria independent of blood pressure, diabetes and other potential confounding variables (odds ratio [OR] 1.18, 95% confidence interval [CI] 1.03-1.34 for arterioles and OR 1.24, CI 1.05-1.47 for venules). Measures of tortuosity or retinal arteriolar and venular calibre were not significantly associated with ACR.
This study supports previously reported associations between retinal microvascular FD and other metabolic disturbances affecting the systemic vasculature. The association between retinal microvascular FD and albuminuria, independent of diabetes and blood pressure, may represent a useful indicator of systemic vascular damage associated with albuminuria.
先前已有研究报道微血管变异与慢性肾脏病（CKD）之间存在关联。非侵入性眼底视网膜成像可评估微血管网络，并可能为与 CKD 相关的系统性风险提供深入了解。
使用视网膜血管评估和测量平台（VAMPIRE）第 3.1 版（VAMPIRE 组，苏格兰邓迪大学和爱丁堡大学）从黄斑中心的眼底图像中量化视网膜微血管参数（分形维数[FD] - 衡量血管网络的复杂性、迂曲度以及视网膜动静脉口径），并在嵌套于英国生物银行多中心队列研究中的病例对照研究中评估其与肾脏损害的相关性。参与者根据尿白蛋白与肌酐比值（ACR）阈值被指定为病例或对照。ACR≥3mg/mmol（ACR 阶段 A2-A3）的参与者被定义为病例，而 ACR<3mg/mmol（ACR 阶段 A1）的参与者被归类为对照。参与者按年龄、性别和种族背景匹配。
FD 降低（微血管分支减少）与白蛋白尿的几率略有增加独立于血压、糖尿病和其他潜在混杂变量相关（动静脉的优势比[OR] 1.18，95%置信区间[CI] 1.03-1.34；OR 1.24，CI 1.05-1.47）。迂曲度或视网膜动静脉口径与 ACR 无显著相关性。
本研究支持先前报道的视网膜微血管 FD 与影响系统性血管的其他代谢紊乱之间的关联。FD 与白蛋白尿的关联，独立于糖尿病和血压，可能是与白蛋白尿相关的系统性血管损伤的有用指标。
