糖尿病患者视网膜血管特征预测心血管代谢疾病发病风险。
Retinal vascular profile in predicting incident cardiometabolic diseases among individuals with diabetes.
机构信息
Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.
出版信息
Microcirculation. 2022 Jul;29(4-5):e12772. doi: 10.1111/micc.12772. Epub 2022 Jun 26.
OBJECTIVE
To determine the longitudinal associations between retinal vascular profile (RVP) and four major cardiometabolic diseases; and to quantify the predictive improvements when adding RVP beyond traditional risk factors in individuals with diabetes.
METHODS
Subjects were enrolled from the Singapore Epidemiology of Eye Disease (SEED) study, a multi-ethnic population-based cohort. Four incident cardiometabolic diseases, calculated over a ~ 6-year period, were considered: cardiovascular disease (CVD), hypertension (HTN), diabetic kidney disease (DKD), and hyperlipidemia (HLD). The RVP-vessel tortuosity, branching angle, branching coefficient, fractal dimension, vessel caliber, and DR status-was characterized at baseline using a computer-assisted program. Traditional risk factors at baseline included age, gender, ethnicity, smoking, blood pressure (BP), HbA1c, estimated glomerular filtration rate (eGFR), or cholesterol. The improvements in predictive performance when adding RVP (compared with only traditional risk factors) was calculated using several metrics including area under the receiver operating characteristics curve (AUC) and net reclassification improvement (NRI).
RESULTS
Among 1770 individuals with diabetes, incidences were 6.3% (n = 79/1259) for CVD, 48.7% (n = 166/341) for HTN, 14.6% (n = 175/1199) for DKD, and 59.4% (n = 336/566) for HLD. DR preceded the onset of CVD (RR 1.85[1.14;3.00]) and DKD (1.44 [1.06;1.96]). Narrower arteriolar caliber preceding the onset of HTN (0.84 [0.72;0.99]), and changes in arteriolar branching angle preceded the onset of CVD (0.78 [0.62;0.98]) and HTN (1.15 [1.03;1.29]). The largest predictive improvement was found for HTN with AUC increment of 3.4% (p = .027) and better reclassification of 11.4% of the cases and 4.6% of the controls (p = .008).
CONCLUSION
We found that RVPs improved the prediction of HTN in individuals with diabetes, but add limited information for CVD, DKD, and HLD predictions.
目的
确定视网膜血管形态（RVP）与四种主要的心血管代谢疾病之间的纵向关联，并量化在糖尿病患者中，除传统危险因素外，增加 RVP 对预测的改善程度。
方法
研究对象来自新加坡眼病流行病学研究（SEED），这是一个多民族的基于人群的队列。在大约 6 年的时间内，考虑了四个新发生的心血管代谢疾病：心血管疾病（CVD）、高血压（HTN）、糖尿病肾病（DKD）和高脂血症（HLD）。使用计算机辅助程序在基线时对 RVP-血管扭曲度、分支角度、分支系数、分形维数、血管口径和 DR 状态进行特征描述。基线时的传统危险因素包括年龄、性别、种族、吸烟、血压（BP）、HbA1c、估算肾小球滤过率（eGFR）或胆固醇。使用几个指标，包括接收者操作特征曲线下面积（AUC）和净重新分类改善（NRI），计算增加 RVP（与仅传统危险因素相比）对预测性能的改善。
结果
在 1770 名糖尿病患者中，CVD 的发生率为 6.3%（n=79/1259），HTN 为 48.7%（n=166/341），DKD 为 14.6%（n=175/1199），HLD 为 59.4%（n=336/566）。DR 先于 CVD（RR 1.85[1.14;3.00]）和 DKD（1.44 [1.06;1.96]）的发生。HTN 发病前，动脉口径变窄（0.84 [0.72;0.99]），CVD 和 HTN 发病前，动脉分支角度发生变化（0.78 [0.62;0.98]）和 HTN（1.15 [1.03;1.29]）。HTN 的预测改善最大，AUC 增加 3.4%（p=0.027），病例更好的重新分类为 11.4%，对照组为 4.6%（p=0.008）。
结论
我们发现，RVP 提高了对糖尿病患者中 HTN 的预测，但对 CVD、DKD 和 HLD 的预测增加了有限的信息。
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