视网膜变化与心脏生物标志物评估与慢性肾脏病的关系：一项单中心研究。

Retinal changes and cardiac biomarker assessment in relation to chronic kidney disease: a single centre study.

机构信息

Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.

Department of Ophthalmology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.

出版信息

BMC Nephrol. 2023 Nov 13;24(1):338. doi: 10.1186/s12882-023-03386-w.

DOI:10.1186/s12882-023-03386-w

PMID:37957551

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10644488/

Abstract

BACKGROUND

The prevalence of chronic kidney disease (CKD) is rising in Malaysia. Early detection is necessary to prevent disease progression, especially in terms of cardiovascular (CV) risk, the main cause of death in end-stage renal disease (ESRD). Retinal changes have proven to be a good predictor of CKD whereas cardiac biomarkers are useful in cardiovascular risk stratification. We aimed to demonstrate the correlation between retinal changes and cardiac biomarkers with CKD.

METHODS

This single-centre cross-sectional study was conducted among patients with CKD stages 3, 4, and 5 (not on dialysis) from the Nephrology Clinic, Universiti Kebangsaan Malaysia Medical Centre. A total of 84 patients were recruited with an even distribution across all three stages. They underwent fundus photography where images were analysed for vessel calibre (central retinal venular equivalent (CRVE), central retinal arterial equivalent (CRAE), and tortuosity indices. Optical coherence tomography was used to measure macular volume. Blood samples were sent for laboratory measurement of high-sensitivity C-reactive protein (hs-CRP) and asymmetric dimethylarginine (ADMA). These parameters were analysed in relation to CKD.

RESULTS

The mean age was 58.8 ± 11.7 years, with 52.4% male and 47.6% female patients. Among them, 64.3% were diabetics. Retinal vessel tortuosity (r = -0.220, p-value = 0.044) had a negative correlation with the estimated glomerular filtration rate (eGFR). CRVE showed a positive correlation with proteinuria (r = 0.342, p = 0.001) but negative correlation with eGFR (r = -0.236, p = 0.031). Hs-CRP positively correlated with proteinuria (r = 0.313, p = 0.04) and negatively correlated with eGFR (r = -0.370, p = 0.001). Diabetic patients had a higher CRVE compared to non-diabetic patients (p = 0.02). History of ischaemic heart disease was associated with a smaller macula volume (p = 0.038). Male gender (r = 0.066, p = 0.031) and HbA1c had a positive influence (r = 0.066, p = 0.047) on retinal vessel tortuosity. There was a positive influence of age (r = 0.183, p = 0.012) and hs-CRP (r = 0.183, p = 0.045) on CRVE. As for macula volume, it negatively correlated with diabetes (r = 0.015, p = 0.040) and positively correlated with smoking (r = 0.015, p = 0.012).

CONCLUSION

Our study showed that eGFR value affects retinal vessel tortuosity, CRVE and hs-CRP. These parameters bear potential to be used as non-invasive tools in assessing CKD. However, only macula volume may be associated with CVD risk among the CKD population.

摘要

背景

马来西亚慢性肾脏病（CKD）的患病率正在上升。早期发现对于预防疾病进展，特别是心血管（CV）风险至关重要，CV 风险是终末期肾病（ESRD）的主要死亡原因。视网膜变化已被证明是 CKD 的良好预测指标，而心脏生物标志物则可用于心血管风险分层。我们旨在证明视网膜变化和心脏生物标志物与 CKD 之间的相关性。

方法

这项单中心横断面研究在马来西亚国民大学医学中心肾脏病诊所的 CKD 3、4 和 5 期（未透析）患者中进行。共有 84 名患者入组，在所有三个阶段均均匀分布。对他们进行眼底摄影，分析血管口径（中央视网膜静脉等效物（CRVE）、中央视网膜动脉等效物（CRAE）和扭曲指数）。使用光学相干断层扫描测量黄斑体积。采集血样用于实验室测量高敏 C 反应蛋白（hs-CRP）和不对称二甲基精氨酸（ADMA）。分析这些参数与 CKD 的关系。

结果

平均年龄为 58.8±11.7 岁，男性占 52.4%，女性占 47.6%。其中，64.3%为糖尿病患者。视网膜血管扭曲（r=-0.220，p 值=0.044）与估计肾小球滤过率（eGFR）呈负相关。CRVE 与蛋白尿呈正相关（r=0.342，p=0.001），与 eGFR 呈负相关（r=-0.236，p=0.031）。hs-CRP 与蛋白尿呈正相关（r=0.313，p=0.04），与 eGFR 呈负相关（r=-0.370，p=0.001）。与非糖尿病患者相比，糖尿病患者的 CRVE 更高（p=0.02）。缺血性心脏病史与黄斑体积较小有关（p=0.038）。性别（r=0.066，p=0.031）和 HbA1c 对视网膜血管扭曲有积极影响（r=0.066，p=0.047）。年龄（r=0.183，p=0.012）和 hs-CRP（r=0.183，p=0.045）对 CRVE 有积极影响。黄斑体积与糖尿病呈负相关（r=-0.015，p=0.040），与吸烟呈正相关（r=-0.015，p=0.012）。