未接受降压治疗人群血浆晚期糖基化终末产物与视网膜小血管直径的相关性

Correlation between plasma advanced glycation end products and retinal microvessel diameter in patients without antihypertensive therapy

目的在疑似高血压并至高血压门诊就诊的未接受降压治疗者中,研究血浆晚期糖基化终末产物(AGEs)浓度与眼底视网膜中央小血管直径的关系。方法选择2011-2012年至瑞金医院高血压门诊就诊且未接受降压治疗者,作为研究对象。采用免散瞳法进行眼底视网膜照相(德国蔡司VISUCAM PRO NM),并使用相机自带眼底血管分析软件进行眼底图像分析,测算视网膜中央小动脉直径等效值(CRAE)、视网膜中央小静脉直径等效值(CRVE)和动静脉直径比值(AVR)。使用酶联免疫吸附法,检测血浆AGEs浓度。采用逐步回归分析血浆AGEs浓度的影响因素。结果共纳入398例患者,平均年龄为50.3岁,其中女性占47.2%,糖尿病患者占7.5%,糖尿病前期者占6.1%,高血压患者占29.9%。随着血浆AGEs浓度增加,体质量指数(BMI,P<0.001)、空腹血糖(P=0.001)、血清三酰甘油(P<0.001)、血清总胆固醇与高密度脂蛋白胆固醇(HDL-C)的比值(总胆固醇/HDL-C,P<0.001)及CRVE(P=0.012)增加。相关分析显示,血浆AGEs浓度与CRVE呈正相关(r=0.14,P=0.006)。调整混杂因素后,多元线性回归分析结果显示,血浆AGEs浓度每增加1个单位,CRVE增加5.49μm(P=0.041),而CRAE(P=0.110)及AVR(P=0.690)的变化则无统计学意义。分层分析结果显示,血浆AGEs浓度与CRVE的关系仅见于糖尿病及糖尿病前期者(血浆AGEs浓度每增加1个单位,CRVE增加23.30μm,P=0.038),而非正常血糖者(P=0.130)。结论血浆AGEs浓度与CRVE呈正相关,尤其糖尿病及糖尿病前期患者。

Objective To investigate the relationship between the concentration of plasma advanced glycation end products(AGEs)and the diameter of retinal microvessel caliber in patients with suspected hypertension who were from hypertension outpatient clinic and had not received antihypertensive treatment. Methods Between 2011 and 2012,the untreated hypertensives were recruited from Hypertension Clinic,Ruijin Hospital. The fundus retinography(VIMUCAM PRO NM,ZEISS,Germany)was performed by non-mydriasis method,and the fundus images were analyzed with the built-in vascular analysis software. Central retinal arteriolar equivalent(CRAE),central retinal venular equivalent(CRVE)and arteriole-to-venule diameter ratio(AVR)were calculated. Plasma AGEs concentration was measured by enzyme-linked immunosorbent assay method. And the influencing factors of plasma AGEs was assessed by stepwise regression analysis. Results A total of 398 patients were enrolled,with an average age of 50.3years. Among them,47.2% were female,7.5% were diabetic,6.1% were pre-diabetes and29.9% were hypertensives. Body mass index(BMI,P<0.001),fasting blood glucose(P=0.001),serum triacylglycerol(P<0.001),the ratio of serum total cholesterol to high density lipoprotein cholesterol(TC/HDL-C,P<0.001)and CRVE(P=0.012)increased with plasma AGEs concentration. Correlation analysis showed that plasma AGEs concentration was positively correlated with CRVE(r=0.140,P=0.006). After adjusting for the confounders,the results of multiple linear regression analysis indicated that plasma AGEs concentration was significantly associated with CRVE(CRVE increased by 5.49μm for every 1unit increase of plasma AGEs,P=0.041),but not with CRAE(P=0.110)or AVR(P=0.690). The stratified analysis showed that the relationship between plasma AGEs concentration and CRVE was only found in diabetic and pre-diabetic patients(CRVE increased by 23.30μm for every 1unit increase of AGEs,P=0.038),but not in normal blood glucose patients(P=0.130).Conclusion Plasma AGEs concentration is positively correlated with CRVE,especially in diabetic and pre-diabetic patients.