视网膜血管定量指标与血压及心脑血管危险因素的相关性研究

Correlation study of retinal vascular quantitative index with blood pressure and cardiovascular and cerebrovascular disease risk factors

目的通过半自动化分析软件SIVA 4.0来测量体检人群视网膜血管定量指标,并且进一步探讨其与血压的相关性。方法纳入2019年8月到华东疗养院体检的上海市企事业单位员工共3067人,筛选出符合本试验研究的人群(1435人),所有研究对象均进行了血清实验室检测及眼底照片采集,应用半自动化图像处理软件SIVA4.0定量检测研究对象的视网膜血管定量指标,并比较分析其与血压的相关性。结果高血压与非高血压相比,视网膜中央动脉直径(CRAE)、视网膜动静脉比(AVR)、视网膜血分形维数(Df)、视网膜动脉分形维数(DFa)、视网膜静脉分形维数(DFv)差异均有统计学意义,进行性别、年龄等因素调整后结果显示除了CRVE和DFv,其余指标均与高血压相关。将视网膜定量指标与血压值进行分析,结果显示CRAE、CRVE与平均动脉压有关,AVR与舒张压、脉压差、平均动脉压有关,DFa与收缩压、舒张压、平均动脉压有关,DFv与收缩压和平均动脉压有关,Df与收缩压、舒张压、平均动脉压有关。多重线性回归显示CRAE、AVR、Df、Dfa与平均动脉压均为负相关,其中回归性最强的为Dfa。分析Df与心血管危险因素之间的关系,简单线性回归显示年龄、腰臀比、体质量指数(BMI)、平均动脉压、吸烟史、高血压均与Df有线性相关性。校正了年龄及性别,逐步回归分析显示腰臀比、平均动脉压、吸烟史、糖尿病、高血压均与Df呈负相关。结论CRAE、AVR、Df与平均动脉压呈负相关,而Dfa的相关性最强,Df与心脑血管危险因素相关,视网膜血管的定量分析可以提供有关微血管结构和最佳状态的额外信息,有望成为预测心脑血管危险因素的无创预测因子。

Objective The semi-automated analysis software SIVA(Singapore I Vessel Assessment)was used to measure the quantitative indicators related to retinal vessels in patients with hypertension,and to further explore their correlation with blood pressure.Methods This cross-sectional study involved a total of 1435 participants from 3067 subjects who participated in physical examination to East China sanatorium in August 2019.All participants underwent evaluation of serum laboratory testing,fundus photographs.We applied semi-automatic image processing software SIVA4.0 to detect retinal blood vessel indicators,and analyzed its correlation with blood pressure.Results Compared with non-hypertension,CRAE,AVR,DF,DFa and DFv were statistically different.After adjusting for gender,age and other factors,the results showed that except CRVE and DFv,all the other indicators were related to hypertension.Quantitative indicators to the retina and the blood pressure value is analyzed,the results showed that CRAE,CRVE is associated with mean arterial pressure,AVR and diastolic blood pressure,pulse pressure and mean arterial pressure;DFa is associated with systolic blood pressure,diastolic pressure and mean arterial pressure;DFv is associated with systolic blood pressure and mean arterial pressure,Df and systolic pressure,diastolic pressure and mean arterial pressure.Multiple linear regression showed there was negative correlation between CRAE,AVR,Df and Dfa and mean arterial pressure,among which Dfa had the strongest regression.To analyze the relationship between Df and cardiovascular risk factors,simple linear regression showed that age,waist-to-hip ratio,BMI,mean arterial pressure,smoking history and hypertension were all linearly correlated with Df.Age and sex were corrected,and stepwise regression analysis showed that Df was negatively correlated with waist-to-hip ratio,mean arterial pressure,smoking history,diabetes,and hypertension.Conclusion CRAE,AVR and Df were significantly negatively correlated with mean arterial pressure,while Dfa had the strongest correlation.Df was correlated with cardiovascular and cerebrovascular risk factors,and was expected to be a non-invasive predictor of cardiovascular and cerebrovascular disease risk factors.