北京社区人群臂踝脉搏波传导速度和颈股脉搏波传导速度与视网膜动脉硬化的关系

Association of brachial-ankle pulse-wave velocity and carotid-femoral pulse-wave velocity with retinal arteriosclerosis in a community-based population in Beijing

目的探讨北京社区人群臂踝脉搏波传导速度(baPWV)和颈股脉搏波传导速度(cfPWV)与视网膜动脉硬化分级的关系。设计横断面研究。研究对象北京市石景山社区人群动脉粥样硬化研究队列中完成2019年12月至2020年1月随访,具有完整调查问卷、baPWV和cfPWV测量资料、免散瞳彩色眼底像清晰可读的751例。方法由眼科医生对眼底彩照中视网膜动脉硬化依据Scheie分级法进行分级,采用Logistic回归分别分析baPWV和cfPWV对视网膜动脉硬化分级的影响。主要指标baPWV、cfPWV、视网膜动脉硬化分级。结果751例受试者平均年龄(62.3±7.3)岁,女性458例(61.0%),合并高血压、血脂异常、糖尿病和心脑血管疾病的比例分别为54.9%(n=412)、78.3%(n=588)、32.8%(n=246)、11.6%(n=87)。baPWV和cfPWV检测值分别为(17.1±4.0)m/s和(9.1±2.2)m/so Logistic回归分析,调整性别、年龄、体质指数(BMI)、现吸烟状况、空腹血糖、血压、甘油三酯(TG)、总胆固醇(TC)、肾小球滤过率(eGFR)、服用降脂药、降糖药、降压药、高血压、糖尿病、血脂异常及心脑血管病史等因素后,baPWV与视网膜动脉硬化程度显著正相关:baPWV每升高1 m/s,视网膜动脉硬化程度加重的患病比例增加6%(0R=1.06,95%CI:1.00-1.12,P=0.037);相较于baPWV<14 m/s的人群,baPWV≥14 m/s的人群视网膜动脉硬化程度加重的患病比例升高74%(0R=1.74,95%CI:1.12~2.70,P=0.013);baPWV介于14-18 m/s之间的人群较baPWV<14 m/s的人群,视网膜动脉硬化程度加重的患病比例升高66%(OR=1.66,95%CI:1.07~2.59,P=0.025),而baPWV≥18 m/s的人群视网膜动脉硬化程度加重的患病比例升高125%(0R=2.25,95%CI:1.29~3.91,P=0.004)。cfPWV与视网膜动脉硬化分级无显著相关性。结论baPWV与视网膜动脉硬化分级显著正相关,baPWV越高,其视网膜动脉硬化程度越重。相较于cfPWV,baPWV更能够反映视网膜小动脉硬化的程度。

Objective To investigate the association of brachial-ankle pulse-wave velocity(baPWV) and carotid-femoral pulse-wave velocity(cfPWV) with retinal arteriosclerosis in a community-based population in Beijing.Design Cross-sectional study.Participants A total of 751 subjects with complete questionnaire,baPWV,cfPWV and fundus photograph data were included from an atherosclerosis cohort of Peking University First Hospital in Shijingshan District,Beijing,followed up from December 2019 to January2020.Methods Retinal arteriosclerosis was graded according to Scheie’s classification by an experienced ophthalmologist.Logistic-regression model were used to investigate the association of PWV indices and retinal arteriosclerosis grading.Main Outcome Measures baPWV,cfPWV,retinal arteriosclerosis grading.Results Subjects were 62.3±7.3 years old,61.0%(n=458) were female,54.9%(n=412)had hypertension,78.3%(n=588) had dyslipidemia,32.8%(n=246) had diabetes,and 11.6%(n=87) had cardiovascular disease.baPWV and cfPWV was 17.1±4.0 m/s and 9.1±2.2 m/s respectively.In Logistic-regression model analysis,there was a positive correlation between baPWV and retinal arteriosclerosis grading after adjustment for sex,age,BMI,smoking status,fasting plasma glucose,systolic blood pressure(SBP),total cholesterol,triglycerides,eGFR group,hypoglycemic agents,lipid-lowering drugs,antihypertensive drugs,dyslipidemia and history of cardiovascular disease.Retinal arteriosclerosis increased 6% for every 1 m/s increase of baPWV(OR=1.06,95%CI:1.00-1.12,P=0.037).Compared with baPWV<14 m/s group,the risk of retinal arteriosclerosis aggravation increased 74% in subjects with baPWV≥14 m/s(OR=1.74,95%CI:1.12-2.70,P=0.013).Compared with baPWV<14 m/s group,the risk of retinal arteriosclerosis aggravation increased 66% in subjects with baPWV between 14 m/s and 18 m/s(OR=1.66,95%CI:1.07-2.59,P=0.025).Compared with baPWV<14 m/s group,the risk of retinal arteriosclerosis aggravation increased 125% in subjects with baPWV ≥18 m/s(OR=2.25,95%CI:1.29-3.91,P=0.004).However,no significant relationship was observed between cfPWV and retinal arteriosclerosis grading.Conclusions baPWV was significantly associated with Scheie’ s retinal arteriosclerosis grading.The higher the baPWV,the more severe the retinal arteriosclerosis.Compared with cfPWV,baPWV can better reflect the degree of retinal arteriosclerosis.(Ophthalmol CHN,2021,30:337-342)