北京社区人群中心动脉压与视网膜动脉硬化分级的关系

Association of central systolic blood pressure and retinal arteriosclerosis:a cross-sectional community-based study in Beijing

目的探讨北京社区人群中心动脉收缩压(cSBP)与视网膜动脉硬化分级之间的关系。方法选取北京市石景山区动脉粥样硬化研究队列中参加2019年12月至2020年1月调研,问卷资料完整,完成中心动脉压测量,并且彩色眼底照图片清晰可读的755人作为研究对象。由眼科医生对彩色眼底照图片进行视网膜动脉硬化分级(Scheie分级标准),采用多因素logistic回归分析cSBP与视网膜动脉硬化分级的关系。结果研究对象年龄为(62.3±7.3)岁,女性占61.1%(461人),合并高血压比例为54.7%(413人),cSBP值为(118.6±15.6)mm Hg。视网膜动脉硬化0~1级、2级和3~4级所占比例分别为55.2%(417人)、38.3%(289人)和6.5%(49人)。单因素logistic回归分析结果显示,cSBP与视网膜动脉硬化分级呈正相关;调整性别、年龄、体质量指数(BMI)、吸烟状况、估算的肾小球滤过率(eGFR)分组、降压药、降脂药、降糖药、糖尿病、血脂异常和心血管病史后,多因素logistic回归分析结果显示,cSBP每升高10 mm Hg,视网膜动脉硬化3~4级(较0~1级)患病风险增加40%(OR=1.40,95%CI 1.13~1.73,P<0.01);与cSBP<130 mm Hg的人群相比,cSBP≥130 mm Hg的人群视网膜动脉硬化3~4级(较0~1级)患病风险增加1.05倍(OR=2.05,95%CI 1.03~4.08,P=0.04)。交互作用分析结果显示,与患有糖尿病的人群相比,无糖尿病的人群cSBP升高与视网膜动脉硬化程度加重的关联更强(交互作用P=0.03)。结论北京社区人群中cSBP水平与视网膜动脉硬化分级呈正相关,中心动脉压升高人群中重度(3~4级)视网膜动脉硬化的患病比例更高,在无糖尿病人群中上述关联更强。

Objective To investigate the relationship between central systolic blood pressure(cSBP)and retinal arteriosclerosis grade in Beijing community population.Methods The subjects were from the Atherosclerosis Research cohort in Shijingshan District,Beijing,China.A total of 755 subjects who completed the follow-up from December 2019 to January 2020,with completed cSBP data,questionnaire data and clear color fundus photographs were included.Retinal arteriosclerosis was graded according to the Scheie’s classification.Multivariate logistic regression was used to analyze the relationship between cSBP and retinal arteriosclerosis grading.Results The age of the subjects was(62.3±7.3)years old,women accounted for 61.1%(n=461).The proportion of hypertension was 54.7%(n=413).The average cSBP was(118.6±15.6)mm Hg.The proportions of retinal arteriosclerosis grades 0-1,2 and 3-4 were 55.2%(n=417),38.3%(n=289)and 6.5%(n=49),respectively.Univariate analysis showed that cSBP was positively associated with the grade of retinal arteriosclerosis.After adjusted for factors including gender,age,body mass index(BMI),smoking status,estimated glomerular filtration rate(eGFR),antihypertensive drugs,lipid-lowering drugs,hypoglycemic agents,diabetes,dyslipidemia and cardiovascular disease history,multivariate logistic regression analysis showed that grade 3-4 retinal arteriosclerosis increased by 40%(OR=1.40,95%CI 1.13-1.73,P<0.01)compared to grade 0-1 at every 10 mm Hg increase in cSBP.Compared with cSBP<130 mm Hg group,the ratio of retinal arteriosclerosis grade 3-4 increased by 105%compared to grade 0-1 in cSBP≥130 mm Hg group(OR=2.05,95%CI 1.03-4.08,P=0.04).The results of interaction analysis demonstrated that there was a stronger association between cSBP and retinal arteriosclerosis grading in subjects without diabetes(P=0.03).Conclusions There is a significant positive association between cSBP and retinal arteriosclerosis in Beijing community population.The proportion of severe retinal arteriosclerosis is higher in subjects with elevated cSBP,and the above relationship is more significant in subjects without diabetes mellitus.