视网膜微血管异常与MRI确诊的亚临床脑梗死:动脉粥样硬化风险的社区研究

Background and Purpose-Retinal microvascular abnormalities reflect cumulative small vessel damage from elevated blood pressure and may reflect subclinical cerebral microvascular changes.We examined their associations with MRI-defined cerebral infarcts.Methods-Population-based,cross-sectional study of 1684 persons 55 to 74 years of age without a history of clinical stroke,sampled from 2 US southeastern communities.Retinal photographs were obtained and graded for presence of retinal microvascular abnormalities,including arteriovenous nicking,focal arteriolar narrowing,retinal hemorrhages,soft exudates and microaneurysms.Photographs were also digitized,and retinal vessel diameters were measured and summarized as the arteriole-to-venule ratio(AVR).Cerebral MRI scans were graded for presence of cerebral infarct,defined as a lesion ≥ 3 mm diameter in a vascular distribution with typical imaging characteristics.Results-There were a total of 183 MRI cerebral infarcts.After adjustment for age,gender,race,6-year mean arterial blood pressure,diabetes,and other stroke risk factors,cerebral infarcts were associated with retinal microvascular abnormalities,with odds ratios 1.90(95% CI,1.25 to 2.88)for arteriovenous nicking,1.89(95% CI,1.22 to 2.92)for focal arteriolar narrowing,2.95(95% CI,1.30 to 6.71)for blot hemorrhages,2.08(95% CI,0.69,6.31)for soft exudates,3.17(95% CI,1.05 to 9.64)-for microaneurysms,and 1.74(95% CI,0.95 to 3.21)for smallest compared with largest AVR.In stratified analyses,these associations were only present in persons with hypertension.Conclusions-Retinal microvascular abnormalities are associated with MRI-defined subclinical cerebral infarcts independent of stroke risk factors.These data suggest that retinal photography may be useful for studying subclinical cerebrovascular disease in population-based studies.

非糖尿病患者的视网膜病表现是否可作为糖尿病发病的预测因子

Background/aims: Isolated retinopathy signs are common in non-diabetic individuals and have been shown to be associated with impaired glucose metabolism. In a cohort of people without diabetes,the association of these retinopathy signs and subsequent development of diabetes were examined. Methods: A population based cohort study of 7992 people aged 49-73 years without diabetes was conducted. Retinal photographs of these participants were evaluated for the presence of retinopathy signs according to a standardised protocol. Incident cases of diabetes were identified prospectively. Results: After a follow up of 3 years,291 (3.6% ) people developed incident diabetes. In the total cohort,retinopathy was not significantly associated with incident diabetes (4.7% v 3.6% ,multivariable adjusted odds ratio (OR) 1.1,95% confidence intervals (CI),0.7 to 1.9). However,among participants with a positive family history of diabetes,retinopathy was associated with incident diabetes (10.4% v 4.8% ,multivariable adjusted OR 2.3,95% CI,1.0 to 5.3). Among participants without a family history of diabetes,retinopathy was not associated with incident diabetes Conclusions: In individuals with a family history of diabetes,retinopathy signs predict subsequent risk of clinical diabetes.

美国多种族人群的糖尿病性视网膜病变调查

PURPOSE: To describe the prevalence and risk factors of diabetic retinopathy in a multi-ethnic US population of whites,blacks,hispanics,and chinese. DESIGN: Cross-sectional study of 778 individuals from ages 45 to 85 years with diabetes,participating in the Multi-Ethnic Study of Atherosclerosis (MESA). METHODS: Retinal photographs were obtained with a 45° nonmydriatic digital fundus camera. Presence and severity of diabetic retinopathy were graded at a central reading center on the basis of a modification of the Airlie House classification system. All participants underwent a standardized interview,examination,and laboratory investigations. RESULTS: In this population with diabetes,the prevalence of any retinopathy was 33.2% and macular edema 9.0% . The prevalence of any diabetic retinopathy and macular edema was significantly higher in blacks (36.7% and 11.1% ) and hispanics (37.4% and 10.7% ) than in whites (24.8% and 2.7% ) and chinese (25.7% and 8.9% ) (P=.01 and P=.007,comparing racial/ethnic differences for retinopathy and macular edema,respectively). Significant independent predictors of any retinopathy were longer duration of diabetes,higher fasting serum glucose,use of diabetic oral medication or insulin,and greater waist-hip ratio. Race was not an independent predictor of any retinopathy. CONCLUSIONS: This study provides contemporary data on the prevalence of and risk factors for diabetic retinopathy among whites,blacks,hispanics,and chinese participating in the MESA.

人群研究载脂蛋白E基因与早期年龄相关性黄斑变性的相关性:动脉粥样硬化的发病风险

Objective: To examine the association between the apolipo-protein E (APOE) gene and early age-related maculopathy (ARM) in middle-aged persons. Design: Population-based cross-sectional study. Participants: Participants from the Atherosclerosis Risk in Communities Study (n=10 139; age range,49-73 years). Methods: Retinal photographywas performed on 1 randomly selected eye,and grading for presence of ARMwas carried out using a modification of the Wisconsin ARM Grading System. Early ARM was defined as the presence of either soft drusen alone,retinal pigment epithelial depigmentation alone,or a combination of soft drusen with increased retinal pigment and/or depigmentation. DNA extracted from blood samples of participants were analyzed for common allelic variants of the APOE gene ( 2, 3,and  4). Main Outcome Measures: Presence of early ARM on retinal photographs. Results: The prevalence of early ARM was similar in participants with differentAPOE genotypes:  2/ 2 (5.9% ), 2/ 3 (5.2% ), 2/ 4 (3.2% ), 3/ 3 (5.2% ), 3/ 4 (4.9% ),and  4/ 4 (4.1% ). After controlling for age,gender,race,cigarette smoking,and other factors,early ARM was not associated with APOE genotypes,with an odds ratio (OR) of 1.35 (95% confidence interval CI,0.54-3.38) for  2/ 2 genotype,an OR of 1.06 (95% CI,0.80-1.40) for  2/ 3 genotype,an OR of 0.63 (95% CI,0.32-1.24) for  2/ 4 genotype,an OR of 0.99 (95% CI,0.80-1.24) for  3/ 4 genotype,and an OR of 0.88 (95% CI,0.47-1.63) for  4/ 4 genotype,as compared with 3/3 genotype (reference). No associations were found for specific early ARM signs or in analyses stratified by age,gender,race,or cigarette smoking status. Conclusions: These data provide no evidence of a strong association between the APOE gene and early ARM in middle-aged persons. This suggests that APOE is not likely a major determinant of the early stages of ARM in younger people. However,our study does not exclude the possibility of a weaker association or that APOE may influence only the development of late ARM in older populations,as reported in other studies.

隐性远视与高血压之间不存在关联:蓝山眼科研究

PURPOSE:An association between hypermetropia and hypertension was recently reported.We sought to verify this finding in the Blue Mountains Eye Study cohort(n=3654;ages 49 to 97 years).DESIGN:Cohort study.METHODS:We defined hypermetropia as mean spheric equivalent refraction(SER)>1.00 diopter,myopia as mean SER <-1.00 diopters,and emmetropia as mean SER ≤ 1.00 diopters and <-1.00 diopters,inclusive.We used the 2003 World Health Organization/International Society of Hypertension guidelines to define severe hypertension as grade 2 or higher.RESULTS:Of 1290 people who were at risk of the development of hypertension,378 people developed incident severe hypertension after five years.The multivariate-adjusted relative risk of incident hypertension in persons with hypermetropia compared with those with emmetropia was 1.06(95% CI,0.89 to 1.26);the relative risk in persons with myopia was 1.22(95% CI,0.96 to 1.56).CONCLUSION:Neither hypermetropia nor myopia was associated with incident hypertension in this older population.