Methods for evaluation of retinal microvascular abnormalities associated with hypertension/sclerosis in the atherosclerosis risk in communities study
Methods for evaluation of retinal microvascular abnormalities associated with hypertension/sclerosis in the atherosclerosis risk in communities study
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DOI：
10.1016/s0161-6420(99)90525-0
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发表时间：
1999-12-01
期刊：
影响因子：
13.7
通讯作者：
Cai, JW
中科院分区：
文献类型：
--
作者：
Hubbard, LD;Brothers, RJ;Cai, JW
目的：制定用于拍摄和评估社区动脉粥样硬化风险中视网膜血管异常（ARIC）研究的方案；测试分级系统的可重复性；并探索这些微血管变化与血压的关系。设计：基于人群的，横断面研究。参与者：在4个检查中心，1114名参与者（48-73岁）在他们的第三次三年期检查之后，排除了人之后使用此分析的糖尿病。阅读中心的学生通过检查灯箱上的载玻片和测量的光盘上的所有容器的直径，以增强数字化图像，评估了局灶性小动脉狭窄，动静脉（AV）刻痕和视网膜病变。为了衡量广义狭窄，将血管直径合并到中央小动脉和静脉当量，并对分支进行调整公式，并计算出等效物（AAI比）的比率（AAI比率）。梅恩结果测量值视网膜血管异常，均值动脉血压（MABP）。回收。在11114名参与者中，获得99％的照片，质量足以进行视网膜评估为81％。在具有可用照片的9040名受试者中，A/V比（较低的值表示通用的小动脉变窄）范围从0.57到1.22（中位数= 0.84，四分位间范围= 0,10），局灶性小动脉狭窄以7％的形式缩小，在7％中脱颖而出。 6％，视网膜病为4％。由于受试者的流失和方法的局限性，异常患病率可能被低估了。控制性别，种族，年龄和吸烟状况，这些视网膜变化与较高的育雏压力有关。 MABP每增加10 mmHg，A/V比降低0.02单位（P <0.0001），局灶性小动脉狭窄的优势比（OR）为2.00（95％置信区间[CI] = 1.87-2.14），AV Nicking的或1.25（95％CI = 1.16-1,34），视网膜病有或1,25（95％） CI = 1.15-1.37）。对于任何程度的广义狭窄，焦点狭窄的个体的MABP比没有的MABP高约8 mmHg（p <0.0001）。对样本的掩盖重复评估发现以下可重现性：对于A/V比，相关系数= 0.79，中值绝对差= 0.03；对于局灶性小动脉变窄，kappa = 0.45;对于AV Nicking，Kappa = 0.61;对于视网膜病变，Kappa = 0.89。结论：已开发了用于非乳清底摄影的方案和评估视网膜血管异常。几种微血管变化与较高的血压显着相关。随访将表明它们是否可以预测后来的脑血管或心血管疾病，而与其他已知危险因素无关。
Objective: To develop protocols to photograph and evaluate retinal vascular abnormalities in the Atherosclerosis Risk in Communities (ARIC) Study; to test reproducibility of the grading system; and to explore the relationship of these microvascular changes with blood pressure.Design: Population-based, cross-sectional study.Participants: Among 4 examination centers, 11,114 participants (48-73 years of age) at their third triennial examination, after excluding persons with diabetes from this analysis.Methods: One eye of each participant was photographed by technicians with nonmydriatic fundus cameras. Reading center graders evaluated focal arteriolar narrowing, arteriovenous (AV) nicking, and retinopathy by examining slides on a light box and measured diameters of all vessels in a zone surrounding the optic disc on enhanced digitized images. To gauge generalized narrowing, vessel diameters were combined into central arteriolar and venular equivalents with formulas adjusting for branching, and the ratio of equivalents (AAI ratio) was calculated.Main Outcome Measures Retinal vascular abnormalities, mean arteriolar blood pressure (MABP).Results: Among 11,114 participants, photographs were obtained of 99%, with quality sufficient to perform retinal evaluations in 81%. In the 9040 subjects with usable photographs, A/V ratio (lower Values indicate generalized arteriolar narrowing) ranged from 0.57 to 1.22 (median = 0.84, interquartile range = 0,10), focal arteriolar narrowing was found in 7%, AV nicking in 6%, and retinopathy in 4%. Because of attrition of subjects and limitation of methods, prevalence of abnormality was likely underestimated. Controlling for gender, race, age, and smoking status, these retinal changes were associated with higher brood pressure. For every 10-mmHg increase in MABP, A/V ratio decreased by 0.02 unit (P < 0.0001), focal arteriolar narrowing had an odds ratio (OR) of 2.00 (95% confidence interval [CI] = 1.87-2.14), AV nicking had an OR of 1.25 (95% CI = 1.16-1,34), and retinopathy had an OR of 1,25 (95% CI = 1.15-1.37). For any degree of generalized narrowing, individuals with focal narrowing had MABP approximately 8 mmHg higher than those without (P < 0.0001). Masked replicate assessment of a sample found the following reproducibility: for A/V ratio, correlation coefficient = 0.79 and median absolute difference = 0.03; for focal arteriolar narrowing, kappa = 0.45; for AV nicking, kappa = 0.61; and for retinopathy, kappa = 0.89.Conclusion: Protocols have been developed for nonmydriatic fundus photography and for evaluation of retinal vascular abnormalities. Several microvascular changes were significantly associated with higher blood pressure; follow-up will show whether these are predictive of later cerebrovascular or cardiovascular disease independently of other known risk factors.