Structural Changes in the Retinal Microvasculature and Renal Function
Structural Changes in the Retinal Microvasculature and Renal Function
复制标题
DOI：
10.1167/iovs.13-11941
复制
发表时间：
2013-04-01
影响因子：
4.4
通讯作者：
Wong, Tien Yin
中科院分区：
文献类型：
--
作者：
Lim, Laurence Shen;Cheung, Carol Yim-lui;Wong, Tien Yin
目的.评估慢性肾脏病（CKD）和微量白蛋白尿之间的关系，以及包括传统和新的视网膜血管测量在内的一系列视网膜微血管异常。这是一项以人口为基础的横断面研究，研究对象为3280名城市马来成年人。白蛋白/肌酐比值（ACR）从现场尿液样本计算。根据血清肌酸酐浓度计算估计的肾小球滤过率（eGFR）。使用半自动计算机辅助程序从视网膜眼底照片定量视网膜血管口径和几何形状。定性变化包括局灶性小动脉狭窄、动静脉切口和小动脉壁混浊由经过培训的分级员进行评估。在校正了年龄、性别、高血压、糖尿病和吸烟的多变量分析中，视网膜小动脉口径变窄（P = 0.008）、视网膜血管分形维数变小（P = 0.014）、AV切口和混浊（分别为P = 0.005和P < 0.001）与eGFR降低显著相关。在多变量校正的逻辑回归分析中，没有视网膜标记物与CKD相关。较小的分形维数（P < 0.001）和局灶性小动脉狭窄、AV切口和混浊的存在与较高的ACR相关（分别为P < 0.001、P = 0.01和P = 0.002）。视网膜小动脉变窄（P = 0.041）、分形维数变小（P = 0.006）、局灶性小动脉变窄、AV切口和混浊（分别为P = 0.007、P = 0.007和P = 0.012）与微量白蛋白尿的可能性增加相关。视网膜血管几何形状的定量变化和血管结构的定性变化与肾功能障碍和损伤的标志物相关。
PURPOSE. To evaluate the associations between chronic kidney disease (CKD) and microalbuminuria, and a comprehensive range of retinal microvascular abnormalities including traditional and new retinal vascular measures.METHODS. This was a population-based, cross-sectional study on 3280 urban Malay adults. The albumin/creatinine ratio (ACR) was calculated from spot urine samples. Estimated glomerular filtration rate (eGFR) was calculated from serum creatinine concentration. Retinal vascular caliber and geometry were quantified from retinal fundus photographs using a semiautomated computer-assisted program. Qualitative changes including focal arteriolar narrowing, arteriovenous nicking, and opacification of the arteriolar wall were assessed by trained graders.RESULTS. In multivariate analyses adjusting for age, sex, hypertension, diabetes, and smoking, narrower retinal arteriolar caliber (P = 0.008), smaller retinal vascular fractal dimensions (P = 0.014), and the presence of AV nicking and opacification (P = 0.005 and P < 0.001, respectively) were significantly associated with lower eGFR. In multivariate adjusted logistic regression analyses, none of the retinal markers was associated with CKD. A smaller fractal dimension (P < 0.001) and the presence of focal arteriolar narrowing, AV nicking and opacification were associated with higher ACR (P < 0.001, P = 0.01, and P = 0.002, respectively). Narrower retinal arterioles (P = 0.041); smaller fractal dimensions (P = 0.006); and focal arteriolar narrowing, AV nicking, and opacification (P = 0.007, P = 0.007, and P = 0.012, respectively) were associated with higher likelihoods of having microalbuminuria.CONCLUSIONS. Quantitative changes of the retinal vascular geometry and qualitative changes in the vessel architecture are associated with markers of renal dysfunction and damage.