血压波动及时间趋势与视网膜血管管径的相关性

目的：探讨高血压人群和非高血压人群中血压波动及时间趋势与视网膜血管管径的相关关系。方法：前瞻性设计,纳入在广州市干部疗养院/广州市第十一人民医院体检的年龄40 岁及以上、无严重心脑血管疾患的公务员。从2008年至2012年,对研究对象进行每年一次的血压监测随访。2012年,采集研究对象眼底照片,采用有效的眼底血管分析方法（IVAN软件）测定视网膜动静脉管径。采用多重线性回归模型分析血压时间趋势及波动与视网膜血管管径的相关关系。结果：共纳入3 419 名个体,其中,高血压个体1 428名,非高血压个体1 991名。多重线性回归分析发现,在高血压人群,独立于基线血压水平和其他传统的心脑血管危险因素,收缩压和舒张压的逐年上升趋势与视网膜动脉（收缩压趋势：β=-0.53,P < 0.001;舒张压趋势：β=-0.63,P =0.006）及静脉（收缩压趋势：β=-0.49,P =0.006;舒张压趋势：β=-0.73,P =0.008）的狭窄相关。在非高血压人群中,血压时间趋势及波动与视网膜血管管径均无相关关系。结论： 血压的逐年上升趋势与高血压人群视网膜动脉和静脉的狭窄相关。血压逐年上升的时间趋势可能是独立于平均血压水平之外的新的血管健康因素。     

单项血脂及其比值与翼状胬肉的相关性研究

目的:分析单项血脂和血脂比值与翼状胬肉的关系。方法:采用回顾性病例研究。纳入2016-01/2019-02在我院眼科和体检中心确诊的翼状胬肉患者500例(翼状胬肉组)和同期进行健康体检、年龄和性别匹配的健康体检者500例(正常对照组),检测两组研究对象外周静脉血中血清甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)水平,计算TG/HDL、TC/HDL、LDL/HDL的比值。结果:翼状胬肉患者500例中,血脂异常者68.2%(341/500),翼状胬肉组血清TG、TC、LDL-C水平和TG/HDL、TC/HDL、LDL/HDL的比值均明显高于正常对照组(P<0.001),血清HDL水平低于正常对照组,但无差异(P>0.05)。Logistic回归分析提示,TG(OR=4.132)、TC(OR=2.194)、TG/HDL (OR=2.184)、TC/HDL (OR=2.007)均是翼状胬肉发病的影响因素(P<0.05)。结论:血脂代谢异常是翼状胬肉发病的影响因素,加强血脂管理对翼状胬肉患者的发病和治疗均具有重要的临床意义。     

静坐和运动时间与视网膜血管管径的相关性

目的：探讨静坐和运动时间与视网膜血管管径的相关性。方法：横断面研究。收集2008 年3 月至2017 年7 月在广州市第十一人民医院体检的40 岁及以上、未发生过全身重大心脑血管事件的公务员6 560名,对该群体静坐时间、高强度运动（指使呼吸比平常明显急促的运动,如快跑、游泳、打篮球等）、中等强度运动（指使呼吸比较急促的运动,如打太极拳、踢毽子、正常速度骑单车等）和走路时间等生活习惯进行问卷调查,通过眼底照相和有效的眼底血管分析方法测量视网膜动静脉管径。利 用单变量线性回归进行混杂因素的筛选,在校正年龄、性别、血压（包括收缩压和舒张压）、吸烟、饮酒等因素后,采用多重线性回归模型分析静坐和运动时间与视网膜血管管径的相关性。结果：共纳入5 857名参与者,在校正了年龄、性别、血压等传统心血管疾病危险因素之后,结果显示静坐时间与视网膜中央动脉管径相关且为视网膜中央动脉管径狭窄的危险因素（β=-0.29,P =0.032）,高强度运动、中等强度运动和行走时间对视网膜血管并无保护作用。结论：静坐时间是视网膜动脉管径狭窄的危险因素,运动对视网膜动静脉管径并无明显影响。     

早期糖尿病患者黄斑区厚度与相关生化指标的关系

目的：研究早期糖尿病患者黄斑区视网膜厚度与相关生化指标的关系。 方法：糖尿病组40例40眼（男、女各20例）,对照组40例40眼（男、女各20例）,应用OCT测量黄斑区视网膜厚度,应用相关生化仪检测糖尿病组的尿微量白蛋白(mAlb)、糖化血红蛋白比(HbA1c)、C-肽(C-PR)、总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白（LDL）、高密度脂蛋白（HDL）的值。比较两组黄斑区视网膜的厚度,分析糖尿病组黄斑区厚度与相关生化指标的关系。 结果：糖尿病组所选患者黄斑区厚度比正常组大（P＜001),黄斑区视网膜厚度与尿微量白蛋白(mAlb)、总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白（LDL）呈正相关（P＜0.05);与高密度脂蛋白（HDL）呈负相关（P＜005);与糖化血红蛋白比(HbA1c)和C-肽(C-PR)无相关性（P＞0.05)。 结论：对于早期糖尿病患者,检测黄斑区厚度和尿微量白蛋白(mAlb)、总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白（LDL）、高密度脂蛋白（HDL）的变化,有利于糖尿病早期并发症的预测。     

糖尿病视网膜病变与血脂的关系

目的探讨糖尿病视网膜病变与血脂的关系。方法随机选择2型糖尿病患者90例,按有无糖尿病视网膜病变分组,测定他们的空腹血糖、血脂、脂蛋白、糖基化血红蛋白并进行分析总结。结果DR组与NDR组比较血清总胆固醇（rich）、甘油三脂（Tg）、低密度脂蛋白（LDL—C）、载脂蛋白B（APOB）明显增高（P〈0．001）;血高密度脂蛋白（HDL—C）、载脂蛋白A1（APOA1）明显下降（P〈0．001）。PDR组与BDR组比较,Tch、Tg显著增高（P〈0．001）,而HDL—C显著下降（P〈0．05）、APOA1显著下降（P〈0．001）。相关分析表明,DR患者的病变严重程度与FPG、HbA1c、Tch、Tg、LDL—C及APOB呈显著正相关,与HDL—C及APOA1呈显著负相关,结论血脂代谢异常影响着DR的发生发展。因此,糖尿病患者应严格控制血糖、血脂水平。     

健康人视网膜血管参数变化研究

目的　测量健康人群视网膜血管形态学几何参数（弯曲度、管径、分形维数）,并探讨这些参数随年龄、性别、体质量指数（body mass index,BMI）的变化特征。方法　观察性横断面研究。纳入147名健康人,拍摄眼底彩照,测量血管分形维数,测量距离视盘中心1.5~3.0个视盘直径的视网膜动脉、静脉血管弯曲度和血管管径。按眼别、视网膜象限、性别、年龄、BMI分组,比较各组视网膜血管的分形维数、弯曲度、管径值。结果　左右眼视网膜血管几何参数比较差异均无统计学意义（均为P＞0.05）。颞侧与鼻侧象限视网膜动脉弯曲度、动静脉管径比较差异均有统计学意义（均为P＜0.05）。男性与女性视网膜动静脉弯曲度、动静脉管径比较差异均无统计学意义（均为P>0.05）,分形维数比较差异有统计学意义（P＜0.05）。不同年龄亚组视网膜血管几何参数比较差异均有统计学意义（均为P＜0.05）,随年龄增大,视网膜动静脉弯曲度增加,视网膜动静脉管径、血管分形维数变小。不同BMI亚组视网膜动静脉管径比较差异有统计学意义（P＜0.05）;视网膜动静脉弯曲度、分形维数比较差异均无统计学意义（均为P>0.05）;动静脉管径随BMI增高而减小。结论　正常人群视网膜血管几何参数是微循环状态的潜在新生物标记,其随性别、年龄、BMI的不同而变化,且具有象限差异。     

血脂代谢异常与糖尿病视网膜病变的关系探讨

目的 探讨糖尿病视网膜病变(diabetic retinopathy,DR)与血脂代谢异常的关系.方法 采用大样本多中心研究方法,对符合纳入标准的603例糖尿病患者按照诊断标准分组,所有患者均经常规眼科检查及眼底荧光素血管造影术确定DR的分期,本组患者临床前期166例,非增生期296例和增生期141例,检测所有患者总胆固醇(total cholesterol,TCH)、甘油三脂(triglyceride,TG)、高密度脂蛋白胆固醇(high density lipoprotein,HDL)和低密度脂蛋白胆固醇(low density lipoprotein,LDL).结果 各期DR HDL、LDL、TCH和TG的差异无统计学意义(P＞0.05),但各期TG平均水平均高于正常(正常值0.56～1.70 mmol·L-1).同时以各指标正常值为标准判定血脂各项指标异常率,结果显示HDL、LDL、TG的异常率在DR不同时期间差异无统计学意义(P＞0.05),但DR各期间TCH异常率差异有统计学意义(P＜0.05).TG与TCH在DR的不同时期表现出明显的异常,且随DR病情严重程度的加重有增加趋势.结论 脂质代谢异常可促使糖尿病患者DR的发生、发展,在防治DR时,应注意控制血脂.     

封面图片说明

高血压性视网膜病变。左图:男性,34岁,原发性高血压病史5年,眼底像上可见视网膜动脉弥漫性缩窄,反光增强,动静管径比值约1/2,静脉迂曲,血管袢出现,动静脉交叉征,局限性视网膜神经纤维层缺损以及多处棉绒斑。右图:女性,55岁,原发性高血压病史8年,眼底像上可见视网膜动脉弥漫性及局限性缩窄,动脉呈铜丝状,动静管径比值约1/3,动静脉交叉征,多处火焰状出血,黄斑前膜。     

视网膜静脉阻塞与血脂和颈动脉改变的相关性研究

目的：探讨视网膜静脉阻塞（ RVO ）与血脂、颈动脉改变的相关性。
　　方法：选取2013－05／2014－04在新乡医学院眼科医院住院的40例40眼视网膜静脉阻塞患者为研究对象,进行血脂、颈动脉彩色超声多普勒检查,包括总胆固醇（ TC ）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL－C）、低密度脂蛋白胆固醇（ LDL－C ）,颈总动脉内膜－中层厚度、颈动脉斑块、颈内动脉血流动力学参数。对照组30例30眼为我院同期健康体检者,同行以上检查。
　　结果：RVO组TC,TG,LDL－C明显高于对照组（P＜0．05）,而HDL－C水平明显低于对照组（ P＜0．05）。 RVO组颈动脉斑块形成发生率明显高于对照组。 RVO组颈总动脉内膜－中层厚度（ IMT）明显增加,颈内动脉收缩期峰值血流速度（ PSV）及舒张末期血流速度（ EDV）明显降低,阻力指数（RI）明显增高（P＜0．05）。患眼同侧及对侧颈动脉各测量值比较无统计学差异（P＞0．05）。对照组同侧及对侧颈动脉各测量值比较也无统计学差异（P＞0．05）。两组性别、年龄无统计学差异（P＞0．05）。
　　结论：脂质代谢紊乱、颈动脉改变与 RVO 的发病密切相关。     

日常饮茶与视网膜血管管径的相关性

目的探讨日常饮茶种类和饮茶量与视网膜血管管径的相关关系。方法横断面研究。纳入年龄40岁及以上、无严重心脑血管疾患的广州市公务员4430人。通过问卷采集参与者日常主要饮茶种类（包括绿茶、乌龙茶、红茶或普洱茶3类）和平均饮茶量（分为从不饮茶、偶有饮茶、少于每天1杯、每天1~2杯、每天2杯以上5组）。通过IVAN眼底血管分析系统测定研究对象的眼底照片评估视网膜血管管径。多重线性回归模型分析日常饮茶与视网膜血管管径的相关关系。结果本研究参与者年龄为（58.8±9.9）岁,其中男性占56.00%,从不饮茶为775人（17.49%）,饮用绿茶、乌龙茶、红茶的人数分别是645人（14.56%）、1240人（27.99%）、1770人（39.95%）。在矫正了年龄、血压等传统心脑血管危险因素及日常生活习惯后,在3个不同的饮茶种类人群中,视网膜血管管径与饮茶量不相关（P>0.05）。结论日常生活的饮茶量与视网膜血管管径并无相关关系。     

糖尿病视网膜病变与血脂,脂质过氧化的关系

目的:观察和探讨糖尿病视网膜病变与脂质代谢和脂质过氧化反应的关系。方法:对30名早期糖尿病视网膜病变患者与24名健康人空腹血清中甘油三脂(TC),总胆固醇(TG),高密度脂蛋白—胆固醇(HDL—C),低密度脂蛋白—胆固醇(LDL—C),过氧化物歧化酶SOD)和脂质过氧化物(LPO)的含量进行了检测。结果:发现患者组中TC、TG、LDL—C与LPO均明显高于对照组,而HDL—C与SOD都低于健康对照组。结论:糖尿病引起的脂质代谢紊乱和脂质过氧化反应的增强可能是促进视网病变的危险因素之一。眼科学报1998;14:100—102。     

Retinal vascular calibres are significantly associated with cardiovascular risk factors: the Tromsø Eye Study

Purpose: To describe the association between retinal vascular calibres and cardiovascular risk factors. Methods: Population‐based cross‐sectional study including 6353 participants of the Tromsø Eye Study in Norway aged 38–87 years. Retinal arteriolar calibre (central retinal artery equivalent) and retinal venular calibre (central retinal vein equivalent) were measured computer‐assisted on retinal photographs. Data on blood pressure, body mass index (BMI), high‐density lipoprotein (HDL) and low‐density lipoprotein (LDL) cholesterol, glycosylated haemoglobin (HbA1c) and smoking were collected. Association between retinal vessel calibre and the cardiovascular risk factors was assessed by multivariable linear and logistic regression analyses. Results: Retinal arteriolar calibre was independently associated with age, blood pressure, HbA1c and smoking in women and men, and with HDL cholesterol in men only. Blood pressure had the strongest effect on arteriolar calibre, with a decrease in calibre of 3.6 μm (women)/4.1 μm (men) per standard deviation increase in mean arterial blood pressure. Retinal venular calibre was independently associated with age, blood pressure, BMI, HDL and LDL cholesterol and smoking in men and women. The effect of BMI and HDL cholesterol on venular calibre was significantly stronger in men than in women. Current smoking was the most important factor for venular calibre, where smokers had 13.2 μm (women)/15.2 μm (men) wider calibre than nonsmokers. Conclusion: All the explored cardiovascular risk factors were independently associated with retinal vascular calibre, with stronger effect of HDL cholesterol and BMI in men than in women. Blood pressure and smoking contributed most to the explained variance.     

糖尿病视网膜病变与脂质代谢紊乱的关系

目的探讨非胰岛素依赖型糖尿病（non-insulin-dependent diabetes mellitus，NIDDM）患者的糖尿病视网膜病变（diabetic retinopathy，DR）与脂质代谢紊乱的关系。方法对有DR的NIDDM患者60例，无DR的NIDDM患者75例以及正常对照55例，检测了血浆总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白（HDL-C）及其亚类，以及空腹血糖（FPG）、空腹血浆胰岛素（FINS）和糖基化血红蛋白（HbA_1C）。同时按公式计算血浆低密度脂蛋白（LDL）和极低密度脂蛋白（VLDL）。结果DR组的TC、LDL、FPG、HbA_1C及病程高于或长于非DR组。在DR患者中，增殖型DR患者的TC、LDL、FPG、FINS、HbA_1C及病程高于或长于单纯型DR患者。相关分析表明，DR患者的病变严重程度与TC、LDL、HbA_1C和病程呈显著正相关。结论脂质代谢紊乱在NIDDM患者的DR发生、发展中，可能起着一定的作用。(中华眼底病杂志,1998,14:21-23)     

Retinal vascular caliber, blood pressure, and cardiovascular risk factors in an Asian population: the Singapore Malay Eye Study

PURPOSE: To describe the relationship of retinal vascular caliber with cardiovascular risk factors in an Asian population. METHODS: The Singapore Malay Eye Study is a population-based, cross-sectional survey that included 3280 (78.7% response) persons aged 40 to 80 years. Retinal vascular caliber was measured from digital retinal photographs using a validated standardized protocol. Data on major cardiovascular risk factors were collected from all participants. RESULTS: Of the 3019 participants with retinal vascular caliber data available, the mean retinal arteriolar caliber (CRAE) was 139.5 +/- 15.7 microm (SD), and mean venular caliber (CRVE) was 219.3 +/- 22.2 microm (SD). Smaller retinal arteriolar caliber was associated with higher current mean blood pressure and male sex (P < 0.001 for both). Larger retinal venular caliber was associated with younger age, current cigarette smoking, greater body mass index, higher glycosylated hemoglobin level, and lower HDL cholesterol (P = 0.012 for glycosylated hemoglobin level and P < 0.001 for other risk factors). The association of retinal arteriolar narrowing and blood pressure was stronger in younger people than in older people and in men than in women (P for interaction < 0.001 for both). CONCLUSIONS: In this Asian population, smaller retinal arteriolar caliber was associated with hypertension and larger retinal venular caliber with cigarette smoking, dyslipidemia, hyperglycemia, and higher body mass index. The pattern of these associations is similar to that in white populations.     

Apolipoprotein B: novel indicator of elevated intraocular pressure

Purpose

Many studies have reported associations between elevated intraocular pressure (IOP) and systemic health parameters, which suggest a common mechanism links IOP elevation and various related cardiometabolic risk factors. Furthermore, according to a recent study, serum apolipoprotein B (APO B) level is a predictor of coronary artery disease. This study was undertaken to analyse the relationship between serum apolipoprotein levels and IOP.

Methods

Healthy people (28 852) who attended a community hospital for a health checkup between January 2011 and December 2013 were enroled in the study. We measured age, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), serum levels of total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and apolipoprotein A1 (APO A1) and APO B, APO B/APO A1 ratios, and IOP.

Results

Univariate regression analysis showed IOP was positively correlated with BMI, SBP, DBP, TC, LDL-C, TG, APO B, and APO B/APO A1 (P<0.001), and negatively correlated with HDL-C (P<0.001). On the other hand, multivariate regression analysis adjusted for age, BMI, SBP, and DBP, revealed IOP was positive correlated with TC, TG, LDL-C, APO B, and APO B/APO A1, and negatively correlated with HDL-C (all <0.05).

Conclusions

Among the various lipid profiles investigated, APO B was found to be most strongly correlated with IOP, regardless of sex. Additional studies are required to confirm the validity of apolipoprotein level as an index for predicting IOP.     

Intraretinal leakage and oxidation of LDL in diabetic retinopathy

PURPOSE: The pathogenesis of diabetic retinopathy (DR) is not fully understood. Clinical studies suggest that dyslipidemia is associated with the initiation and progression of DR. However, no direct evidence supports this theory. METHODS: Immunostaining of apolipoprotein B100 (ApoB100, a marker of low-density lipoprotein [LDL]), macrophages, and oxidized LDL was performed in retinal sections from four different groups of subjects: nondiabetic, type 2 diabetic without clinical retinopathy, diabetic with moderate nonproliferative diabetic retinopathy (NPDR), and diabetic with proliferative diabetic retinopathy (PDR). Apoptosis was characterized using the TUNEL assay. In addition, in cell culture studies using in vitro-modified LDL, the induction of apoptosis by heavily oxidized-glycated LDL (HOG-LDL) in human retinal capillary pericytes (HRCPs) was assessed. RESULTS: Intraretinal immunofluorescence of ApoB100 increased with the severity of DR. Macrophages were prominent only in sections from diabetic patients with PDR. Merged images revealed that ApoB100 partially colocalized with macrophages. Intraretinal oxidized LDL was absent in nondiabetic subjects but present in all three diabetic groups, increasing with the severity of DR. TUNEL-positive cells were present in retinas from diabetic subjects but absent in those from nondiabetic subjects. In cell culture, HOG-LDL induced the activation of caspase, mitochondrial dysfunction, and apoptosis in HRCPs. CONCLUSIONS: These findings suggest a potentially important role for extravasated, modified LDL in promoting DR by promoting apoptotic pericyte loss.     

原发性双眼翼状胬肉与高脂血症的关系研究

目的：探讨原发性双眼翼状胬肉与高脂血症之间的关系。

方法：回顾性分析原发性双眼翼状胬肉患者(胬肉组)40例和健康体检者(对照组)40例,胬肉组按翼状胬肉分级分为1级(Group1)、2级(Group2)和3级(Group3)。所有研究对象空腹抽静脉血检测血清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白A1(APOA1)和载脂蛋白B(APOB)。比较胬肉组与对照组、翼状胬肉分级组间的血脂水平。

结果：胬肉组TC、LDL-C和APOB高于对照组(P=0.024、0.012、0.009); 胬肉组TG高于对照组,HDL-C和APOA1低于对照组,但均无差异(P>0.05)。三组翼状胬肉分级组间LDL-C差异有统计学意义(2.76±0.57、3.40±0.96、3.85±1.16mmol/L,P=0.036),而其余指标比较无差异(P>0.05); Group3组LDL-C高于Group1(P=0.012)。

结论：原发性双眼翼状胬肉与高脂血症之间关系密切,可能是其发病的危险因素之一。     

Effects of carteolol and timolol on plasma lipid profiles in older women with ocular hypertension or primary open-angle glaucoma

PURPOSE: To determine the effect on serum lipid levels of carteolol hydrochloride 1.0% or timolol maleate 0.5% given twice a day to women age 60 years and older with primary open-angle glaucoma or ocular hypertension. METHOD: We included 112 patients in this double-masked, randomized, multicenter trial. Fasting clinical laboratory studies were evaluated at baseline and at 12 weeks. Patients were instructed not to change their dietary, alcohol consumption, or exercise habits during the study. RESULTS: For the carteolol group, the high-density lipoprotein (HDL) and total cholesterol/high-density lipoprotein (TC/HDL) ratio at baseline of 50.1 +/- 1.5 mg/dl and 4.7 +/- 0.2 changed by the 12-week visit to 51.3 +/- 1.9 mg/dl (P = .25) and 4.6 +/- .02 (P = .47), respectively. For the timolol maleate group, the baseline HDL and TC/HDL ratio of 53.6 +/- 2.2 mg/dl and 4.4 +/- 0.2 changed to 50.2 +/- 1.9 mg/dl (P < .001) and 4.7 +/- 0.2 (P = .001), respectively, at the 12-week visit. Carteolol patients showed no significant change from baseline, whereas the HDL (P < .001) and TC/HDL ratio decreased (P = .001) significantly in the timolol maleate group. There also was a significant difference in the change from baseline at 12 weeks between carteolol and timolol maleate groups for the HDL and TC/HDL ratio (P = .01 and .012, respectively). No differences in TC, low-density lipoprotein (LDL), or triglycerides (TG) or in changes from baseline were observed between groups at 12 weeks (P > .05). At 12 weeks, no differences were observed between carteolol and timolol maleate groups in intraocular pressure or safety (P > .05), except that patients given carteolol demonstrated fewer solicited ocular symptoms (P = .007). CONCLUSIONS: Carteolol appears to be neutral in its effect on serum lipid levels, whereas timolol maleate adversely affects the HDL and TC/HDL ratio in women age 60 years and older with ocular hypertension or primary open-angle glaucoma.