高血压人群肱-踝动脉脉搏波传导速度与视网膜动脉硬化的关系

Relationship between pulse wave velocity and retinal arteriosclerosis in hypertensive population

摘要

目的 探讨高血压人群肱-踝动脉脉搏波传导速度（baPWV）与视网膜动脉硬化的关系。方法 纳入2021年6月至2024年6月在杭州市拱墅区天水武林街道社区卫生服务中心的高血压患者2 631例，所有患者均进行baPWV检测以及根据双眼眼底图像进行视网膜动脉硬化分级。其中高血压合并视网膜动脉硬化1 131例（Scheie分级：1级475例，2级396例，3级203例，4级57例），高血压未合并视网膜动脉硬化1 500例。采用逐步检验法结合Bootstrap法分析baPWV与视网膜动脉硬化相关性的中介因素（中介分析）。采用含交互项的多因素logistic回归模型分析baPWV与糖尿病、血脂异常的交互作用对视网膜动脉硬化的影响。结果 与未合并视网膜动脉硬化者比较,合并1～4级视网膜动脉硬化者baPWV逐渐升高[（1 354±176）比（1 367±178）、（1 400±182）、（1 495±194）、（1 558±203） cm/s, F=89.76，P＜0.001]。以视网膜动脉硬化分级为因变量，基线baPWV为自变量，高敏C反应蛋白（hsCRP）为中介变量进行分析，结果显示：baPWV通过升高hsCRP（β = 0.12，95%CI：0.05～0.19）间接促进视网膜动脉硬化（OR = 1.41，95%CI：1.12～1.78），中介效应值为0.042，Bootstrap 95%CI：0.023～0.089，P=0.002。以基线baPWV为因变量，视网膜动脉硬化分级为自变量，外周血管阻力指数（PVRI）为中介变量进行分析，结果显示：视网膜动脉硬化分级升高可通过增加PVRI（β = 0.85，95%CI：0.32～1.38）间接导致baPWV升高（β = 12.3，95%CI：8.5～16.1），中介效应值为10.455，Bootstrap 95%CI：3.21～17.70，差异具有统计学意义。多因素logistic回归模型交互检验结果显示，与合并糖尿病人群比较，无合并糖尿病人群baPWV与高血压视网膜硬化的关联更明显（交互作用P = 0.003）；与合并血脂异常人群比较，无合并血脂异常人群baPWV与高血压视网膜硬化的关联更明显（交互作用P = 0.004）。结论 baPWV与视网膜动脉硬化存在双向因果路径，baPWV可能通过hsCRP促进视网膜动脉硬化，而视网膜动脉硬化可能通过PVRI反向升高baPWV。在无合并糖尿病和无合并血脂异常人群中的关联更明显。

Abstract

Objective To explore the relationship between brachial-ankle pulse wave velocity (baPWV) and retinal arteriosclerosis in hypertensive population. Methods A total of 2 631 hypertensive patients admitted to Tianshui Wulin Street Community Health Service Center, Gongshu District, Hangzhou from June 2021 to June 2024 were enrolled. All patients underwent baPWV detection and retinal arteriosclerosis grading based on binocular fundus images. Among them, 1 131 patients had hypertension combined with retinal arteriosclerosis (Scheie classification: 475 cases of grade 1, 396 cases of grade 2, 203 cases of grade 3, 57 cases of grade 4), and 1 500 patients had hypertension without retinal arteriosclerosis. Stepwise test combined with Bootstrap method was used to analyze the mediating factors of the correlation between baPWV and retinal arteriosclerosis (mediation analysis). A multivariate logistic regression model with interaction terms was used to analyze the interaction effect of baPWV with diabetes mellitus and dyslipidemia on retinal ateriosclerosis. Results Compared with patients without retinal arteriosclerosis, the baPWV in patients with grade 1-4 retinaarteriosclerosis gradually increased([1354±176] vs [1367±178]，[1400±182]，[1495±194]，[1558±203] cm/sF=89.76,P＜0.001). Taking retinal arteriosclerosis grade as the dependent variable, baseline baPWV as the independenvariable,and high-sensitivity C-reactive protein (hsCRP) as the mediating variable,the analysis showed that baPWindirectly promoted retinal arteriosclerosis by increasing hsCRP(β=0.12,95%CI:0.05 to 0.19)(OR=1.41,95%CI: 1.12 to 1.78), with a mediating effect value of 0.042 (Bootstrap 95%CI:0.023 to 0.089,P=0.002).Taking baseline baPWV as thdependent variable, retinal ateriosclerosis grade as the independent variable, and peripheral vascular resistance index (PVRIas the mediating variable, the analysis showed that the increase in retinal arteriosclerosis grade could indirectly lead toelevated baPWV(β=12.3, 95%CI:8.5 to 16.1) by increasing PVRI(β=0.85,95%CI:0.32 to 1.38), with a mediating effecvalue of 10.455 (Bootstrap 95%CI: 3.21 to 17.70), and the difference was statistically significant. The results ofthe interaction test of the multivariate logistic regression model showed that compared with the population with diabetemellitus,the association between baPWV and hypertensive retinal sclerosis was more significant in the populatiotwithout diabetes mellitus (interaction P=0.003); compared with the population with dyslipidemia, the association betweenbaPWV and hypertensive retinal sclerosis was more significant in the population without dyslipidemit(interaction P=0.004). Conclusions There is a bidirectional causal pathway between baPWV and retinal arteriosclerosisbaPWV may promote retinal arteriosclerosis through hsCRP, while retinal ateriosclerosis may reversely increase baPWTthrough PVRI.The association is more significant in populations without diabetes mellitus and without dyslipidemia.

关键词

脉搏波传导速度 / 视网膜动脉硬化 / 高血压

Key words

pulse wave velocity / retinal arteriosclerosis / hypertension

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