北京社区人群视网膜动脉硬化分级与10年心血管病风险(China-PAR预测模型)的关系研究  

Relationship between retinal arteriosclerosis grading and predicted 10-year risks of cardiovascular disease(China-PAR Equations)in a community-based population in Beijing

作　　者：佘海澄 严棽棽 孙蓬飞 范芳芳[2,3] 姜一梦 贾佳[2,3] 刘博 周金琼 张岩[2,3] She Haicheng;Yan Shenshen;Sun Pengfei;Fan Fangfang;Jiang Yimeng;Jia Jia;Liu Bo;Zhou Jinqiang;Zhang Yan(Beijing Tongren Eye Center,Beijing Key Laboratory of Ophthalmology and Visual Sciences,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China;Department of Cardiology,Peking University First Hospital,Beijing 100034,China;Institute of Cardiovascular Disease,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]首都医科大学附属北京同仁医院,北京同仁眼科中心,眼科学与视觉科学北京市重点实验室,100730 [2]北京大学第一医院心内科,100034 [3]北京大学第一医院心血管疾病研究所,100034

出　　处：《眼科》2022年第4期260-265,共6页Ophthalmology in China

基　　金：首都卫生发展科研专项(首发2020-2-2053);北京大学医学部-密歇根大学医学院转化医学与临床研究联合研究所和中央高校基本科研项目(BMU20110177、BMU20160530);国家重点研发计划(2017YFC1307704);中国心血管健康联盟进阶基金(2019-CCA-ACCEESS-112);首都医科大学附属北京同仁医院青年人才培养计划种子基金(2018-YJJ-ZZL-031)。

摘　　要：目的探讨北京社区人群视网膜动脉硬化分级与中国动脉粥样硬化性心血管疾病风险预测(China-PAR)模型预测10年心血管病(CVD)风险的关系。设计横断面研究。研究对象北京市石景山社区动脉粥样硬化研究队列中完成2019年12月至2020年1月随访、无心血管疾病史、问卷调查资料完整且完成双眼彩色眼底照检查者673例。方法视网膜动脉硬化程度分级采用Scheie分级法。采用多因素Logistic回归分析视网膜动脉硬化分级与10年CVD发病风险的关系,并进一步调整了China-PAR模型中不包含的变量:降血糖药、降血脂药及肾小球滤过率(eGFR)分组。主要指标10年心血管病风险(China-PAR预测模型)。结果受试者平均年龄(61.9±7.4)岁,女性占62.7%(422例),合并高血压、血脂异常和糖尿病的比例分别为53.0%(357例)、78.0%(525例)和30.5%(205例),合并心血管病家族史者占23.5%(158例),视网膜动脉硬化0~1级、2级和3~4级分别为57.1%(384例)、37.3%(251例)和5.6%(38例)。在China-PAR模型计算的10年CVD发病风险中,低危209例(31.1%),中危206例(31.1%),高危258例(38.3%)。多因素回归分析结果显示,视网膜动脉硬化分级与10年CVD发病风险呈正相关,与视网膜动脉硬化0~1级相比,2级视网膜动脉硬化CVD中风险比例增加52%(OR=1.52,95%CI:1.00~2.31,P=0.048),而CVD高风险比例增加92%(OR=1.92,95%CI:1.24~2.96,P=0.003);与视网膜动脉硬化0~1级相比,3~4级视网膜动脉硬化CVD中风险比例增加6.47倍(OR=7.47,95%CI:1.62~34.52,P=0.010),而CVD高风险比例增加7.62倍(OR=8.62,95%CI:1.87~39.69,P=0.006)。结论视网膜动脉硬化分级与China-PAR模型预测的10年CVD风险显著相关,视网膜动脉硬化程度越重,10年CVD发病风险越高。Objective To explore the relationship between retinal arteriosclerosis grading and China-PAR model in predicting10-year cardiovascular disease(CVD)risk in a Beijing community.Design Cross-sectional study.Participants The subjects were from the atherosclerosis research cohort in Shijingshan community,Beijing.This study was a cross-sectional study followed up from December 2019 to January 2020.A total of 673 participants who had no history of cardiovascular disease,with complete questionnaire data and fundus photograph were finally included.Methods The degree of retinal arteriosclerosis was graded according to the Scheie’s classification.Multivariate Logistic regression was used to analyze the relationship between retinal arteriosclerosis grading and 10-year CVD risk,and further adjustment including hypoglycemic drugs,lipid-lowering drugs and estimated glomerular filtration rate(eGFR)was made.Main Outcome Measures 10-year CVD risk calculated by China-PAR model.Results The subjects were 61.9±7.4 years old and 422(62.7%)were women.Of all the subjects,53.0%(n=357)had hypertension,78.0%(n=525)had dyslipidemia,30.5%(n=205)had diabetes and 23.5%(n=158)had a family history of CVD.The percentage of subjects with grad 0-1,grad 2 and grade 3-4 arteriosclerosis were 57.1%(n=384),37.3%(n=251)and 5.6%(n=38),respectively.Of the10-year CVD risk calculated by China-PAR model,209(31.1%)subjects were at low risk,206 subjects(31.1%)were at medium risk and 258(38.3%)subjects were at high risk.Multivariate regression analysis showed that the retinal arteriosclerosis grading was positively correlated with the10-year risk of CVD.Compared with grade 0-1 retinal arteriosclerosis,the risk ratio of medium risk CVD increased by 52%(OR=1.52,95%CI:1.00~2.31,P=0.048)in grade 2 retinal arteriosclerosis;and the risk ratio of high risk CVD increased by 92%(OR=1.92,95%CI:1.24~2.96,P=0.003)in grade 2 retinal arteriosclerosis.Compared with grade 0-1 retinal arteriosclerosis,the risk ratio of medium risk CVD increased by 6.47 times(OR=7.47,95%CI:1.6

关 键 词：视网膜动脉硬化 心血管病 风险预测 China-PAR模型 

分 类 号：R774.1[医药卫生—眼科] R54[医药卫生—临床医学]