目的利用深度学习探讨低密度脂蛋白胆固醇(LDL-C)对视网膜动脉硬化进展的影响及其阈值效应。
方法采用队列研究方法，收集2016年1月至2023年8月在北京怡健殿诊所进行体检的1 928人的临床资料，包括一般情况、体格检查、血清学检查及彩色眼底照相，利用深度学习模型统一识别视网膜动脉硬化情况。按照LDL-C水平进行五等分分组，其中第1分组(0.64~1.90 mmol/L)389人，第2分组(1.91~2.26 mmol/L)387人，第3分组(2.27~2.57 mmol/L)384人，第4分组(2.58~2.95 mmol/L)385人，第5分组(2.96~6.06 mmol/L)383人。采用Logistic回归分析及限制性立方样条(RCS)回归模型分析LDL-C水平与视网膜动脉硬化进展的关联性以及剂量－反应关系。
结果在平均随访时间(66.84±6.58)个月中，视网膜动脉硬化进展的发生率为22.10%(426/1 928)。第1、2、3、4、5分组受试者眼底情况出现进展的比例分别为15.68%(61/389)、21.71%(84/387)、21.35%(82/384)、25.71%(99/385)和26.11%(100/383)，总体比较差异有统计学意义( χ 2＝15.97， P＝0.003)。以LDL-C第1分组作为参照，LDL-C 2.58~2.95 mmol/L是视网膜动脉硬化进展的独立危险因素( OR＝1.52，95% CI：1.04~2.22)。RCS分析显示两者呈"L"型关联。LDL-C对于视网膜动脉硬化的影响呈现阈值效应，当LDL-C<2.34 mmol/L时，视网膜动脉硬化进展风险随LDL-C水平升高而增加( OR＝1.97，95% CI：1.10~3.62)，当LDL-C≥2.34 mmol/L时风险趋于平缓。
结论LDL-C对视网膜动脉硬化进展的影响具有阈值效应，阈值为2.34 mmol/L。
ObjectiveTo investigate the effect of low density lipoprotein cholesterol (LDL-C) on the progression of retinal arteriosclerosis by using a deep learning model.
MethodsA cohort study was performed.Data of 1 928 individuals who underwent the medical examination at Beijing Yijiandian Clinic between January 2016 and August 2023 were reviewed, including baseline demographics, physical examination, serological test and fundus photography.Retinal arteriosclerosis was identified using a deep learning model.Five groups were divided according to LDL-C levels, including 389 subjects in group 1 (0.64-1.90 mmol/L), 387 subjects in group 2 (1.91-2.26 mmol/L), 384 subjects in group 3 (2.27-2.57 mmol/L), 385 subjects in group 4 (2.58-2.95 mmol/L), and 383 subjects in group 5 (2.96-6.06 mmol/L).The association between LDL-C levels and progression of retinal arteriosclerosis and the dose-response relationship were analyzed by logistic regression analysis and restricted cubic spline (RCS) regression model.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Peking University People's Hospital (No.2021PHB058-001).Written informed consent was obtained from each subject.
ResultsThe incidence of retinal arteriosclerosis progression was 22.10% (426/1 928) during the mean follow-up (66.84±6.58) months.The proportions of fundus progression in groups 1, 2, 3, 4, and 5 were 15.68%(61/389), 21.71%(84/387), 21.35%(82/384), 25.71%(99/385), and 26.11%(100/383), respectively, with statistical significant differences among them ( χ 2=15.97, P=0.003).Using group 1 as a reference, LDL-C 2.58-2.95 mmol/L was an independent risk factor for progression of retinal arteriosclerosis ( OR=1.52, 95% CI: 1.04-2.22), and RCS analysis showed an " L" shaped association.The effect of LDL-C on retinal arteriosclerosis showed a threshold effect, with the risk of retinal arteriosclerosis progression increasing with increasing LDL-C when LDL-C was <2.34 mmol/L ( OR=1.97, 95% CI: 1.10-3.62), and stabilizing when LDL-C was ≥2.34 mmol/L.
ConclusionsLDL-C has a threshold effect on the impact of retinal arteriosclerosis progression, and the threshold is 2.34 mmol/L.
罗澜,孙摇遥,周思锦,等. 利用深度学习探讨LDL-C对视网膜动脉硬化进展的影响及其阈值效应[J]. 中华实验眼科杂志,2024,42(12)：1127-1133.
DOI:10.3760/cma.j.cn115989-20240609-00148版权归中华医学会所有。
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罗澜：酝酿和设计试验、采集数据、分析/解释数据、统计分析、起草文章；孙摇遥、姚昱欧：酝酿和设计试验、指导研究、对文章的知识性内容作批评性审阅；周思锦：采集数据、分析/解释数据、统计分析；张胜楠：采集数据；马彤、琚烈、常献刚：分析/解释数据；赵明威：酝酿和设计试验、指导研究、对文章的知识性内容作批评性审阅及定稿
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