Transcript Sublingual Microcirculation ——Characteristics and Determinants in Chinese and Flemish Populations Yan Li MD PhD Shanghai Institute of Hypertension http://www.rjh.com.cn.

Sublingual Microcirculation
——Characteristics and Determinants in
Chinese and Flemish Populations
Yan Li
MD PhD
Shanghai Institute of Hypertension
http://www.rjh.com.cn
Hypertension and Microcirculation
Hypertension
Impaired
vasodilation
…
Structural
rarefaction
Functional
rarefaction
Apoptosis in
endothelial cells
Vascular Glycocalyx
The glycocalyx is a gel-like layer about 0.5 μm thick
covering the endothelium. It serves as a physical barrier
and plays an important role in vascular hemeostasis.
Sublingual Capillary Microscopy
and GlycoCheck
Handheld Video Capillary Microscope (KK Research Technology, UK)
interfaced with a computer running the GlycoCheck software
(GlycoCheck BV, Maastricht, The Netherlands).
GlycoCheck Measurement 1
― Capillary Density
Total density (RBC filling >0%)
no segments / mm2
Perfused density (RBC filling ≥50%)
Perfused-to-total density ratio
0
.4
mm
GlycoCheck Measurements 2
― Perfused Boundary Region (PBR)
RBC column width at the 3000 capillary segments 10 um apart was determined and the
median and the 5th-95th percentile interval of RBC width was used for the calculation of
PBR.
Healthy and Impaired Glycocalyx as
Measured by PBR
Previous Studies with
Sublingual Glycocheck
The sublingual glycocalyx estimated by the
PBR is decreased in patients with DM, CKD,
CVD, and critically ill patients.
Limitations: case-control studies; small
sample size; no population data
Study Objective
We investigated the characteristics and
associations of the sublingual capillary density
and glycocalyx with common CV risk factors in
general Chinese and Flemish populations.
Gu YM, et al. Hypertension.
2015;65:993-1001.
Study Populations ― Flemish
From April 2013 to June 2014, 487 participants
were invited, 320 signed informed consent(65.7%).
The number of participants analyzed totaled 254.
Eksel, Belgium
Coordinating Center in Leuven, Beglium
Study Populations ― Han and She Chinese
In May 2013, 931 Chinese were invited, 663 (71.2%)
gave informed consent. The number of participants
analyzed totaled 472, including 252 Han and 220
She people.
JingNing County
Villages in JingNing
She Minority
Measurements in the 3 Ethnic Groups
Sublingual GlycoCheck
Standardized questionnaires
Anthropometric measurements
Blood biochemical measurements
Characteristics of Participants (1)
Han
(n=252)
She
(n=220)
Flemish
(n=254)
Age, y
51.8
51.7
49.8
BMI, kg/m2
23.2‡
23.5†
26.5
124/78*‡
129/81
129/83
PP, mm Hg
46.8
47.6
46.5
Pulse rate, beats/min
72.1‡
73.2†
63.3
Hematocrit, %
43.3‡
42.7†
41.1
Total cholesterol, mmol/L
5.40‡
5.57†
4.82
Blood glucose, mmol/L
4.99‡
4.79†
4.57
Characteristics
SBP/DBP, mmHg
Significance of the difference: * Han vs. She, † She vs. Flemish, ‡ Han vs. Flemish.
Characteristics of Participants (2)
Han
(n=252)
She
(n=220)
Flemish
(n=254)
Women
55.6
62.7†
46.9
Smokers
21.8
17.3
14.2
Drinking alcohol
34.1‡
31.4†
76.4
29 (42)
36 (48)
38 (44)
Previous CVD
3.2
1.8
5.5
Diabetes
6.4‡
1.8
0.4
Characteristics,%
HT (Anti-HT)
Significance of the difference: * Han vs. She, † She vs. Flemish, ‡ Han vs. Flemish.
GlycoCheck Measurements
Han
(n=252)
She
(n=220)
Flemish
(n=254)
PBR, nm
2019‡
2000†
1876
Total Capillary density, NO/mm2
580‡
573†
546
Perfused Capillary density, NO/mm2
342‡
334
320
Perfused-to-total density ratio
0.59
0.59
0.59
Significance of the difference : * Han vs. She, † She vs. Flemish, ‡ Han vs. Flemish.
PBR, Hemotocrit and Capillary Density
PBR (nm)
Han
Flemish
She
2700
2700
2500
2500
2500
2300
2300
2300
2100
2100
1900
1900
1700
1700
1500
2100
1900
1700
1500
30
35
100
200
300
40
400
45
500
50
600
55
1500
30
35
40
45
100
200
300
400
500
50
600
55
1200
30
35
40
45
50
100
200
300
400
500
600
55
Distribution of Standardized PBR
Standardized PBR
P<0.0001
Standardized
PBR (nm) 2050
2000
P<0.0001
2024
1990
1950
1900
1875
1850
1800
Han
She
Flemish
Correlates of Standardized PBR
Model 1
Model 2
Model 3
Han (vs. average)
50.4*
49.3*
53.6*
She (vs. average)
24.3
24.6
20.8
Flemish (vs. average)
–74.7*
–73.9*
–74.5*
BMI (+3.9 kg/m2)
–18.4
–17.4
–25.3*
MAP (+13.1 mmHg)
–23.3*
DBP (+11.2 mmHg)
–25.4*
The covariables considered were sex, age, BMI, smoking, cholesterol, glucose, g-GT, AH-drug,
CVD, and MAP and PP in Model 1, or SBP and DBP in Model 2. or Framingham risk score in
Model 3. Significance of effect size: * P≤0.05.
Correlates of Standardized PBR
by Ethnicities
BMI
MAP
None of the between-ethnicity comparisons reached significance.
Correlates of Perfused Capillary Density
Regression line (95% CI) in individual participants
Mean (95%CI) per quintile
Perfused density (n°/mm2)
Age
BMI
Framingham score
Cholesterol
375
p=0.45
p=0.0024
p=0.009
p=0.14
350
325
300
30
40
50
60
year
70
80
15
20
25
30
35
kg/m2
Perfused capillary density was standardised for ethnicity.
3
4
5
mmol/L
6
7
–8
–4
0
4
point
8
12
Correlates of Capillary Density
Perfused Density
Total density
Correlates
Model 1
Model 2
Model 1
Model 2
Han (vs. average)
10.0*
9.29*
15.2*
13.5*
She (vs. average)
1.58
1.49
6.65
6.59
Flemish (vs. average)
–11.6*
–10.8*
–21.8*
–20.1*
Age (+13.7y)
9.31†
Framingham score
(+6.53 pts)
…
7.93†
…
The covariables considered were sex, age, BMI, smoking, cholesterol, glucose, g-GT, AHdrug, CVD. Model1 additionally included MAP and PP, whereas Model 2 had Framingham
risk score. Significance of effect size: * P≤0.05.
Correlates of Perfused-to-Total
Capillary Density Ratio
Model 1
Model 2
Han (vs. average)
0.0060
0.0050
She (vs. average)
–0.0051
–0.0027
Flemish (vs. average)
–0.0009
–0.0023
Age (+14.4 y)
0.0092*
BMI (+3.90 kg/m2)
0.0085*
Cholesterol (+1.02mm/L)
0.0102*
Smoking (0,1)
–0.0202*
Framingham risk score
(+6.53pts)
0.0066
0.0145†
Correlates of Perfused-to-Total
Capillary Density Ratio by Ethnicities
Age
BMI
TC
FRS
None of the between-ethnicity comparisons reached significance.
Summary
Higher age, body mass index, total cholesterol and
Framingham risk score were associated with
functional capillary recruitment.
In capillaries that remain perfused, glycocalyx width
increased with higher BMI, MAP and DBP.
There were no ethnic differences in these
associations.
Conclusion
A higher cardiovascular risk profile is
associated with recruitment of capillaries
with preserved glycocalyx that protects
the endothelium.
Further research on microcirculation with
the use of this novel technique is
warranted.
Acknowledgements
Leuven
Shanghai
Jan A. Staessen
Jiguang Wang
Yumei Gu
Yan Li
Yanping Liu
Changsheng Sheng
Lutgarde Thijs
Tatiana Kuznetsova
Peter Verhamme
Thibault Petit
Zhengyu Zhang
Fangfei Wei
Qifang Huang
Shuai Wang
Yuanyuan Kang
Feika Li
Jie Song
Yibang Cheng
Qianhui Guo
Thank You
谢
谢