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Yan Li MD PhD
Shanghai Institute of Hypertension
Sublingual Microcirculation
——Characteristics and Determinants in
Chinese and Flemish Populations
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Hypertension and Microcirculation
Apoptosis in endothelial cells
Hypertension
Impaired
vasodilation
…
Functional rarefaction
Structural rarefaction
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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.
Vascular Glycocalyx
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Handheld Video Capillary Microscope (KK Research Technology, UK) interfaced with a computer running the
GlycoCheck software (GlycoCheck BV, Maastricht, The Netherlands).
Sublingual Capillary Microscopy
and GlycoCheck
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GlycoCheck Measurement 1
― Capillary Density
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
m
m
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GlycoCheck Measurements 2
― Perfused Boundary Region (PBR)
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.
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Healthy and Impaired Glycocalyx as Measured by PBRHealthy and Impaired Glycocalyx as Measured by PBR
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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
Previous Studies with
Sublingual Glycocheck
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We investigated the characteristics and associations of the sublingual capillary
density and glycocalyx with common CV risk factors in general Chinese and
Flemish populations.
Study Objective
Gu YM, et al. Hypertension. 2015;65:993-1001.
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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
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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
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Measurements in the 3 Ethnic GroupsMeasurements in the 3 Ethnic Groups
Sublingual GlycoCheck
Standardized questionnaires
Anthropometric measurements
Blood biochemical measurements
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Characteristics of Participants (1)
Characteristics 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
SBP/DBP, mmHg 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
Significance of the difference: * Han vs. She, † She vs. Flemish, ‡ Han vs. Flemish.
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Characteristics of Participants (2)
Characteristics,% 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
HT (Anti-HT) 29 (42) 36 (48) 38 (44)
Previous CVD 3.2 1.8 5.5
Diabetes 6.4‡ 1.8 0.4
Significance of the difference: * Han vs. She, † She vs. Flemish, ‡ Han vs. Flemish.
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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.
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PBR, Hemotocrit and Capillary DensityPBR, Hemotocrit and Capillary Density
She
Perfu
sed d
ensi
ty
(n°/m
m2)
2700
2500
2300
2100
1900
1700
1500
30
35
40
45
55
50600
500
400
300
200
100
Haematocrit (%
)
p<0.0001p<0.
0001
Flemish
2500
2300
2100
1900
1700
1500
1200
30
35
40
45
55
50600
500
400
300
200
100
Perfu
sed d
ensi
ty
(n°/m
m2)
Haematocrit (%
)
P<0.0001P<0.
0001
Han
2700
2500
2300
2100
1900
1700
150030
35
40
45
55
50600
500
400
300
200
100
Perfu
sed d
ensi
ty
(n°/m
m2)
Haematocrit (%
)
PB
R (
nm
)
p<0.0001 p<0.00
01
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Distribution of Standardized PBRDistribution of Standardized PBR
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Standardized PBR (nm)
P<0.0001
Standardized PBRStandardized PBR
Han She Flemish1800
1850
1900
1950
2000
2050
2024
1990
1875
P<0.0001
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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 PBRCorrelates 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*
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Correlates of Standardized PBR
by Ethnicities
Correlates of Standardized PBR
by Ethnicities
None of the between-ethnicity comparisons reached significance.
BMI MAP
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Perfused capillary density was standardised for ethnicity.
Correlates of Perfused Capillary DensityCorrelates of Perfused Capillary Density
80
Regression line (95% CI) in individual participants
Mean (95%CI) per quintile
Pe
rfu
sed
den
sit
y (n
°/m
m2)
30 40 50 60 70
p=0.0024
year
375
350
325
300
Age
p=0.009
–8 –4 0 4 8
point
12
Framingham score
p=0.45 p=0.14
15 20 25 30 35
kg/m2
3 4 5 6 7
mmol/L
BMI Cholesterol
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CorrelatesPerfused Density Total density
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, AH-drug, CVD. Model1 additionally included MAP and PP,
whereas Model 2 had Framingham risk score. Significance of effect size: * P≤0.05.
Correlates of Capillary Density
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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* 0.0066
Cholesterol (+1.02mm/L) 0.0102*
Smoking (0,1) –0.0202*
Framingham risk score (+6.53pts) 0.0145†
Correlates of Perfused-to-Total
Capillary Density Ratio
Correlates of Perfused-to-Total
Capillary Density Ratio
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Correlates of Perfused-to-Total
Capillary Density Ratio by Ethnicities
Correlates of Perfused-to-Total
Capillary Density Ratio by Ethnicities
None of the between-ethnicity comparisons reached significance.
Age BMI TC FRS
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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.
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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.
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Acknowledgements
Shanghai
Jiguang Wang
Yan Li
Changsheng Sheng
Qifang Huang
Shuai Wang
Yuanyuan Kang
Feika Li
Jie Song
Yibang Cheng
Qianhui Guo
Leuven
Jan A. Staessen
Yumei Gu
Yanping Liu
Lutgarde Thijs
Tatiana Kuznetsova
Peter Verhamme
Thibault Petit
Zhengyu Zhang
Fangfei Wei
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Thank You
谢
谢