糖尿病视网膜病变综合诊疗进展：从分子机制到精准医学管理

Advancing Integrated Management of Diabetic Retinopathy: From Molecular Pathogenesis to Precision Medicine

摘要: 糖尿病视网膜病变(Diabetic Retinopathy, DR)作为糖尿病最常见且特征性的微血管并发症，是全球工作年龄人群视力丧失的首要病因。该疾病的病理生理过程构成一个高度复杂的网络，核心环节包括长期高血糖所驱动的氧化应激、持续低度炎症、血管内皮生长因子信号通路异常活化以及神经血管单元整体功能损害。在临床诊疗方面，当前策略依赖于多模态影像学评估，并采取融合系统性危险因素管理与眼部特异性治疗(如抗血管内皮生长因子药物、激光及手术)的综合方案。随着人工智能辅助筛查系统的应用、新型靶向疗法的探索以及多学科协作模式的不断完善，DR的防治体系正在向早期预警、精准干预和全周期管理的新范式深刻演进。

Abstract: Diabetic retinopathy (DR), the hallmark microvascular complication of diabetes mellitus, represents the leading cause of vision loss among the global working-age population. Its pathophysiological cascade entails a highly intricate network, central to which are chronic hyperglycemia-driven oxidative stress, sustained low-grade inflammation, aberrant activation of vascular endothelial growth factor signaling, and dysfunction of the neurovascular unit. Current clinical management relies on multimodal imaging for assessment and adopts an integrated strategy that combines systemic risk factor control with local ocular interventions, including anti-VEGF agents, laser therapy, and surgery. The integration of artificial intelligence-assisted screening systems, the exploration of novel targeted therapies, and the refinement of multidisciplinary care models are collectively driving a profound transformation in the DR management paradigm toward early prediction, precise intervention, and holistic, life-cycle-based care.