肥胖及维生素D缺乏致糖尿病视网膜病变的 机制与研究进展

Mechanisms and Research Progress of Diabetic Retinopathy Induced by Obesity and Vitamin D Deficiency

摘要: 糖尿病视网膜病变(Diabetic Retinopathy)是糖尿病最常见的微血管并发症，现已成为视力损害和失明的主要原因之一。近年来，肥胖与维生素D缺乏的流行趋势日益严峻，两者均被证实与DR的发生发展密切相关。值得注意的是，肥胖与维生素D缺乏之间存在着双向作用的恶性循环。而在DR的发生发展中，维生素D缺乏与肥胖通过多条交互通路发挥致病作用。维生素D缺乏可放大肥胖所致的脂肪因子失衡，加重肥胖诱导的慢性低度炎症与氧化应激，二者也会共同加剧胰岛素抵抗，形成高血糖恶性循环，从而加重DR的进展。种种研究表明维生素D缺乏是DR的独立危险因素，而肥胖与DR的关系较为复杂，呈现种族差异性及“肥胖悖论”现象。本文系统综述肥胖与维生素D缺乏的双向调控机制，及其协同加剧糖尿病视网膜病变的交互作用，旨在为DR的早期预防和综合干预提供新的理论依据。

Abstract: Diabetic retinopathy (DR), the most common microvascular complication of diabetes mellitus, has become one of the leading causes of visual impairment and blindness. In recent years, the increasing prevalence of obesity and vitamin D deficiency has drawn significant attention, as both have been confirmed to be closely associated with the onset and progression of DR. Notably, a bidirectional vicious cycle exists between obesity and vitamin D deficiency. In the pathogenesis of DR, vitamin D deficiency and obesity exert pathogenic effects through multiple interactive pathways. Vitamin D deficiency can exacerbate obesity-induced adipokine imbalance, intensify chronic low-grade inflammation and oxidative stress, and together they worsen insulin resistance, thereby forming a hyperglycemic vicious cycle that accelerates DR progression. Accumulating evidence indicates that vitamin D deficiency is an independent risk factor for DR. In contrast, the relationship between obesity and DR is more complex, characterized by racial differences and the “obesity paradox”. This article systematically reviews the bidirectional regulatory mechanisms between obesity and vitamin D deficiency, as well as their synergistic effects in exacerbating diabetic retinopathy, aiming to provide a new theoretical basis for the early prevention and comprehensive intervention of DR.