糖尿病视网膜病变的研究现状
Research Status of Diabetic Retinopathy
DOI: 10.12677/ACM.2022.127981, PDF,   
作者: 白旭旭：延安大学，陕西 延安；王理论：延安大学附属医院，陕西 延安
关键词: 糖尿病视网膜病变；机制；治疗；Diabetic Retinopathy； Mechanism； Treatment
摘要: 全世界糖尿病患者人数居高不下，我国糖尿病的患病率位于第一位。糖尿病视网膜病变(diabetic retinopathy, DR)一种常见的糖尿病微血管并发症，可引起不同程度的视功能损害。DR的发生因素多种多样，其发生机制尚不完全清楚。目前临床上也出现了DR的各种治疗方式，疗效各不相同。随着DR发病机制研究的不断进展，治疗该病的方法也不断被更新。本文就近年的研究报道对DR目前的流行病学、危险因素、机制和治疗方法的现状进行以下综述，希望可以对DR的临床治疗提供参考意见。
Abstract: The number of diabetic patients in the world remains high, and the prevalence of diabetes in my country ranks first. Diabetic retinopathy (DR) is a common microvascular complication of diabetes, which can cause different degrees of visual impairment. The occurrence factors of DR are varied, and its mechanism is not fully understood. At present, various treatment methods for DR have also appeared in clinical practice, and the curative effects are different. With the continuous progress of the research on the pathogenesis of DR, the methods for the treatment of the disease are also con-stantly updated. In this paper, the current status of epidemiology, risk factors, mechanisms and treatment methods of DR is reviewed based on the research reports in recent years, hoping to pro-vide reference for the clinical treatment of DR.
文章引用：白旭旭, 王理论. 糖尿病视网膜病变的研究现状[J]. 临床医学进展, 2022, 12(7): 6804-6811. https://doi.org/10.12677/ACM.2022.127981

参考文献

[1] Chen, H.J., Wang, C.G., Dou, H.L., et al. (2020) Effect of Intravitreal Ranibizumab Pretreatment on Vitrectomy in Young Patients with Proliferative Diabetic Retinopathy. Annals of Palliative Medicine, 9, 82-89. [Google Scholar] [CrossRef] [PubMed]
[2] 中国老年2型糖尿病防治临床指南(2022年版) [J]. 中国糖尿病杂志, 2022, 30(1): 2-51.
[3] 李筱荣, 杨千惠. 美国眼科学会《糖尿病视网膜病变临床指南》解读[J]. 中华实验眼科杂志, 2020, 38(9): 795-798.
[4] 刘旭, 王霞, 何媛. 糖尿病视网膜病变危险因素与预防研究进展[J]. 眼科新进展, 2018, 38(7): 687-691.
[5] 覃水喷. 糖尿病视网膜病变的临床治疗现状及研究进展[J]. 国际医药卫生导报, 2022, 28(8): 1180-1184.
[6] 祝伟, 苏冠方, 王晨光, 等. 糖尿病视网膜病变的病理机制和新型药物研究进展[J]. 中国老年学杂志, 2013, 33(5): 1207-1210.
[7] 贺鹏程, 刘昌汶, 尹卫东, 等. 糖尿病性视网膜病中血-视网膜屏障损伤的研究进展[J]. 临床与病理杂志, 2019, 39(5): 1090-1094.
[8] Bai, Y., Ma, J.X., Guo, J., et al. (2009) Muller Cell-Derived VEGF Is a Significant Contributor to Retinal Neovascularization. The Journal of Pathology, 219, 446-454. [Google Scholar] [CrossRef] [PubMed]
[9] Feng, S., Yu, H., Yu, Y., et al. (2018) Levels of Inflamma-tory Cytokines IL-1beta, IL-6, IL-8, IL-17A, and TNF-Alpha in Aqueous Humour of Patients with Diabetic Retinopathy. Journal of Diabetes Research, 2018, Article ID: 8546423. [Google Scholar] [CrossRef] [PubMed]
[10] Hammes, H.P. (2018) Diabetic Retinopathy: Hyperglycaemia, Oxida-tive Stress and beyond. Diabetologia, 61, 29-38. [Google Scholar] [CrossRef] [PubMed]
[11] 刘钰, 李乐乐, 桑爱民. 氧化应激在糖尿病视网膜病变发病机制中的作用[J]. 国际眼科纵览, 2022, 46(1): 5-10.
[12] Chang, K.C., Snow, A., LaBarbera, D.V., et al. (2015) Aldose Reductase Inhibition Alleviates Hyperglycemic Effects on Human Retinal Pigment Epithelial Cells. Chemi-co-Biological Interactions, 234, 254-260. [Google Scholar] [CrossRef] [PubMed]
[13] Stitt, A.W. (2003) The Role of Advanced Glycation in the Patho-genesis of Diabetic Retinopathy. Experimental and Molecular Pathology, 75, 95-108. [Google Scholar] [CrossRef] 
[14] 邢薇, 董志军, 张铁民. 糖尿病视网膜病变发病机制的研究进展[J]. 中国实用眼科杂志, 2014, 32(6): 675-678.
[15] 崔彦, 许迅. 糖尿病性视网膜病变分子机制的研究进展[J]. 眼视光学杂志, 2007, 9(2): 135-138.
[16] 张凤俊, 李晶明, 刘秋平. 糖尿病视网膜病变发病机制及潜在治疗研究进展[J]. 眼科新进展, 2020, 40(7): 677-685.
[17] 陈小红, 王云鹏, 陈梅珠. VEGF在糖尿病性视网膜病变发病机制中的作用及抗VEGF治疗新进展[J]. 眼科新进展, 2015, 35(7): 692-696.
[18] 任洪芹, 朱鸿, 施彩虹. 糖尿病视网膜病变相关炎性细胞因子研究进展[J]. 国际眼科杂志, 2010, 10(4): 697-699.
[19] Demircan, N., Saf-ran, B.G., Soylu, M., et al. (2006) Determination of Vitreous Interleukin-1 (IL-1) and Tumour Necrosis Factor (TNF) Levels in Proliferative Diabetic Retinopathy. Eye, 20, 1366-1369. [Google Scholar] [CrossRef] [PubMed]
[20] 于宏飞, 董志军, 张铁民. 糖尿病视网膜病变相关炎性因子的研究进展[J]. 中国实用眼科杂志, 2015, 33(7): 713-716.
[21] 周林, 康建芳, 冯军, 等. 糖尿病视网膜病变患者房水VEGF和IL-6水平的测定及其临床意义[J]. 中国实用眼科杂志, 2011, 29(1): 21-24.
[22] Joy, S.S. and Siddiqui, K. (2019) Molecular and Pathophysiological Mechanisms of Diabetic Retinopathy in Relation to Adhesion Molecules. Cur-rent Diabetes Reviews, 15, 363-371. [Google Scholar] [CrossRef] [PubMed]
[23] Zietz, B., Buechler, C., Kobuch, K., et al. (2008) Se-rum Levels of Adiponectin Are Associated with Diabetic Retinopathy and with Adiponectin Gene Mutations in Cauca-sian Patients with Diabetes Mellitus Type 2. Experimental and Clinical Endocrinology & Diabetes, 116, 532-536. [Google Scholar] [CrossRef] [PubMed]
[24] 刘艳, 隋虹, 罗志忠, 等. 糖尿病性视网膜病变与糖尿病控制状态研究[J]. 中国糖尿病杂志, 2002, 10(1): 37-39.
[25] Ting, D.S., Cheung, G.C. and Wong, T.Y. (2016) Diabetic Retinopathy: Global Prevalence, Major Risk Factors, Screening Practices and Public Health Challenges: A Review. Clin-ical & Experimental Ophthalmology, 44, 260-277. [Google Scholar] [CrossRef] [PubMed]
[26] Rodriguez-Fontal, M., Kerrison, J.B., Alfaro, D.V. and Jablon, E.P. (2009) Metabolic Control and Diabetic Retinopathy. Current Diabetes Reviews, 5, 3-7. [Google Scholar] [CrossRef] [PubMed]
[27] Yoon, Y.H., Boyer, D.S., Maturi, R.K., et al. (2019) Natural History of Diabetic Macular Edema and Factors Predicting Outcomes in Sham-Treated Patients (MEAD Study). Graefe’s Archive for Clinical and Experimental Ophthalmology, 257, 2639-2653. [Google Scholar] [CrossRef] [PubMed]
[28] Lock, J.H. and Fong, K.C.S. (2010) Retinal Laser Photocoagu-lation. Medical Journal of Malaysia, 65, 88-94.
[29] 高晔, 孙桂波, 罗云, 等. 糖尿病视网膜病的发病机制及药物干预研究进展[J]. 中国药理学通报, 2020, 36(4): 491-495.
[30] 周爱意, 陈凌, 周陈静, 等. 全视网膜激光光凝治疗高危增生型糖尿病视网膜病变的效果分析[J]. 眼科新进展, 2016, 36(4): 352-355.
[31] 陈家欣, 吴瑜瑜. 全视网膜光凝术对糖尿病视网膜病变视网膜神经纤维层及黄斑区视网膜的影响[J]. 眼科新进展, 2015, 35(4): 380-383.
[32] Chen, H., Pan, X.F., Yang, J.Y., et al. (2021) Application of 5G Technology to Conduct Real-Time Teleretinal Laser Photocoagulation for the Treatment of Diabetic Retinopathy. JAMA Ophthalmology, 139, 975-982. [Google Scholar] [CrossRef] [PubMed]
[33] 陈娟, 吕红彬. 抗VEGF药物在糖尿病性视网膜病变治疗中的应用[J]. 眼科新进展, 2014, 34(4): 397-400.
[34] 邓玲, 潘颖喆, 王慧. 糖尿病性视网膜病变的治疗进展[J]. 2020, 20(3): 489-491.
[35] Googe, J., Brucker, A.J., Bressler, N.M., et al. (2011) Randomized Trial Evaluating Short-Term Effects of Intravitreal Ranibizumab or Triamcinolone Acetonide on Macular Edema after Focal/Grid Laser for Diabetic Macular Edema in Eyes Also Receiving Panretinal Photocoagulation. Retina, 31, 1009-1027. [Google Scholar] [CrossRef] 
[36] Machemer, R., Sugita, G. and Tano, Y. (1979) Treatment of Intraocular Proliferations with Intravitreal Steroids. Transactions of the American Ophthalmological Society, 77, 171-180.
[37] Ciardella, A.P., Klancnik, J., Schiff, W., et al. (2004) Intravitreal Triamcinolone for the Treatment of Re-fractory Diabetic Macular Oedema with Hard Exudates: An Optical Coherence Tomography Study. British Journal of Ophthalmology, 88, 1131-1136. [Google Scholar] [CrossRef] [PubMed]
[38] He, Y., Ren, X.J., Hu, B.J., et al. (2018) A Meta-Analysis of the Effect of a Dexamethasone Intravitreal Implant versus Intravitreal Anti-Vascular Endothe-lial Growth Factor Treatment for Diabetic Macular Edema. BMC Ophthalmology, 18, Article No. 121. [Google Scholar] [CrossRef] [PubMed]
[39] Ciulla, T.A., Harris, A., McIntyre, N., et al. (2014) Treatment of Diabetic Macular Edema with Sustained-Release Glucocorticoids: Intravitreal Triamcinolone Acetonide, Dexamethasone Implant, and Fluocinolone Acetonide Implant. Expert Opinion on Pharmacotherapy, 15, 953-959. [Google Scholar] [CrossRef] [PubMed]
[40] Lin, J., Chang, J.S., Yannuzzi, N.A., et al. (2018) Cost Eval-uation of Early Vitrectomy versus Panretinal Photocoagulation and Intravitreal Ranibizumab for Proliferative Diabetic Retinopathy. Ophthalmology, 125, 1393-1400. [Google Scholar] [CrossRef] [PubMed]
[41] 杨艳风, 程萍, 魏婷. 玻璃体切除联合白内障手术治疗增生性糖尿病视网膜病变的疗效[J]. 国际眼科杂志, 2018, 18(3): 544-546.
[42] Al-Khersan, H., Venincasa, M.J., Kloosterboer, A., et al. (2020) Pars Plana Vitrectomy Reoperations for Complications of Proliferative Diabetic Retinopa-thy. Clinical Ophthalmology, 14, 1559-1563. [Google Scholar] [CrossRef] 
[43] Zhang, Z.H., Liu, H.Y., Hernandez-Da, M.S., et al. (2013) Vitrec-tomy with or without Preoperative Intravitreal Bevacizumab for Proliferative Diabetic Retinopathy: A Meta-Analysis of Randomized Controlled Trials. American Journal of Ophthalmology, 156, 106-115. [Google Scholar] [CrossRef] [PubMed]

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