吸烟对年龄相关性黄斑变性发生和发展的影响

年龄相关性黄斑变性(AMD)的视力损失多由视网膜色素上皮细胞的凋亡和光感受器的退化引起。主动、被动吸烟会增加AMD发病率及向晚期AMD进展的风险,并且影响湿性AMD的治疗效果。吸烟可引起脉络膜血管收缩、血管阻力增加、血管内皮功能障碍、脉络膜和神经节细胞复合体变薄,导致脉络膜和视网膜血管反应性受损。香烟中的尼古丁可导致血管内皮生长因子(VEGF)过度表达,VEGF增加血管通透性及诱导内皮细胞增生,从而诱发脉络膜新生血管(CNV)的形成。吸烟可诱发氧化应激,导致氧化损伤,减少补体因子H表达,增加膜攻击复合物,导致巨噬细胞功能异常,促进玻璃膜疣形成,诱导CNV形成。因此,在控制AMD发生、预防CNV形成中应充分认识吸烟与CNV以及AMD的关系,这对AMD的早期预防及探索更有效的治疗途径有着重要的意义。

Influence of smoking on the occurrence and development of age-related macular degeneration

Age-related macular degeneration(AMD)causes vision loss mainly due to apoptosis of retinal pigment epithelium cells and subsequent degeneration of photoreceptors.Active and passive smoking can increase the incidence of AMD and the progression risk of advanced AMD,and affect the treatment effect of wet AMD.Smoking can cause choroidal vasoconstriction,increased vascular resistance,vascular endothelial dysfunction,thinned choroid and ganglion cell complexes,resulting in impaired vascular reactivity of choroid and retinal vessels.Nicotine in cigarettes can lead to the overexpression of vascular endothelial growth factor(VEGF),which increases the permeability of vessel and proliferation of endothelial cells,thus induces the formation of choroidal neovascularization(CNV).Smoking can induce oxidative stress leading to oxidative damage,reduce the expression of complement factor H,increase the membrane attack complex,lead to macrophage dysfunction,promote the formation of drusen,and induce the formation of CNV.Therefore,a full and deep understanding of the relationship between smoking and CNV and AMD in controlling the occurrence of AMD and preventing the formation of CNV is of great significance for the early prevention of AMD and the exploration of more effective treatment approaches.