卡托普利对早期糖尿病视网膜病变的防治效果

目的探讨卡托普利对早期糖尿病视网膜病变(diabetic retinopathy,DR)的预防及治疗作用,寻求延缓其发生发展的有效方法。方法选取2008年8月至2009年6月就诊于我院的2型糖尿病患者122例。随机分为卡托普利治疗组52例52眼,健康教育对照组70例70眼。随访18个月,比较两组的疗效及各项检查指标。结果卡托普利治疗组31眼有效(59.62%),21眼无效;健康教育对照组25眼有效(35.71%),45眼无效,差异有统计学意义(P<0.01)。随访18个月后,治疗组与对照组相比糖化血红蛋白、收缩压、舒张压无统计学差异(P>0.05),而血肌酐显著低于对照组,2组比较差异有显著统计学意义(P<0.01)。结论卡托普利可以明显延缓早期DR的发生和发展,提示血管紧张素转换酶抑制剂类药物可能成为预防和治疗早期DR的有效手段之一。     

2型糖尿病视网膜病变眼部血管血流动力学超声检测及其发生发展相关因素分析

目的：利用彩色多普勒超声检测2型糖尿病视网膜病变(diabetic retinopathy,DR)患者的滑车上动脉(supratrochlear artery,STCA)与球后相关动脉的血流动力学变化,并分析影响2型糖尿病DR发生发展的因素,以为糖尿病患者早期发现DR发病趋势、预防DR发生、采取有效干预措施阻止DR进展提供依据。

方法：选取2型糖尿病患者106例106眼,区分为糖尿病视网膜病变组(DR组)56例56眼右眼、糖尿病无视网膜病变组(NDR组)50例50眼右眼,选取同期于我院门诊体检的健康志愿者40例40眼右眼作为对照组(HC组); 彩色多普勒超声检测所有研究对象的STCA、视网膜中央动脉(central retinal artery,CRA)、睫状后动脉(posterior ciliary artery,PCA)的血流动力学变化,观察糖尿病患者血流频谱形态与血流动力学参数收缩期峰值血流速(peak systolic blood flow velocity,PSV)、舒张末期血流速度(end diastolic blood flow velocity,EDV)与血管阻力指数(vascular resistance index,RI)的改变情况; 检测所有研究对象空腹血糖(fasting blood glucose,FBG)、血清总胆固醇(total cholesterol,TC)、甘油三酯(Triglyceride,TG)、低密度脂蛋白胆固醇(low density lipoprotein-cholesterol,LDL-C)、高密度脂蛋白胆固醇(high density lipoprotein-cholesterol,HDL-C); 记录DR组与NDR组的糖尿病病程、体重指数(body mass index,BMI)、既往病史(高血压、糖尿病、高血脂等)、家族遗传病史、吸烟饮酒史,对相关因素做非条件Logistic多因素回归分析。

结果：在血流频谱形态方面,DR组与NDR组均发生了较明显的频谱形态改变; 在血流动力学参数方面,STCA、CRA、PCA的PSV、EDV在CH组、NDR组、DR组依次下降,RI依次上升; NDR组、DR组眼部动脉各血流参数值与HC组相比差异均有统计学意义(P<0.05),DR组STCA、CRA、PCA的PSV、EDV、RI与NDR组相比较,差异有统计学意义(P<0.05); 在DR发生发展相关因素方面,DR组与NDR组相比较,糖尿病病程、高血压病史与高血脂病史例数、舒张压、FBG、TG、LDL-C的差异有统计学意义(P<0.05)。

结论：对于糖尿病患者,超声检测血流动力学可作为早期预防DR、早期发现DR的主要手段,视网膜发生明显病变之前眼部血管血流动力学即可发生异常改变,且其改变程度与视网膜病变程度呈正相关,DR的发生发展与血糖、血压、血脂水平以及糖尿病病程等相关因素有密切关系。     

糖尿病视网膜病变的临床观察

目的　探讨糖尿病视网膜病变 (diabetic retinopathy,DR)由单纯型进展至增殖型 (proliferative dia-betic retinopathy,PDR)与诸因素的关系。方法　观察 6 8例 (116只眼 )经检眼镜及荧光眼底血管造影 (fundus fluo-rescein angiography,FFA)检查确诊为 DR的患者 ,其单纯型 DR进展至 PDR IV期的时间眼数及糖尿病性黄斑病变 (diabetic maculopathy,DM)的发展情况 ,并作统计分析。结果　单纯型 DR进展至 PDR IV期的百分率 2年为12 .7% ,5年为 2 9% ,且 > > ,差别具有显著性 (P <0 .0 0 5 )。DR的发展与糖尿病病程及血糖水平呈正相关 ,与高血压及肾脏病变有关。结论　早期发现 DR及 DR进展至 PDR的危险性因素 ,并进行有效的控制 ,是预防和减少 DR致盲的关键     

重视基于代谢异质性的糖尿病视网膜病变早期诊断和精准防治研究

糖尿病是多病因引起的慢性代谢性疾病,糖尿病视网膜病变(DR)是糖尿病的主要眼部并发症,是导致工作年龄人群不可逆盲的代谢性眼病。目前全球糖尿病患病率明显增加,且因DR早期导致的眼底血管神经单元病变无明显体征而常常延误诊疗,故DR的早期诊断和防控面临着巨大挑战。现阶段DR的早期临床预测指标具有较好的预测和防控DR发生发展的...     

亚临床期糖尿病视网膜病变的多焦视网膜电流图

多焦视网膜电流图(multifocalelectroretinogram,mERG或mfERG)是一种新兴的眼科检查手段,通过使用特殊m-序列刺激手段短时间内提取局部ERG信号,客观、定量地反映视网膜功能。糖尿病引起的眼部并发症是糖尿病患者致盲的一个主要原因,能够在亚临床期早期诊断糖尿病视网膜疾病(diabeticretinopathy,DR),对于预防和治疗DR有着重要的意义。mERG能够客观地检测DR,应用于研究和临床,评估那些预防和治疗DR方法的效果。     

亚临床期糖尿病视网膜病变与肾损害的对比研究

目的 从临床角度对比早期糖尿病视网膜病变(DR)和糖尿病肾病(DN)两者间的关系。 方法 对102例非胰岛素依赖型糖尿病患者做反映早期DR和DN敏感指标OPs和UAER、GFR的检测,进行两者关系的对比分析。结果 UAER正常的DR前期糖尿病患者,OPs总波辐降低,同时GFR呈相关性升高,OPs与GFR呈负相关(r=-0.63,P<0.01)。 结论 早期DR和DN呈平行关系,且两者似乎均与微血管异常有关,可能DR和DN是糖尿病微血管病变在不同部位的表现。     

基于视网膜神经血管单元损伤及其耦联失衡防治糖尿病视网膜病变的研究进展

糖尿病视网膜病变(DR)作为常见的糖尿病并发症之一,是导致失明的主要原因。传统上,DR主要被认为是一种微血管疾病,随着研究的进展,目前认为神经-胶质-血管单元(NVU)破坏及其耦联机制(coupling)失衡在DR发病的早期起到了关键作用。了解NVU的细胞和分子基础,以及糖尿病如何改变正常的细胞通讯和破坏细胞环境,对DR的早期防治具有重要的意义。本文总结视网膜NVU及其参与DR发病分子机制,基于视网膜NVU修复的DR治疗,并对DR未来发展前景及问题进行探讨。     

糖尿病视网膜病变相关基因多态性的研究进展

糖尿病视网膜病变( diabetic retinopathy,DR)为糖尿病的严重并发症之一,是目前全球第二大致盲性疾病。早期的流行病学资料表明,其发生发展与血糖水平、糖尿病病程、血脂等多种因素相关。近年来,基因多态性与DR发生的相关性受到广泛关注。准确把握基因在DR发生发展过程中的作用机制及其表达的差异性,对DR早期诊断和防治具有重要意义。因此本文对DR发生有关的基因研究进展进行综述。     

非胰岛素依赖性糖尿病患者的自动化视野改变

目的　从视功能的角度来观察分析糖尿病性视网膜病变(DR)的一些特点。方法　用自动视野计(Humphrey-640)对51例86眼伴早期DR的型糖尿病人作静态中心30°白色视野检测。结果　早期轻症DR患者的白色中心视野指标MD(平均偏差)和CPSD(矫正图样标准差)较正常对照组有显著性差异(P<0.001);空腹血糖与视野指标呈弱相关,糖化血红蛋白水平与视野损害有密切相关性(P<0.01)。　结论　早期无或仅有轻微DR的糖尿病患者中心视野可有明显异常;除视网膜形态性损害外,糖尿病条件下代谢因素影响亦是视野损害的重要原因。     

复方血栓通胶囊对糖尿病大鼠视网膜氧化应激损伤保护作用的观察

糖尿病的并发症糖尿病视网膜病变(DR)严重影响患者生活质量,目前越来越多的证据显示氧化应激是DR发生与发展的关键机制~([1]).因此如果对糖尿病患者早期干预氧化应激损伤将起到预防或阻止视网膜病变发生发展的关键作用.本研究选用现代活血化瘀中药复方血栓通胶囊,现代药理研究证实该复方具有抗氧化、清除自由基、抗血小板、保护血管内皮细胞、降低血液黏度等作用~([2,3]).我们通过建立诱导的糖尿病大鼠模型,观察了复方血栓通胶囊对糖尿病大鼠视网膜氧化应激损伤保护作用.现将结果报道如下.     

2型糖尿病强化治疗中视网膜变坏的危险因素分析

目的 探讨2型糖尿病患者强化治疗过程中视网膜变坏的相关危险因素.方法 对空腹血糖＞11.1 mmol/1或随机血糖＞13mmol/l的50例2型糖尿病患者进行强化治疗,强化治疗前和治疗后血糖达标进行眼科检查,糖尿病视网膜病变(diabetic retinopathyDR)程度采用Wisconsin scale分级,DR加重2级及以上定义为糖尿病视网膜病变变坏,分析比较视网膜变坏组和无视网膜变坏组相关临床指标.结果 强化治疗显示出快速稳定的降血糖效果.与无视网膜变坏组比较,视网膜变坏组糖尿病病程长,合并糖尿病肾病和糖尿病视网膜病变严重.多因素Logistic回归分析显示强化治疗前糖尿病视网膜病变与视网膜变坏的发生呈正相关.结论 强化治疗前存在糖尿病视网膜病变是强化治疗过程中发生视网膜变坏的独立危险因素,其严重程度与视网膜变坏呈正相关.     

Novel approaches for treating diabetic retinopathy based on recent pathogenic evidence

Diabetic retinopathy remains as a leading cause of blindness in developed countries. Current treatments target late stages of DR when vision has already been significantly affected. A better understanding of the pathogenesis of DR would permit the development of more efficient preventional/interventional strategies against early stages of DR. In this article a critical review of the state of the art of this issue is provided along with a discussion of problems which have yet to be overcome. Neuroprotection as a new approach for the treatment of the early stages of DR has been particularly emphasized.The development and progression of DR is not homogeneous and, apart from blood glucose levels and blood pressure, it depends on genetic factors which remain to be elucidated. In addition, the role of the pathogenic pathways is not the same in all patients. All these factors should be taken into account in the near future when an individualized oriented treatment for DR could become feasible. The new techniques in retinal imaging acquisition, the identification of useful circulating biomarkers and the individualized analysis of biological samples could facilitate the development of early and personalized therapy in the setting of DR.Finally, it should be noted that only a coordinated action among ophthalmologists, diabetologists, basic researchers, experts in pharmaco-economics and health care providers addressed to the design of rational strategies targeting prevention and the early stages of DR will be effective in reducing the burden and improving the clinical outcome of this devastating complication of diabetes.     

糖尿病视网膜病变的早期防治

糖尿病视网膜病变（diabetic retinopathy,DR）是一种难于逆转的致盲性眼病。鉴于目前我国治疗严重、复杂DR的医疗资源非常有限,因此,有必要将防盲工作的重点转移到DR的早期防治方面。但由于我国DR防治体系相对薄弱,尚缺乏根据循证医学原则所制定的恰当的防治指南,故广泛开展DR的早期防治工作尚面临较多困难。为此,充分认识DR早期防治的必要性和重要性,积极推广DR国际分型标准,采用公共卫生的途径,从初级卫生保健抓起,多方通力协作,加强其早期防治的实践和研究工作,将成为各级政府和DR防治工作者所面临的一项重要任务。（中华眼科杂志,2008,44：9-11）     

The worldwide epidemic of diabetic retinopathy

Diabetic retinopathy (DR), a major microvascular complication of diabetes, has a significant impact on the world's health systems. Globally, the number of people with DR will grow from 126.6 million in 2010 to 191.0 million by 2030, and we estimate that the number with vision-threatening diabetic retinopathy (VTDR) will increase from 37.3 million to 56.3 million, if prompt action is not taken. Despite growing evidence documenting the effectiveness of routine DR screening and early treatment, DR frequently leads to poor visual functioning and represents the leading cause of blindness in working-age populations. DR has been neglected in health-care research and planning in many low-income countries, where access to trained eye-care professionals and tertiary eye-care services may be inadequate. Demand for, as well as, supply of services may be a problem. Rates of compliance with diabetes medications and annual eye examinations may be low, the reasons for which are multifactorial. Innovative and comprehensive approaches are needed to reduce the risk of vision loss by prompt diagnosis and early treatment of VTDR.     

精确评估和控制糖尿病视网膜病变的进展

我国成人糖尿病患病率已达到12.8%。糖尿病视网膜病变（DR）患者约占糖尿病人群的1/4~1/3。而重度非增生型DR、增生型DR和糖尿病黄斑水肿（DME）等威胁视力的晚期病变患者数量估计各在数百万之多。在系统性防控糖尿病及其并发症的基础上,控制中度和高危的非增生型病变向晚期病变发展是避免糖尿病盲的重要关口。应用DR严重...     

Fenofibrate for the prevention of progression of non-proliferative diabetic retinopathy: review, consensus recommendations and guidance for clinical practice

The prevalence of diabetic retinopathy (DR), and associated morbidity is high in the Asia-Pacific region. Emerging evidence suggests a potential role for fenofibrate in the prevention of progression of DR, especially in patients with cardiovascular risk, and pre-existing mild-to-moderate DR. Fenofibrate has also been found to reduce maculopathy, and the need for laser treatment in these patients. Considering these benefits of fenofibrate, a group of experts from the fields of endocrinology and ophthalmology convened in May 2017, to discuss on the the mechanism of action, and clinical efficacy of fenofibrate in DR. The findings from key clinical studies on fenofibrate in DR were reviewed by the experts, and consensus statements were derived to define the role of fenofibrate in the prevention and treatment of DR. The statements were rated based on the GRADE criteria. An algorithm was also developed for the screening and treatment of DR in patients with type 2 diabetes (T2D), and the place of fenofibrate was defined in the algorithm. The expert recommendations, and the algorithm provided in this review will serve as a guide to the clinicians to reconsider the adjunctive use of fenofibrate for preventing the progression of DR in selected T2D patients.     

糖尿病视网膜病变早期优化代谢治疗研究进展

糖尿病视网膜病变（DR）是导致糖尿病人群视力严重损害的主要原因。现有的治疗措施大多针对已有视力受损的中晚期患者,且为有创性治疗,效果有限。因此,迫切需要早期预防DR发生风险或延缓DR进展的非侵入性新疗法和新靶点。早期优化代谢治疗,即在糖尿病早期严格控制血糖、血压、血脂至正常范围,可能预防或改善潜在的、可逆的微血管病变,...     

“代谢记忆”现象与糖尿病视网膜病变

“代谢记忆”现象是指,糖尿病患者发病时,如果高血糖不能及时调整到正常,即使后来血糖持续稳定在正常水平,其慢性并发症（包括视网膜病变）仍然会发生发展,难以逆转。糖尿病视网膜病变是一种常见的糖尿病并发症。现就“代谢记忆”与糖尿病视网膜病变发病的关系、“代谢记忆”现象的产生机制以及抗“代谢记忆”药物等研究状况进行简要综述,以期为糖尿病视网膜病变的防治提供新的策略。     

Diabetic retinopathy in pregnancy - A review

Diabetes and gestational diabetes (GD) are areas of concern worldwide. GD can eventually lead to serious development of diabetic retinopathy (DR) during pregnancy or worsening of an already existing DR. GD confers future risk of diabetes, both in the mother and fetus, further complicating their lives. DR in pregnant women has been intriguing in terms of understanding the prevalence, assessing risk factors causing pathogenesis, and problems associated with treating them. Pregnancy itself is a risk factor for progression of DR. Physiological changes such as metabolic, vascular, immunologic, and hormonal changes that occur during pregnancy can cause development as well as worsening of DR. This can eventually lead to permanent visual loss if not addressed on time. Timing of laser, choice of treatment for diabetic macular edema with laser, intravitreal anti-vascular endothelial growth factor agents (VEGF), and intravitreal steroids pose a serious challenge in managing these patients without causing damage to the mother and fetus. This review article showcases the prevalence, risk factors, and pathogenesis, outlines the management of DR in pregnancy, and recommends guidelines based on the available evidence. PubMed and MEDLINE searches were performed pertaining to the prevalence of GD in India, DR in pregnancy, risk factors for progression of DR, role of vasoactive mediators in DR, role of angiopoietic factors in DR, hormonal influence of DR, role of growth factors in DR, use of fluorescein and indocyanine green angiography, retinal lasers, anti-VEGF agents, intravitreal steroids, anesthesia, and retinal surgery, all pertaining to pregnancy and guidelines and recommendations for managing DR in pregnancy.