早期糖尿病患者糖尿病视网膜病变发生率的调查分析

为调查早期糖尿病患者（病程＜５年）糖尿病视网膜病变的发生率。对本院内分泌科住院治疗的糖尿病患者（经ＷＨＯＩＤＤＭ诊断标准确诊，病程＜５年）７２例１４４只眼，双眼散瞳详细检查眼底，对可疑及有明确病变的患者行ＦＦＡ检查确诊。结果：７２例患者１４４只眼中眼底镜下有明确病变的４例５只眼，可疑１４例，该１８例患者行眼底荧光血管造影（ＦＦＡ）检查，最后确诊有糖尿病视网膜病变的６例７只眼，占８．３％。结论：要高度重视早期糖尿病患者糖尿病视网膜病变的发生     

糖尿病视网膜病变发病机制及治疗研究进展

糖尿病视网膜病变是糖尿病的重要并发症之一 ,它与多元醇代谢异常、蛋白质非酶糖化、脂质氧化及自由基作用、细胞凋亡、DG PKC系统的激活及细胞因子等多种因素有关。本研究就其病理、发病机制及防治作一综述     

关于加强患者遵守糖尿病视网膜病变筛选的意义和存在的问题

在中国,糖尿病视网膜病变已经成为主要的致盲疾病之一。大多数盲是可以避免的,因为及时的激光治疗在挽救视力时被证明是有效的。但是许多患者在早期没有症状,到出现症状时,对于有效的激光治疗为时已晚。所以做为糖尿病患者整体护理的一部分,对糖尿病患者仔细的和定期的眼部监测是非常有必要的。但是目前在中国对糖尿病视网膜病变的筛选还远远不够。作为将来糖尿病视网膜病变的干预基础,这篇文章分析了糖尿病视网膜病变筛查的重要性及执行问题。     

糖尿病性视网膜病变的随访观察

随访糖尿病视网膜病变（ＤＲ）单纯型Ⅰ、Ⅱ、Ⅲ期８５例１４５眼,单纯型进展为增殖型糖尿病视网膜病变（ＰＤＲ）Ⅳ期者,随访２年为２１眼（１４％）,５年为４９眼（３４％）;Ⅰ、Ⅱ、Ⅲ进展至Ⅳ期的发生率,Ⅲ期〉Ⅱ期,Ⅱ期〉Ⅰ期,差别有显著性（Ｐ〈０．０５）。糖尿病黄斑水肿随访年限增长而增加,初诊黄斑水肿３５眼,２年内增至４３眼,５年内增至５５眼,视网膜静脉串珠状改变,视网膜内大量微血管异常和四个象限内存在出血和／或微血管瘤是单纯型进展至ＰＤＲ的危险性病变,血糖控制不良,糖尿病病程长和高血压可能是单纯型进展至ＰＤＲ的危险性因素。为预防或减少ＤＲ致盲,应早期发现ＤＲ,并给予长期随访。     

糖尿病视网膜病变发病机制的研究进展

糖尿病视网膜病变是糖尿病的重要并发症之一,它与高血糖、多元醇代谢异常、蛋白质非酶糖化、细胞凋亡、DG2PKC系统的激活、细胞因子及自由基作用等多种因素有关。本研究就其病理、发病机制作一综述。     

氨基胍与糖尿病视网膜病变

糖尿病视网膜病变是严重的致盲眼病，氨基胍通过抑制蛋白非酶糖基化终末产物形成、一氧化氮合酶活性、对半卡巴肼敏感的胺氧化酶活性、毛细血管内白细胞粘滞、血管内皮生长因子以及抑制醛糖还原酶、防止低密度脂蛋白氧化修饰等途径来改善糖尿病视网膜病变。     

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。     

Management of diabetic retinopathy by Australian optometrists

Purpose: To describe current practices related to the management of diabetic retinopathy by Australian optometrists. Setting and Methods: A two-page self-administered questionnaire was mailed to a random sample of 504 Australian optometrists. The survey included questions about the practice (such as size and location); current practice with regard to management of patients with diabetic retinopathy; barriers to use of dilating drops; and a number of patient scenarios related to screening, follow-up and treatment of diabetic retinopathy. Results: Completed questionnaires were returned by 407 of the 473 eligible optometrists (86%). They had been practising optometry between 1 and 50 years (median 14). Of the 243 optometrists who provided details about the location of their practices, 145 (37%) had at least one of their practices in a rural area. The estimated percentage of patients with diagnosed diabetes ranged from 0.5 to 40% (median = 5.0%). Three-hundred and twenty-two optometrists (79%) reported that they would often or almost always ask new patients over the age of 40 whether they have diabetes. The majority of optometrists (n = 387, 95%) would often or almost always ask their new patients with diabetes about their control of blood glucose levels and the majority of optometrists (n = 330, 81%) would often or almost always tell their patients with diabetes about the importance of strict glucose control in delaying retinopathy. The most common barrier to dilated ophthalmoscopy was patients not wanting to be dilated, with 38.1% of optometrists reporting this to be a moderate or major barrier. The next most common barrier was fear of precipitating angle closure glaucoma; 17.1% of optometrists reported this to be a moderate or major barrier. Conclusion: The National Health and Medical Research Council (NHMRC) guidelines for the management of diabetic retinopathy are timely in relation to the expressed desire of Australian optometrists to learn more about management of diabetic retinopathy. These data will be used prospectively to assess changes in management of patients with diabetic retinopathy as a result of the release of the NHMRC guidelines.     

Lipemic diabetic retinopathy

A study group of eight patients with diabetic retinopathy and marked accumulation of hard exudates in the fundi is described. There was a significant increase in serum triglyceride levels (P less than 0.05) in the study group as compared to a control group of 23 consecutive patients with diabetic retinopathy. This exudative disorder is visually disabling and is associated with legal blindness in 50% of eyes. The authors believe that the term most appropriate to describe such a severe type of exudative response is lipemic diabetic retinopathy.     

高度近视眼与糖尿病视网膜病变的相关性

目前糖尿病视网膜病变的发病机制尚不明确.有研究发现,近视性屈光不正、长眼轴是糖尿病视网膜病变发病的保护性因素.其机制可能与眼轴增长、玻璃体后脱离、视网膜的低血流灌注状态、血管内皮生长因子等细胞因子的调节作用有关.本文对高度近视眼与糖尿病视网膜病变发生发展相关性的机制进行综述,希望能对糖尿病视网膜病变的防治提供一种新的理念.     

炎症在糖尿病视网膜病变中的作用

糖尿病视网膜病变(DR)是糖尿病(DM)最常见的微血管慢性并发症之一,其发病机制复杂,一直是国内外的研究热点之一。神经退行性病变、炎症和血管交替的再生与损伤共同促进DR的发生发展。近年来,越来越多的证据表明,视网膜的慢性低度炎症是DR的一个关键因素,是DR更为早期的表现,然而确切的分子机制尚不完全清楚。本文就炎症在DR发病机制中的作用及干预机制进行综述。     

糖尿病视网膜病变发生的相关危险因素分析

目的 评价糖尿病视网膜病变(DR)的相关危险因素。方法 对186例2型糖尿病患者可能诱发DR的危险因素如年龄、性别、病程、血压、体重指数、空腹血糖、血清胆固醇、甘油三酯、尿素氮、肌酐、尿白蛋白排泄率进行了前瞻性研究。并用单因素χ^2检验和多因素logistic回归分析筛选和判定DR发生的危险因素。结果 115例患者合并有DR，占61．83％。经logistic回归分析，发现病程、空腹血糖、甘油三酯、尿白蛋白排泄率与DR有显著相关。结论 病程、空腹血糖、甘油三酯、尿白蛋白排泄率为DR发生的重要危险冈素，应重视并针对其危险因素加以预防。     

光凝治疗增殖型糖尿病性视网膜病变

目的 观察光凝治疗增殖型糖尿病性视网膜病变的疗效。方法 对患有增殖型糖尿病性视网膜病变的１４３例２６０眼光凝前和光凝后３～６个月进行眼底、视力和荧光血管造影检查,并对造影的特征指标静脉渗漏荧光、出血遮蔽荧光、视网膜微动脉瘤、无灌注区以及视力进行比较和统计分析。结果 光凝后视力较光凝前提高及荧光血管造影特征指标好转均非常明显,差异有极显著性（Ｐ〈０．０００１）。结论 全视网膜光凝对增殖型糖尿病性视网     

SIRT1在糖尿病视网膜病变发病机制中的作用

沉默信息调节因子1（silent information regulator1,SIRT1）属于第Ⅲll型组蛋白去乙酰化酶,与糖尿病视网膜病变发病相关.SIRT1可通过抑制炎性反应,抑制氧化应激对视网膜细胞的损害,影响血管内皮生长因子的生成,抑制视网膜细胞凋亡,从而影响糖尿病视网膜病变的发病及进展.目前已有数个白藜芦醇（SIRT1激动剂）制剂进入治疗2型糖尿病的临床试验阶段,其治疗效果还需进一步验证.     

Susceptibility genes for diabetic retinopathy

Diabetic retinopathy (DR) is a sight-threatening chronic complication of diabetes mellitus and is the leading cause of acquired blindness in adults. Long-term exposure to the hyperglycemia of diabetes patients leads to the development of DR. Several studies have provided evidence that good diabetes control is important to prevent DR. However, emerging evidence suggests that genes are a significant contributor to an individual's risk of retinopathy. This evidence is from evalu- ations of familial aggregation and different incidence of DR in racial and ethnic groups. Some groups of patients develop DR despite good control and some escape retinopathy despite poor control. This suggests that the genes are involved in the susceptibility to DR. Genes suggested as having a role include those encoding aldose reductase, nitric oxide synthase, receptor for advanced glycation end products, angiotensin converting enzyme, vascular endothelial growth factors and pigment epithelium-derived factor. An understanding of the role of susceptibility genes will ultimately allow the development of novel therapeutic strategies. This article reviews the role of genetic factors in the etiology and progression of DR.     

糖尿病视网膜病变的危险因素分析

目的了解糖尿病患者发生糖尿病视网膜病变(diabetic retinopathy,DR)的危险因素,以探索DR的防治策略。方法收集2009年2月至8月中国医科大学第一附属医院内分泌科病房确诊为糖尿病且每年能够进行健康体检的343例患者的临床资料,分别进行问卷调查(一般情况和疾病情况)及实验室相关检查,并进行常规眼科检查,结合免散瞳眼底照相,筛选出患有DR的患者,分析其患病率及相关危险因素。结果 343例糖尿病患者中,DR者131例,患病率38.19%。糖尿病病程、糖尿病家族史、收缩压、舒张压、餐后2h血糖、甘油三酯、尿微量白蛋白是DR发生的危险因素(均为P<0.05),糖尿病病程是DR严重程度的危险因素(t=3.98,P<0.01)。性别、年龄、空腹血糖、糖化血红蛋白、总胆固醇、高密度脂蛋白、低密度脂蛋白、尿肌酐、尿素氮等因素未成为DR发生的危险因素(均为P>0.05)。结论内分泌科住院的糖尿病患者其DR的患病率较高。糖尿病患者的病程是DR发生发展的重要影响因素。     

周细胞与糖尿病视网膜病变

随着对周细胞生理，生化的研究进展，研究者们发现视网膜细血管周细胞与糖尿病视网膜病变的关系越来越密切，通过对周细胞的研究有助于阐明糖尿病视网膜病变的发病机理，从而为防治糖尿病视网膜病变提供一种新的思路。     

全视网膜光凝治疗糖尿病视网膜病变的重复应用指征

目的:探讨重复应用全视网膜光凝治疗糖尿病视网膜病变的指征。方法:糖尿病视网膜病变患者122例(212眼),78例(126眼)为非增生期,44例(86眼)为增生期。采用ND-YAG氩绿激光(波长530nm)进行全视网膜光凝,治疗分3~4期进行。术后24~36mo随访,评价视力变化、视网膜病变进展和视网膜新生血管消退情况。结果:治疗后视力(0.3的患者量明显小于治疗前,继续下降比率明显减少;全视网膜光凝术后3,12,24mo和36mo视网膜病变稳定率分别为73.6%,80.0%,84.0%,85.4%;新生血管消退分别达到38.6%,56.2%,73.6%,81.4%,治疗后视网膜新生血管逐渐减少。结论:如果存在严重视网膜缺氧征象,即出现小动脉瘤、微小出血点积聚、严重的视网膜内微血管异常和小静脉明显形成时,可多次重复应用全视网膜光凝治疗糖尿病视网膜病变。     

增生型糖尿病视网膜病变的B型超声观察

目的 结合临床探讨增生型糖尿病视网膜病变（PDR）的B型超声声像特征。方法 对58例75眼术前PDR病眼进行B型超声检查，13例17眼随访3个月以上。结果 超声检查发现赤道后区域有不完全玻璃体后脱离（PVD）51眼（68%），60眼（80%）有多处玻璃体视网膜粘连。将视网膜前的条带状回声分为4类。发现视网膜脱离（RD）37眼，随访期间PVD范围基本不变15眼，RD范围扩大或隆起度增高7眼。结论 超声检查可用于PDR随访，临床手术时机判断和手术方法提示。