[1]万光明,薛瑢.糖尿病视网膜病变的危险因素与预防控制[J].眼科新进展,2021,41(6):501-505.[doi:10.13389/j.cnki.rao.2021.0104]
　WAN Guangming,XUE Rong.Risk factors for diabetic retinopathy and its prevention and treatment[J].Recent Advances in Ophthalmology,2021,41(6):501-505.[doi:10.13389/j.cnki.rao.2021.0104]
点击复制

糖尿病视网膜病变的危险因素与预防控制/HTML
分享到：

《眼科新进展》[ISSN:1003-5141/CN:41-1105/R]

卷:
41卷
期数:
2021年6期
页码:
501-505
栏目:
述评
出版日期:
2021-06-05

文章信息/Info

Title:
Risk factors for diabetic retinopathy and its prevention and treatment
作者:
万光明; 薛瑢
450052　河南省郑州市，郑州大学第一附属医院眼科
Author(s):
WAN Guangming; XUE Rong
Department of Ophthalmology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,Henan Province,China
关键词:
糖尿病视网膜病变; 危险因素; 预防; 控制; 治疗策略
Keywords:
diabetic retinopathy;  risk factors;  prevention;  control;  treatment strategy
分类号:
R774.1
DOI:
10.13389/j.cnki.rao.2021.0104
文献标志码:
A
摘要:
糖尿病视网膜病变（DR）是糖尿病最常见的并发症之一，随着病情进展可对糖尿病患者的视力造成不同程度的威胁，甚至导致低视力或盲。与DR有关的危险因素包括但不限于糖尿病病程、高血糖、高血压、青春期、妊娠、眼轴长度等，提高对DR相关危险因素的认知，对可改变的危险因素及时采取干预措施有助于防止DR发生。在DR的防控策略中，仍需强调有效的糖尿病管理以及对糖尿病患者加强DR筛查，建设完善的筛查系统。激光光凝、药物治疗和玻璃体切割术是目前延缓DR进展、挽救视力的主要治疗方法，然而DR的发病机制还未完全清楚，仍需要更多的研究继续关注DR治疗的新靶点和新方法。
Abstract:
Diabetic retinopathy (DR) is one of the most common complications of diabetes. With the development of diabetes, DR will threaten the vision of diabetic patients to different degrees and even lead to low vision or blindness. The risk factors related to DR include but not limited to the course of diabetes, hyperglycemia, hypertension, puberty, pregnancy, axial length and so on. Improving awareness about DR and taking measures to control risk factors is helpful to prevent the occurrence of DR. As to the prevention and controlling strategies of DR, the importance of effective diabetes management, continuing systemic risk factors control, strengthening regular screening, and building a well-established screening system still need to be emphasized. Laser photocoagulation, drug therapy, and vitrectomy are currently the main treatments to delay the progress and alleviate visual impairment of DR. However, the pathogenesis of DR is not completely clear, and more research is needed to pay attention to new targets and methods for the treatment of DR.

参考文献/References:

［1］　International Diabetes Federation.IDF Diabetes Atlas-9th edition 2019［EB/OL］.http://www.diabetesatlas.org.
［2］　CHEUNG N,MITCHELL P,WONG T Y.Diabetic retinopathy［J］.Lancet,2010,376(9735):124-136.
［3］　YAU J W,ROGERS S L,KAWASAKI R,LAMOUREUX E L,KOWALSKI J W,BEK T,et al.Global prevalence and major risk factors of diabetic retinopathy［J］.Diabetes Care,2012,35(3):556-564.
［4］　LEASHER J L,BOURNE R R,FLAXMAN S R,JONAS J B,KEEFFE J,NAIDOO K,et al.Global estimates on the number of people blind or visually impaired by diabetic retinopathy:a meta-analysis from 1990 to 2010［J］.Diabetes Care,2016,39(9):1643-1649.
［5］　LEE R,WONG T Y,SABANAYAGAM C.Epidemiology of diabetic retinopathy,diabetic macular edema and related vision loss［J］.Eye Vis (Lond),2015,2:17.
［6］　BERTELSEN G,PETO T,LINDEKLEIV H,SCHIRMER H,SOLBU M D,TOFT I,et al.Tromso eye study:prevalence and risk factors of diabetic retinopathy［J］.Acta Ophthalmol,2013,91(8):716-721.
［7］　ROY M S,KLEIN R,O’COLMAIN B J,KLEIN B E,MOSS S E,KEMPEN J H.The prevalence of diabetic retinopathy among adult type 1 diabetic persons in the United States［J］.Arch Ophthalmol,2004,122(4):546-551.
［8］　LIU L,WU X,LIU L,GENG J,YUAN Z,SHAN Z,et al.Prevalence of diabetic retinopathy in mainland China:a meta-analysis［J］.PLoS One,2012,7(9):e45264.
［9］　RAMAN R,RANI P K,REDDI RACHEPALLE S,GNANAMOORTHY P,UTHRA S,KUMARAMANICKAVEL G,et al.Prevalence of diabetic retinopathy in India:sankara nethralaya diabetic retinopathy epidemiology and molecular genetics study report 2［J］.Ophthalmology,2009,116(2):311-318.
［10］　KLEIN R,KLEIN B E,MOSS S E,DAVIS M D,DEMETS D L.The Wisconsin epidemiologic study of diabetic retinopathy.II.Prevalence and risk of diabetic retinopathy when age at diagnosis is less than 30 years［J］.Arch Ophthalmol,1984,102(4):520-526.
［11］　VARMA R,TORRES M,PEA F,KLEIN R,AZEN S P,Los Angeles Latino Eye Study Group.Prevalence of diabetic retinopathy in adult Latinos:the Los Angeles Latino eye study［J］.Ophthalmology,2004,111(7):1298-1306.
［12］　KLEIN R,KLEIN B E,MOSS S E,DAVIS M D,DEMETS D L.The wisconsin epidemiologic study of diabetic retinopathy.III.Prevalence and risk of diabetic retinopathy when age at diagnosis is 30 or more years［J］.Arch Ophthalmol,1984,102(4):527-532.
［13］　OLSEN B S,SJOLIE A K,HOUGAARD P,JOHANNESEN J,MARINELLI K,JACOBSEN B B,et al.The significance of the prepubertal diabetes duration for the development of retinopathy and nephropathy in patients with type 1 diabetes［J］.J Diabetes Complications,2004,18(3):160-164.
［14］　EGAN A M,MCVICKER L,HEEREY A,CARMODY L,HARNEY F,DUNNE F P.Diabetic retinopathy in pregnancy:a population-based study of women with pregestational diabetes［J］.J Diabetes Res,2015,2015:310239.
［15］　KUMARI N,BHARGAVA M,NGUYEN D Q,GAN A T L,TAN G,CHEUNG N,et al.Six-year incidence and progression of diabetic retinopathy in Indian adults:the Singapore Indian Eye study［J］.Br J Ophthalmol,2019,103(12):1732-1739.
［16］　TAM V H,LAM E P,CHU B C,TSE K K,FUNG L M.Incidence and progression of diabetic retinopathy in Hong Kong Chinese with type 2 diabetes mellitus［J］.J Diabetes Complicat,2009,23(3):185-193.
［17］　DCCT/EDIC Research Group.Retinopathy and nephropathy in patients with type 1 diabetes four years after a trial of intensive therapy［J］.N Engl J Med,2000,342(6):381-389.
［18］　The Writing Team for the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group.Effect of intensive therapy on the microvascular complications of type 1 diabetes mellitus［J］.JAMA,2002,287(19):2563-2569.
［19］　IDRIS I,WARREN G,DONNELLY R.Association between thiazolidinedione treatment and risk of macular edema among patients with type 2 diabetes［J］.Arch Intern Med,2012,172(13):1005-1011.
［20］　LEE J H,KIM Y A,LEE Y,BANG W D,SEO J H.Association between interarm blood pressure differences and diabetic retinopathy in patients with type 2 diabetes［J］.Diab Vasc Dis Res,2020,17(7):1479164120945910.
［21］　YIN L,ZHANG D,REN Q,SU X,SUN Z.Prevalence and risk factors of diabetic retinopathy in diabetic patients:a community based cross-sectional study［J］.Medicine (Baltimore),2020,99(9):e19236.
［22］　ZHONG Y,YUE S,WU J,GUAN P,ZHANG G,LIU L,et al.Association of the serum total cholesterol to triglyceride ratio with diabetic retinopathy in Chinese patients with type 2 diabetes:a community-based study［J］.Diabetes Ther,2019,10(2):597-604.
［23］　SONG P,YU J,CHAN K Y,THEODORATOU E,RUDAN I.Prevalence,risk factors and burden of diabetic retinopathy in China:a systematic review and meta-analysis［J］.J Glob Health,2018,8(1):010803.
［24］　ROMERO-AROCA P,BAGET-BERNALDIZ M,NAVARRO-GIL R,MORENO-RIBAS A,VALLS-MATEU A,SAGARRA-ALAMO R,et al.Glomerular filtration rate and/or ratio of urine albumin to creatinine as markers for diabetic retinopathy:a ten-year follow-up study［J］.J Diabetes Res,2018,2018:5637130.
［25］　GALE R,SCANLON P H,EVANS M,GHANCHI F,YANG Y,SILVESTRI G,et al.Action on diabetic macular oedema:achieving optimal patient management in treating visual impairment due to diabetic eye disease［J］.Eye (Lond),2017,31(S1):S1-S20.
［26］　LIN Z,LI D,ZHAI G,WANG Y,WEN L,DING X X,et al.High myopia is protective against diabetic retinopathy via thinning retinal vein:a report from Fushun Diabetic Retinopathy Cohort Study (FS-DIRECT)［J］.Diab Vasc Dis Res,2020,17(4):1479164120940988.
［27］　KIM D Y,SONG J H,KIM Y J,LEE J Y,KIM J G,YOON Y H,et al.Asymmetric diabetic retinopathy progression in patients with axial anisometropia［J］.Retina,2018,38(9):1809-1815.
［28］　NADERAN M,NADERAN M,REZAGHOLIZADEH F,ZOLFAGHARI M,PAHLEVANI R,RAJABI M T.Association between diabetes and keratoconus:a case-control study［J］.Cornea,2014,33(12):1271-1273.
［29］　LIN S,RAMULU P,LAMOUREUX E L,SABANAYAGAM C.Addressing risk factors,screening,and preventative treatment for diabetic retinopathy in developing countries:a review［J］.Clin Exp Ophthalmol,2016,44(4):300-320.
［30］　SAPKOTA R,CHEN Z,ZHENG D,PARDHAN S.The profile of sight-threatening diabetic retinopathy in patients attending a specialist eye clinic in Hangzhou,China［J］.BMJ Open Ophthalmol,2019,4(1):e000236.
［31］　SHAN R,SARKAR S,MARTIN S S.Digital health technology and mobile devices for the management of diabetes mellitus:state of the art［J］.Diabetologia,2019,62(6):877-887.
［32］　WONG T Y,SABANAYAGAM C.The war on diabetic retinopathy:where are we now? ［J］.Asia Pac J Ophthalmol (Phila),2019,8(6):448-456.
［33］　DAVILA J R,SENGUPTA S S,NIZIOL L M,SINDAL M D,BESIRLI C G,UPADHYAYA S,et al.Predictors of photographic quality with a handheld nonmydriatic fundus camera used for screening of vision-threatening diabetic retinopathy［J］.Ophthalmologica,2017,238(1/2):89-99.
［34］　GULSHAN V,PENG L,CORAM M,STUMPE M C,WU D,NARAYANASWAMY A,et al.Development and validation of a deep learning algorithm for detection of diabetic retinopathy in retinal fundus photographs［J］.JAMA,2016,316(22):2402-2410.
［35］　BELLIMO V,LIM Z W,LIM G,NGUYEN D Q,XIE Y,YIP M Y T,et al.Artificial intelligence using deep learning to screen for referable and vision-threatening diabetic retinopathy in Africa:a clinical validation study［J］.Lancet Digital Health,2019,1:e35-e44.
［36］　Early Treatment Diabetic Retinopathy Study Research Group.Early Treatment Diabetic Retinopathy Study design and baseline patient characteristics.ETDRS report number 7［J］.Ophthalmology,1991,98(5 Suppl):741-756.
［37］　ELMAN M J,QIN H,AIELLO L P,BECK R W,BRESSLER N M.Intravitreal ranibizumab for diabetic macular edema with prompt versus deferred laser treatment:three-year randomized trial results［J］.Ophthalmology,2012,119(11):2312-2318.
［38］　XIAO K,LI F Z,LIANG S Z,WANG J,QIAN C,WAN G M.Efficacy of conversion to aflibercept for diabetic macular edema previously refractory to bevacizumab or ranibizumab:a meta-analysis of high-quality nonrandomized studies［J］.Ann Pharmacother,2020,54(8):750-756.
［39］　MAUER M,ZINMAN B,GARDINER R,SUISSA S,SINAIKO A,STRAND T,et al.Renal and retinal effects of enalapril and losartan in type 1 diabetes［J］.N Engl J Med,2009,361(1):40-51.
［40］　SJOLIE A K,KLEIN R,PORTA M,ORCHARD T,FULLER J,PARVING H H,et al.Effect of candesartan on progression and regression of retinopathy in type 2 diabetes (DIRECT-Protect 2):a randomised placebo-controlled trial［J］.Lancet,2008,372(9647):1385-1393.
［41］　SCOTT I U,JACKSON G R,QUILLEN D A,LARSEN M,KLEIN R,LIAO J,et al.Effect of doxycycline vs placebo on retinal function and diabetic retinopathy progression in patients with severe nonproliferative or non-high-risk proliferative diabetic retinopathy:a randomized clinical trial［J］.JAMA Ophthalmol,2014,132(5):535-543.
［42］　DATILO M N,SANT’ANA M R,FORMIGARI G P,RODRIGUES P B,DE MOURA L P,DA SILVA AS R,et al.Omega-3 from flaxseed oil protects obese mice against diabetic retinopathy through GPR120 receptor［J］.Sci Rep,2018,8(1):14318.
［43］　宋泽娟,徐静,李婵.羟苯磺酸钙联合康柏西普治疗糖尿病性黄斑水肿的疗效和安全性［J］.眼科新进展,2021,41(1):75-78.
SONG Z J,XU J,LI C.Clinical efficacy and safety of calcium dobesilate combined with conbercept in the treatment of diabetic macular edema［J］.Rec Adv Ophthalmol,2021,41(1):75-78.
［44］　The Diabetic Retinopathy Vitrectomy Study Research Group.Early vitrectomy for severe vitreous hemorrhage in diabetic retinopathy.Two-year results of a randomized trial.Diabetic retinopathy vitrectomy Study report 2［J］.Arch Ophthalmol,1985,103(11):1644-1652.
［45］　ZHAO X Y,XIA S,CHEN Y X.Antivascular endothelial growth factor agents pretreatment before vitrectomy for complicated proliferative diabetic retinopathy:a meta-analysis of randomised controlled trials［J］.Br J Ophthalmol,2018,102(8):1077-1085.

相似文献/References:

[1]杜玮 刘子扬 周艳艳 雒雷鸣.糖尿病视网膜病变与血清胆红素水平的关系[J].眼科新进展,2012,32(5):000.
[2]范松涛 卢建民.阿司匹林与糖尿病患者玻璃体出血以及玻璃体切割术疗效的相关性研究[J].眼科新进展,2012,32(11):000.
[3]李艳 李筱荣 袁佳琴 潘斌.糖尿病大鼠视网膜中VEGF、PEDF的表达与血-视网膜屏障损伤[J].眼科新进展,2013,33(1):000.
[4]边领斋 刘巨平 魏瑞华 李筱荣 赵少贞 华宁 王铁成 李颖 任新军 梁娟 邹媛媛 赵小云 刘文洁.云南省高海拔农村多民族聚居区年龄相关性白内障危险因素调查[J].眼科新进展,2013,33(1):000.
[5]李朝晖 崔治华 胡晓英 孟丽珠 张敬维.糖尿病视网膜病变激光面积与疗效的分析[J].眼科新进展,2013,33(2):000.
[6]冯冬梅 朱鸿 施彩虹.CXC趋化因子及其受体在糖尿病视网膜病变中的作用[J].眼科新进展,2013,33(6):000.
[7]牛淑玲.糖尿病视网膜病变患者HbAlc、FPG与血小板参数的变化及危险因素分析[J].眼科新进展,2013,33(7):000.
[8]毕春潮 王睿 王建洲 雷春灵 董晓娟 王小莉 薛晓辉.Ad-PEDF对糖尿病视网膜病变大鼠视网膜新生血管的抑制作用[J].眼科新进展,2013,33(8):000.
[9]杨萍 孙书明 李晓鹏.辛伐他汀对糖尿病视网膜病变和炎症因子的影响[J].眼科新进展,2013,33(8):000.
[10]罗文婷 孙大卫.血管黏附蛋白-1在眼科疾病中的研究进展[J].眼科新进展,2013,33(8):000.
[11]崔颖 郭海科 韩云飞 孟倩丽 张良 尹东明.2型糖尿病住院患者糖尿病视网膜病变患病率及危险因素分析[J].眼科新进展,2012,32(8):000.
[12]吴京阳,刘磊,耿金,等.eGFR作为糖尿病视网膜病变预警因子的研究[J].眼科新进展,2014,34(8):740.[doi:10.13389/j.cnki.rao.2014.0203]
　WU Jing-Yang,LIU Lei,GENG Jin,et al.Study on estimated GFR as predictor of DR[J].Recent Advances in Ophthalmology,2014,34(6):740.[doi:10.13389/j.cnki.rao.2014.0203]
[13]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.[doi:10.13389/j.cnki.rao.2018.0162]
　LIU Xu,WANG Xia,HE Yuan.The research progress of risk factors and prevention in diabetic retinopathy[J].Recent Advances in Ophthalmology,2018,38(6):687.[doi:10.13389/j.cnki.rao.2018.0162]
[14]李涛,吴小利,刘兴德,等.糖尿病视网膜病变与外周血管和心血管病变的相关性研究[J].眼科新进展,2020,40(2):173.[doi:10.13389/j.cnki.rao.2020.0041]
　LI Tao,WU Xiaoli,LIU Xingde,et al.Correlation of diabetic retinopathy with peripheral vascular disease and cardiovascular disease[J].Recent Advances in Ophthalmology,2020,40(6):173.[doi:10.13389/j.cnki.rao.2020.0041]

备注/Memo

备注/Memo:
国家自然科学基金面上项目（编号：81970824）；国家重点研发计划子课题（编号：2018YFA0107304）
更新日期/Last Update: 2021-06-05