炎症因素在糖尿病性黄斑水肿中的作用及展望  

Roles and perspectives of inflammatory factors in diabetic macular edema

作　　者：秦时月 徐国旭[2] 张敬法 Shi-Yue Qin;Guo-Xu Xu;Jing-Fa Zhang(Department of Ophthalmology,Jiangsu Taizhou People's Hospital,Taizhou 225300,Jiangsu Province,China;Department of Ophthalmology,the Second Affiliated Hospital of Soochow University,Suzhou 215004,Jiangsu Province,China;Department of Ophthalmology,Shanghai General Hospital of Shanghai Jiao Tong University School of Medicine,National Clinical Research Center for Eye Diseases,Shanghai Key Laboratory of Ocular Fundus Diseases,Shanghai Engineering Center for Visual Science and Photomedicine,Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases,Shanghai 200080,China)

机构地区：[1]中国江苏省泰州市人民医院眼科,225300 [2]苏州大学附属第二医院眼科,江苏省苏州市215004 [3]上海交通大学医学院附属第一人民医院眼科国家眼部疾病临床医学研究中心上海市眼底病重点实验室上海眼视觉与光医学工程技术研究中心上海市眼科疾病精准诊疗工程技术研究中心,200080上海市

出　　处：《国际眼科杂志》2022年第8期1281-1287,共7页International Eye Science

基　　金：国家自然科学基金面上项目(No.82171062)。

摘　　要：糖尿病视网膜病变(DR)是工作年龄人群中最常见的致盲原因,其中糖尿病性黄斑水肿(DME)是导致DR患者视力受损最常见的原因。研究发现炎症因素在DME的发生发展中发挥着重要作用。慢性高血糖激活不同的生化途径,导致视网膜的缺氧、氧化应激和慢性炎症。视网膜内炎症相关细胞,如小胶质细胞、单核/巨噬细胞、Müller细胞和视网膜色素上皮细胞等活化,并释放大量的炎症相关因子及介质,包括补体系统、血管内皮生长因子(VEGF)、胎盘生长因子(PlGF)、肿瘤坏死因子-α(TNF-α)、白介素-1β(IL-1β)、IL-6及IL-8等,导致血-视网膜屏障破坏及神经元损伤。此外,视网膜血管内皮细胞通过上调细胞间黏附分子-1(ICAM-1)、血管细胞黏附分子-1(VCAM-1)表达,介导白细胞黏附和瘀滞,进一步加重视网膜缺氧以及血-视网膜屏障的破坏,导致视网膜血管渗漏增加、黄斑水肿。因此,早期抗VEGF和抗炎对治疗DME至关重要。本文将讨论炎症因素在DME发病机制中的作用及针对炎症的靶向药物的研究现状,以期为DME的治疗提供借鉴。Diabetic retinopathy is the leading cause of blindness in the working-age population,in which diabetic macular edema(DME)is the most common reason resulting in the vision impairment.Studies showed that inflammation factors play an important role in the pathogenesis and development of DME.Chronic hyperglycemia activates several biochemical pathways,leading to retinal hypoxia,oxidative stress and chronic inflammation.Intraretinal inflammation-related cells,such as microglia,monocytes/macrophages,Müller cells and retinal pigment epithelial cells,become activated and release a large number of inflammation-related factors and mediators,including the complement system,vascular endothelial growth factor(VEGF),placental growth factor(PlGF),tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β),IL-6 and IL-8,etc.,resulting in the breakdown of the blood-retinal barrier and neuronal degeneration.In addition,up-regulatethe expression of intercellular adhesion molecule-1(ICAM-1)and vascular cell adhesion molecule-1(VCAM-1)by retinal vascular endothelial cells increased the adhesion of leukocyte and leukostasis,further aggravating retinal hypoxia and breakdown of the blood-retinal barrier,leading to the increased retinal vascular leakage and macular edema.Therefore,early treatment with anti-VEGF and anti-inflammatory are pivotal for the treatment of DME.In this review,we will discuss the role of inflammation factors in the pathogenesis of DME and the research status of the targeted drugs targeting inflammation,so as to provide reference for the treatment of DME.

关 键 词：糖尿病性黄斑水肿 炎症细胞 炎症因子 血-视网膜屏障 黄斑水肿 

分 类 号：R587.2[医药卫生—内分泌] R774.5[医药卫生—内科学]