糖尿病性黄斑水肿危险因素研究进展  

Research progress on risk factors for diabetic macular edema

作　　者：李梓敬(综述) 金陈进(审校)[1] LI Zijing;JIN Chenjin(State Key Laboratory of Ophthalmology,Zhongshan Ophthalmic Center,Sun Yat-sen University,Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science,Guangzhou 510060,China;Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou 510120,China)

机构地区：[1]中山大学中山眼科中心,眼病防治全国重点实验室,广东省眼科视觉科学重点实验室,广州510060 [2]中山大学孙逸仙纪念医院眼科,广州510120

出　　处：《眼科学报》2024年第7期352-364,共13页Eye Science

基　　金：广东省医学科研基金(A2024187)。

摘　　要：糖尿病性黄斑水肿(diabetic macular edema, DME)是糖尿病最常见和最严重的并发症之一,也是中青年劳动人群常见的致盲原因。DME病理生理机制复杂,是多种因素相互作用的结果,控制这些危险因素是降低发病率的关键。DME是全身病相关性眼病,其发生与发展受众多危险因素的影响,但此前文献对其总结不足,本文从全身因素及眼部因素两个方面就DME的危险因素进行综述。全身危险因素主要包括血糖控制欠佳、糖尿病病程长、高血压、血脂代谢紊乱、肥胖、肾功能异常、妊娠状态、降糖药物使用、贫血、阻塞性睡眠呼吸暂停低通气综合征、遗传因素、吸烟、饮酒、高血钙、低血镁等;而其眼部危险因素主要包括白内障、青光眼及玻璃体切割术、全视网膜激光光凝术、合并视网膜静脉阻塞和相关细胞因子等。深入认识和理解这些危险因素,有助于更好地预防和早期治疗DME,同时为治疗糖尿病视网膜病变过程中控制DME进展提供指引和参考。但是,其中一部分因素还存在一定争议,更多的DME危险因素仍有待进一步探索,期望在不久的将来,更多基础和前瞻性临床研究为DME危险因素及治疗提供高质量的证据。Diabetic macular edema(DME)is one of the most common and severe complications of diabetes,and it is a leading cause of blindness in the working-age population.The pathophysiology of DME is complex,resulting from the interplay of various factors.Controlling these risk factors is crucial in reducing the incidence of DME.As a systemic disease-related ocular condition,the onset and progression of DME are influenced by numerous risk factors.However,previous literature has provided insufficient summaries of these factors.This review aims to summarize the risk factors for DME from both systemic and ocular perspectives.The systemic risk factors primarily include poor glycemic control,prolonged duration of diabetes,hypertension,dyslipidemia,obesity,renal dysfunction,pregnancy,the use of hypoglycemic medications,anemia,obstructive sleep apnea-hypopnea syndrome,genetic factors,smoking,alcohol consumption,hypercalcemia,and hypomagnesemia.On the other hand,ocular risk factors include cataracts,glaucoma and vitrectomy,panretinal photocoagulation,coexisting retinal vein occlusion,and related cytokines.A deeper understanding of these risk factors will aid in the better prevention and early treatment of DME,while also providing guidance and reference for controlling the progression of DME during the treatment of diabetic retinopathy.However,some of these factors remain controversial,and additional DME risk factors still need to be explored.It is hoped that,in the near future,more foundational and prospective clinical studies will provide high-quality evidence on DME risk factors and treatments.

关 键 词：糖尿病性黄斑水肿 危险因素 全身因素 眼部因素 

分 类 号：R774.5[医药卫生—眼科] R587.1[医药卫生—临床医学]