血糖变异性对糖尿病视网膜病变的影响及研究进展  

The impact of blood glucose variability on diabetic retinopathy

作　　者：顾赵赵(综述) 罗雨馨 俞莹(审校)[1] GU Zhaozhao;LUO Yuxin;YU Ying(Eye Institute,Affiliated Hospital of Nantong University,Medical School of Nantong University,Nantong 226001,China)

机构地区：[1]南通大学附属医院眼科,南通大学医学院,南通226001

出　　处：《眼科学报》2025年第2期189-195,共7页Eye Science

基　　金：江苏省医学重点学科(JSDW202245);南通市基础科学研究和社会民生科技计划项目(MSZ2022024)。

摘　　要：糖尿病视网膜病变(diabetic retinopathy, DR)作为糖尿病的一种常见并发症是导致工作年龄人群失明的主要原因。血糖变异性(glycemic variability, GV)指血糖波动的程度。最新研究表明,GV与糖尿病患者的代谢状况和微血管病变密切相关。该文综述了GV对DR的影响及其研究进展。GV是指血糖水平在高点和低点之间波动的不稳定状态,分为长期GV和短期GV。长期GV主要通过空腹血糖(fasting plasma glucose,FPG)、餐后血糖(postprandial plasma glucose, PPG)和糖化血红蛋白(glycated hemoglobin, Hb A1c)评估,短期GV则通过血糖标准差(standard deviation, SD)、变异系数(coefficient of variation, CV)、低血糖指数(low blood glucose index, LBGI)等指标量化。研究表明,GV是糖尿病大血管和微血管并发症的重要风险预测因子,与冠状动脉综合征、心肌梗死、脑卒中、糖尿病肾病、周围神经病变等密切相关。在DR方面,GV可能是其进展的风险因素,高GV会加剧氧化应激、炎症反应、内皮功能障碍和新生血管生成,从而促进DR的发展。治疗策略包括动态血糖监测系统、药物干预(如基础胰岛素、阿格列汀等)、合理饮食和运动等,这些方法可改善GV,降低并发症风险,提高患者预后和生活质量。Diabetic retinopathy(DR)is a common complication of diabetes and is a leading cause of blindness in the working-age population.Glycemic variability(GV)refers to the degree of fluctuation in blood glucose levels.Recent studies have shown that GV is closely related to the metabolic status and microvascular complications in patients with diabetes.This article reviews the impact of glycemic variability(GV)on diabetic retinopathy(DR)and the latest research progress.GV is defined as the unstable state of blood glucose levels fluctuating between highs and lows,which is categorized into long-term GV and short-term GV.Long-term GV is mainly assessed through fasting plasma glucose(FPG),postprandial plasma glucose(PPG),and glycated hemoglobin(HbA1c).Short-term GV is quantified by indicators such as the standard deviation of blood glucose(SD),coefficient of variation(CV),and low blood glucose index(LBGI).Studies have shown that GV is an important risk predictor for both macrovascular and microvascular complications in diabetic patients,being closely associated with conditions such as coronary artery syndrome,myocardial infarction,stroke,diabetic nephropathy,and peripheral neuropathy.Regarding DR,GV is likely a risk factor for its progression.High GV can exacerbate oxidative stress,inflammatory responses,endothelial dysfunction,and neovascularization,thereby promoting the development of DR.Treatment strategies include continuous glucose monitoring systems,pharmacological interventions(such as basal insulin,alogliptin,etc.),as well as proper diet and exercise.These approaches can improve GV,reduce the risk of complications,and enhance patients'prognosis and quality of life.

关 键 词：血糖变异性 糖尿病视网膜病变 糖尿病 

分 类 号：R587.1[医药卫生—内分泌] R771.3[医药卫生—内科学]