[Diabetic retinopathy: pathogenesis and therapeutic implications].
[Diabetic retinopathy: pathogenesis and therapeutic implications].
复制标题
作者：
T. Pelikanova
未标记的糖尿病视网膜病变(DR)在1型和2型糖尿病患者中都会发生，是导致工作人群失明和失明的主要原因。糖尿病视网膜病变的主要危险因素是高血糖，并伴有线粒体活性氧和氧化应激的增加，糖基化终末产物(AGE)和氨基己糖的形成，葡萄糖多元醇代谢的增加。血管损伤的严重程度取决于个体的遗传背景，并受到其他表观遗传、代谢和血液动力学因素的影响，包括高血压、血脂异常和氧化应激。在糖尿病中，视网膜损伤发生在血管系统(内皮细胞和周细胞)、神经元和神经胶质细胞、色素上皮细胞和浸润性免疫活性细胞：单核细胞、粒细胞和淋巴细胞。这些被激活的细胞改变了许多介质的产生模式，如生长因子、促炎细胞因子、血管活性分子、凝血因子和黏附分子，从而导致血流增加、毛细血管通透性增加、细胞外基质增殖和基底膜增厚、改变细胞周转(凋亡、增殖、肥大)、促凝剂和促凝集模式，最终在血管生成和组织重建中。大脑、肝脏、脂肪组织、肠道、骨骼肌和其他组织可能是介质的另一个来源。治疗糖尿病视网膜病变的方法包括减少可改变的危险因素的药物治疗、激光光凝、玻璃体内注射抗血管内皮生长因子药物/类固醇和眼内手术。筛查在早期发现和干预预防糖尿病视网膜病变的进展中起着重要作用。描述了对糖尿病视网膜病变的病理生理机制的洞察，有助于开发更有针对性的方法来预防和治疗糖尿病视网膜病变。关键词抗血管内皮生长因子-糖尿病血脂异常-生长因子-高血糖-高血压-microRNA-氧化应激-视网膜病变。
UNLABELLED Diabetic retinopathy (DR) develops in patients with both type 1 and type 2 diabetes and is the major cause of vision loss and blindness in the working population. The main risk factor of DR is hyperglycemia accompanied by enhanced mitochondrial production of reactive oxygen species and oxidative stress, formation of advanced glycation end products (AGE) and hexosamines, increase in polyol metabolism of glucose. The severity of vascular injury depends on the individual genetic background and is modified by other epigenetic, metabolic and haemodynamic factors, including hypertension, dyslipidemia and oxidative stress. In diabetes, damage to the retina occurs in the vasculature (endothelial cells and pericytes), neurons and glia, pigment epithelial cells and infiltrating immunocompetent cells: monocytes, granulocytes, lymfocytes. These activated cells change the production pattern of a number of mediators such as growth factors, proinflammatory cytokines, vasoactive molecules, coagulation factors and adhesion molecules resulting in increased blood flow, increased capillary permeability, proliferation of extracellular matrix and thickening of basal membranes, altered cell turnover (apoptosis, proliferation, hypertrophy), procoagulant and proaggregant pattern, and finally in angiogenesis and tissue remodelling. Brain, liver, adipose tissue, GUT, skeletal muscle and other tissues could be another source of mediators. Therapeutic approaches used for patients with or at risk for diabetic retinopathy include drug therapy to reduce modifiable risk factors, laser photocoagulation, intravitreous administration of anti-VEGF agents/steroids and intraocular surgery. Screening plays an important role in early detection and intervention to prevent the progression of diabetic retinopathy. Described insights into pathophysiological mechanisms responsible for DR, could help in the development of more targeted approach for prevention and treatment of diabetic retinopathy. KEY WORDS anti-VEGF - diabetic dyslipidemia - growth factors - hyperglycemia - hypertension - microRNA - oxidative stress - retinopathy.