Cha Yong Jae, Kim Sung Jin
Department of Ophthalmology, Eulji University School of Medicine, Nowon-gu, Seoul, Korea.
Korean J Ophthalmol. 2007 Mar;21(1):28-32. doi: 10.3341/kjo.2007.21.1.28.
To evaluate the effects of angiotensin-converting enzyme inhibitors (ACE-I) in retarding progression of severe non-proliferative diabetic retinopathy (NPDR) in normotensive type 2 diabetic patients.
This was a retrospective case control study of 128 patients with normotensive type 2 diabetes with lower than +1 dipstick proteinuria and severe NPDR who were classified into either an ACE-I treated group (Enalapril maleate 10 mg, n=12 , Ramipril 5 mg, n=17) or an ACE-I untreated group (n=99). Medical records were reviewed for endpoints of (a) occurrence of proliferative diabetic retinopathy (PDR) or macular edema (ME) for which laser phototherapy was necessary or (b) development of proteinuria of higher than +1 level requiring medication of ACE-I.
From the total of 128 patients, there were 29 ACE-I treated patients and 99 ACE-I untreated patients. There were no differences in the average age, duration of diabetes, body mass indices, blood pressure and levels of hyperglycemia or HbA1C between the two groups. Blood pressure and HbA1C levels in both groups remained unchanged during the study. The mean follow-up period was 41.6 months. In the ACE-I group, 6 patients progressed to PDR, 5 to ME and 6 developed proteinuria of greater than +1 over the follow-up period. In the control group, 30 patients progressed to PDR, 6 to ME and 9 developed proteinuria of greater than +1 over the follow-up period.
Small doses of ACE-I did not yield any beneficial effects in retarding the progression of severe NPDR.
评估血管紧张素转换酶抑制剂（ACE-I）对血压正常的2型糖尿病患者严重非增殖性糖尿病视网膜病变（NPDR）进展的延缓作用。
这是一项回顾性病例对照研究，研究对象为128例血压正常的2型糖尿病患者，其尿试纸蛋白低于+1且患有严重NPDR，这些患者被分为ACE-I治疗组（马来酸依那普利10毫克，n = 12；雷米普利5毫克，n = 17）或ACE-I未治疗组（n = 99）。查阅医疗记录以确定以下终点：（a）发生需要进行激光光凝治疗的增殖性糖尿病视网膜病变（PDR）或黄斑水肿（ME）；（b）出现高于+1级的蛋白尿且需要使用ACE-I药物治疗。
在总共128例患者中，有29例接受ACE-I治疗的患者和99例未接受ACE-I治疗的患者。两组患者的平均年龄、糖尿病病程、体重指数、血压、血糖水平或糖化血红蛋白（HbA1C）无差异。研究期间两组的血压和HbA1C水平均保持不变。平均随访期为41.6个月。在ACE-I组中，随访期间有6例患者进展为PDR，5例进展为ME，6例出现大于+1的蛋白尿。在对照组中,随访期间有30例患者进展为PDR，6例进展为ME，9例出现大于+1的蛋白尿。
小剂量的ACE-I在延缓严重NPDR进展方面未产生任何有益效果。
