Diabetes and Metabolism Research Unit, Institut de Recerca Hospital Universitari Vall d’Hebron and CIBERDEM, Barcelona, Spain.
Curr Med Chem. 2013;20(26):3258-66. doi: 10.2174/0929867311320260009.
Despite improving standards of care, people with diabetes remain at risk of development and progression of diabetic retinopathy (DR) and visual impairment. Identifying novel therapeutic approaches, preferably targeting more than one pathogenic pathway in DR, and at an earlier stage of disease, is attractive. There is now consistent evidence from two major trials, the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study and the Action to Control Cardiovascular Risk in Diabetes Eye (ACCORD-Eye) study, totalling 11,388 people with type 2 diabetes (5,701 treated with fenofibrate) that fenofibrate reduces the risk of development and progression of DR. Therefore, fenofibrate may be considered a preventive strategy for patients without DR or early intervention strategy for those with mild DR. A number of putative therapeutic mechanisms for fenofibrate, both dependent and independent of lipids, have been proposed. A deeper understanding of the mode of action of fenofibrate will further help to define how best to use fenofibrate clinically as an adjunct to current management of DR.
尽管医疗护理水平在不断提高，但糖尿病患者仍然面临着糖尿病视网膜病变（DR）和视力损害发展和恶化的风险。寻找新的治疗方法，最好是针对 DR 中的多个致病途径，并且在疾病的早期阶段进行治疗，这是非常有吸引力的。目前有两项主要试验——非诺贝特干预和糖尿病结局研究（FIELD）和心血管风险控制行动与糖尿病眼部并发症研究（ACCORD-Eye）——提供了一致的证据，共涉及 11388 名 2 型糖尿病患者（5701 名患者接受非诺贝特治疗），表明非诺贝特可降低 DR 的发展和恶化风险。因此，非诺贝特可被视为无 DR 患者的预防策略，或轻度 DR 患者的早期干预策略。已经提出了非诺贝特的多种推测性治疗机制，包括依赖和不依赖脂质的机制。更深入地了解非诺贝特的作用方式将有助于进一步确定如何最好地将非诺贝特作为 DR 现有治疗方法的辅助手段在临床上使用。
