Virk Sohaib A, Donaghue Kim C, Wong Tien Y, Craig Maria E
Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia; School of Women's and Children's Health, University of New South Wales, Sydney, Australia.
Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia; Discipline of Pediatrics and Child Health, University of Sydney, Sydney, Australia.
Am J Ophthalmol. 2015 Nov;160(5):1055-1064.e4. doi: 10.1016/j.ajo.2015.07.024. Epub 2015 Jul 23.
To systematically review the effectiveness of systemic interventions for diabetic retinopathy (DR) in type 1 diabetes.
Systematic review and meta-analysis.
MEDLINE, EMBASE and Cochrane Library were searched for studies published from January 1990 to December 2014. Randomized controlled trials and controlled cohort studies reporting incidence or progression of DR following systemic intervention were included. Two reviewers selected studies, extracted data, and assessed risk of bias. For each intervention, pooled outcomes were reported as relative risk (RR) estimates with 95% confidence intervals (CI).
Twenty-four studies involving 9302 patients met inclusion criteria. Incident DR was reduced by intensive vs conventional insulin therapy (RR 0.43; 95% CI 0.23-0.83), insulin pumps vs multiple daily injections (RR 0.45; 95% CI 0.24-0.83), and angiotensin receptor blockade vs placebo (RR 0.65; 95% CI 0.49-0.85). The benefit of insulin pumps over multiple daily infections was independent of HbA1c. DR progression was reduced by intensive vs conventional insulin therapy (RR 0.63; 95% CI 0.43-0.92), angiotensin-converting enzyme inhibition vs placebo (RR 0.60; 95% CI 0.41-0.86), and islet cell transplantation vs medical therapy (RR 0.25; 95% CI 0.08-0.71).
Intensive insulin therapy, and specifically insulin pump therapy vs multiple daily injections, prevents DR in both adults and adolescents with type 1 diabetes. Antihypertensive agents provide protection in normotensive, normoalbuminuric adults. In patients with type 1 diabetes of longer duration, islet cell transplantation may be more effective than medical therapy. There is insufficient evidence for antilipid therapy or other systemic interventions.
系统评价1型糖尿病患者糖尿病视网膜病变（DR）全身干预措施的有效性。
系统评价和荟萃分析。
检索MEDLINE、EMBASE和Cochrane图书馆中1990年1月至2014年12月发表的研究。纳入报告全身干预后DR发病率或进展情况的随机对照试验和对照队列研究。两名研究者筛选研究、提取数据并评估偏倚风险。对于每种干预措施，汇总结果以相对危险度（RR）估计值及95%置信区间（CI）报告。
24项涉及9302例患者的研究符合纳入标准。强化胰岛素治疗与传统胰岛素治疗相比，DR发病率降低（RR 0.43；95%CI 0.23 - 0.83）；胰岛素泵治疗与每日多次注射相比，DR发病率降低（RR 0.45；95%CI 0.24 - 0.83）；血管紧张素受体阻滞剂与安慰剂相比，DR发病率降低（RR 0.65；95%CI 0.49 - 0.85）。胰岛素泵治疗优于每日多次注射的益处与糖化血红蛋白（HbA1c）无关。强化胰岛素治疗与传统胰岛素治疗相比，DR进展减缓（RR 0.63；95%CI 0.43 - 0.92）；血管紧张素转换酶抑制剂与安慰剂相比，DR进展减缓（RR 0.60；95%CI 0.41 - 0.86）；胰岛细胞移植与药物治疗相比，DR进展减缓（RR 0.25；95%CI 0.08 - 0.71）。
强化胰岛素治疗，尤其是胰岛素泵治疗与每日多次注射相比，可预防1型糖尿病成人和青少年发生DR。抗高血压药物可为血压正常、尿白蛋白正常的成人提供保护。在病程较长的1型糖尿病患者中，胰岛细胞移植可能比药物治疗更有效。尚无足够证据支持降脂治疗或其他全身干预措施。
