Ioannidou Estelle, Tseriotis Vasilis-Spyridon, Tziomalos Konstantinos
Estelle Ioannidou, Vasilis-Spyridon Tseriotis, Konstantinos Tziomalos, First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 54636 Thessaloniki, Greece.
World J Diabetes. 2017 Jan 15;8(1):1-6. doi: 10.4239/wjd.v8.i1.1.
Diabetic retinopathy affects a substantial proportion of patients with diabetes mellitus (DM) and is the leading cause of blindness in working-aged adults. Even though the incidence of diabetic retinopathy has declined in the last decades, its prevalence increased and is expected to rise further as a result of the increasing incidence of type 2 DM (T2DM) and the longer life expectancy of patients with DM. The pathogenesis of diabetic retinopathy is multifactorial. Some observational studies suggested an association between dyslipidemia and the development and progression of retinopathy in patients with DM but others did not confirm this association. Regarding lipid-lowering agents, studies that evaluated the role of statins in the management of these patients are mostly small and yielded discrepant results. Large randomized studies with statins in patients with T2DM showed no benefit of these agents on diabetic retinopathy but were not designed to address this effect. In contrast, both preclinical data and two large randomized controlled studies, the FIELD and the ACCORD trial, showed that fenofibrate delays the progression of diabetic retinopathy. Even though the mechanisms underpinning this favorable effect are not entirely clear, these findings suggest that fenofibrate might represent a useful tool for the management of diabetic retinopathy.
糖尿病视网膜病变影响着相当一部分糖尿病患者，并且是劳动年龄成年人失明的主要原因。尽管在过去几十年中糖尿病视网膜病变的发病率有所下降，但其患病率却有所上升，并且由于2型糖尿病（T2DM）发病率的增加以及糖尿病患者预期寿命的延长，预计患病率还会进一步上升。糖尿病视网膜病变的发病机制是多因素的。一些观察性研究表明血脂异常与糖尿病患者视网膜病变的发生和发展之间存在关联，但其他研究并未证实这种关联。关于降脂药物，评估他汀类药物在这些患者管理中作用的研究大多规模较小，且结果不一。在T2DM患者中使用他汀类药物的大型随机研究表明，这些药物对糖尿病视网膜病变没有益处，但并非旨在解决这一影响。相比之下，临床前数据以及两项大型随机对照研究——FIELD研究和ACCORD试验——均表明非诺贝特可延缓糖尿病视网膜病变的进展。尽管这种有利作用的潜在机制尚不完全清楚，但这些发现表明非诺贝特可能是管理糖尿病视网膜病变的一种有用工具。
