糖尿病视网膜病变的药物治疗研究进展

Advances in drug therapy of diabetic retinopathy

糖尿病视网膜病变(diabetic retinopathy,DR)是糖尿病最常见的微血管并发症之一,已成为糖尿病患者失明和视力障碍的主要原因之一。DR的发病机制复杂,主要涉及炎症、氧化应激、神经血管性病变等诸多方面,为疾病治疗提供了潜在的干预靶点。当前,抗血管内皮生长因子(vascular endothelial growth factor,VEGF)药物是DR的一线治疗手段,主要针对疾病晚期阶段,但此时视网膜已经发生了不可逆的神经血管损伤及视功能降低。另外,仍有部分患者对抗VEGF治疗反应欠佳、甚至无反应。目前几乎没有针对疾病早期的干预手段,因此,迫切需要基于DR发病机制开发出新型的局部或全身疗法,能够对DR进行早期预防和治疗,并尽可能挽救患者视力。针对不同靶点的药物如抗炎药物(糖皮质激素、非甾体抗炎药)、神经营养和神经保护类药物、靶向生化途径类药物、抗氧化植物化合物、基因治疗类药物等在治疗效果上可以互相补偿,从而能够让更多DR患者获益。该文结合既往研究报道,对DR的发病机制、药物治疗方法以及潜在药物治疗靶点进行综述,旨在为临床治疗及相关研究提供参考。

Diabetic retinopathy(DR)is one of the most common microvascular complications of diabetes and has become one of the leading causes of blindness and visual impairment in diabetes patients.The pathogenesis of DR is multifaceted,involving inflammation,oxidative stress,neurovascular abnormalities,and other factors that present potential targets for disease management interventions.Currently,anti-vascular endothelial growth factor(VEGF)drugs serve as the primary treatment for advanced stages of DR when irreversible neurovascular damage and visual impairment have occurred.Additionally,some patients show poor or no response to anti-VEGF treatment.There is a lack of early intervention options for the initial phases of the disease.Therefore,there is an urgent need to develop novel local or systemic therapies based on the underlying mechanisms of DR to enable early prevention and treatment with the aim of preserving patients′vision.Medications targeting various pathways including anti-inflammatory agents(corticosteroids and nonsteroidal anti-inflammatory drugs),neurotrophic and neuroprotective drugs,drugs modulating biochemical pathways,antioxidant phytochemicals,and gene therapy can complement each other in terms of therapeutic effects to benefit a larger number of individuals affected by DR.This article reviews previous research reports on the pathogenesis,drug treatment methods,and potential therapeutic targets associated with DR in order to provide guidance for clinical practice.