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[摘要]
糖尿病视网膜病变(DR)长期以来被认为是一种微血管病变,但以内层视网膜神经炎症和神经变性为特征的糖尿病视网膜神经病变(DRN)同样发生在糖尿病(DM)患者,而且可先于DM引起的临床上可观察到的血管变化。大量临床研究已确认糖尿病的视网膜损害属于一种高度组织特异性神经血管并发症,并提出“糖尿病视网膜病”(DRD)作为DR更新的术语。DRN在结构上表现为神经细胞凋亡、神经节细胞丧失、反应性胶质增生以及内层视网膜变薄; 在功能上表现为视网膜电图、暗适应、对比敏感度、色觉的缺陷以及微视野和视野心理物理学测试异常。从整合的视角深入研究DRN,将对DRD的新分期、创新疗法与全程管理产生重大影响。
[Key word]
[Abstract]
Diabetic retinopathy(DR)has long been recognized as a microvasculopathy, but diabetic retinal neuropathy(DRN), characterized with inner retinal neuroinflammation and neurodegeneration, also occurs in diabetes mellitus(DM), and even precedes the clinically observed vascular changes in DM. Clinical studies have confirmed the diabetic retinal damage as a highly tissue-specific neurovascular complication, and proposed “diabetic retinal disease”(DRD)as the redefined term for DR. DRN is structurally observed as neuronal apoptosis, ganglion cell loss, reactive glial proliferation, and thinning of the inner retina. Functionally, it is manifested as deficits in retinal electroretinogram, adaptation, contrast sensitivity, color vision, and psychophysical tests of microfield and visual field. In-depth studies from an integrated perspective on DRN will have significant impacts on new stages, novel therapy, and management throughout the entire course of DRD.
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