糖尿病视网膜病变是最为常见的糖尿病微血管并发症，主要由糖尿病引起的机体代谢紊乱导致。而然在临床工作中发现，部分患者通过单纯控制血糖以延缓糖尿病视网膜病变进展，所取得效果不甚理想，一些其他因素对于糖尿病视网膜病变的发生、发展，也起到不可忽视的作用。研究表明，在并发高脂血症的糖尿病视网膜病变患者中，胆固醇代谢异常是诱发视网膜病变的主要原因之一。胆固醇代谢异常通过减弱肝脏X受体，导致胆固醇在视网膜上不断积累，降低视网膜血管内皮功能，从而造成视网膜缺血、缺氧环境的形成，又可通过增加炎症因子和细胞黏附分子-1的表达，使原本病态的糖尿病视网膜血管变得更加脆弱，该文总结了糖尿病视网膜病变的病理因素，对比分析当前糖尿病视网膜病变的主要治疗手段，通过分析胆固醇逆向转运(cholesterol reverse transport,RCT)途径转运对糖尿病视网膜病变发生、发展的影响，发现降低高血脂可提高糖尿病视网膜病变的治愈率，这将为糖尿病视网膜病变的临床防治工作提供新思路。

Diabetic retinopathy is the most common diabetic microvascular complication, which is mainly caused by metabolic disorders caused by diabetes. However, in clinical work, it is found that some patients do not achieve satisfactory results in delaying the progress of diabetic retinopathy by simply controlling blood sugar, and some other factors contribute to the occurrence and development of diabetic retinopathy. Also played a role that can not be ignored. Studies have shown that abnormal cholesterol metabolism is one of the main causes of retinopathy in diabetic retinopathy patients with hyperlipidemia. Abnormal cholesterol metabolism leads to the accumulation of cholesterol in the retina and the decrease of retinal vascular endothelial function by weakening the X receptor in the liver, resulting in the formation of retinal ischemia and hypoxia environment. it can also increase the expression of inflammatory cytokines and cell adhesion molecule-1 to make the originally morbid retinal vessels more fragile. This paper summarizes the pathological factors of diabetic retinopathy. By comparing and analyzing the main treatment methods of diabetic retinopathy at present, and by analyzing the influence of cholesterol reverse transport (cholesterolreversetransport,RCT) pathway on the occurrence and development of diabetic retinopathy, it is found that reducing hyperlipidemia can improve the cure rate of diabetic retinopathy, which will provide new ideas for the clinical prevention and treatment of diabetic retinopathy.

糖尿病视网膜病变是糖尿病引起的微血管病变之一，是不可逆性致盲的眼病。根据其病程可分为根据其病程可分为非增殖期和增殖期，其中还包括糖尿病性黄斑水肿。全科医师需要检测量裸眼视力、矫正视力和眼压，通过裂隙灯显微镜评估眼前节以及眼底检查来评估眼部整体情况。控制血糖、血压、血脂对改善预后很重要。需要重视餐前、餐后血糖，糖化血红蛋白和代谢记忆，一线降血压药物包括血管紧张素转化酶抑制剂和血管紧张素Ⅱ受体阻断剂，调脂药物首选他汀类，而非诺贝特有额外的视网膜保护作用。干预生活方式，宣教，早期发现也同样重要。全科医师需要进行眼底筛查和评分，及时转诊至眼科治疗。眼科治疗包括全视网膜激光光凝术、经平坦部玻璃体切除术、玻璃体抗血管内皮生长因子药物注射术。

Diabetic retinopathy is one of the microvascular diseases caused by diabetes, it is an irreversible blindness eye disease. According to its course, it can be divided into non-proliferative diabetic retinopathy and proliferative diabetic retinopathy, including diabetic macular edema. Te general practitioner needs to measure the uncorrected visual acuity, corrected visual acuity intraocular pressure, use the slit lamp microscope to exam the anterior segment and fundus to evaluate the overall condition of the eye. Controlling blood glucose, blood pressure and blood lipid is very important to improve the prognosis. Attach importance to pre- and postprandial blood glucose, glycosylated hemoglobin and metabolic memory should be carried out. The first-line antihypertensive drugs are angiotensin converting enzyme inhibitors and angiotensin II receptor blockers. Statins are the first choice for lipid-lowering drugs, fenofibrate has additional protective efect of retinal. Intervention in lifestyle, education and early detection are is important. Te general practitioner needs to perform fundus screening and scoring, timely refer to ophthalmology department for treatment. Ophthalmic treatment includes panretinal laser photocoagulation, pars plana vitrectomy, and intravitreal injection of anti-vascular endothelial growth factor drugs.

Diabetic retinopathy (DR), a major micro-vascular complication of diabetes, has emerged as a leading cause of visual impairment and blindness among adults worldwide. However, aside from pathological damage, the traditional laser and multi-needle operation treatments required for more advanced disease can cause further damage to the visual field and increase the operation risk. Therefore, the development of new therapeutic strategies for the prevention and treatment of DR is essential. Some emerging evidence now indicates that pigment epithelium-derived factor (PEDF),  a multifunctional protein, can target multiple pathways to exert neurotropic, neuroprotective, anti-angiogenic, anti-vasopermeability, anti-inflammation, anti-thrombogenic, and anti-oxidative effects against DR. This review addresses the functions of PEDF in different pathways that could lead to potential therapeutics for the treatment of DR.

Diabetic retinopathy (DR), a major micro-vascular complication of diabetes, has emerged as a leading cause of visual impairment and blindness among adults worldwide. However, aside from pathological damage, the traditional laser and multi-needle operation treatments required for more advanced disease can cause further damage to the visual field and increase the operation risk. Therefore, the development of new therapeutic strategies for the prevention and treatment of DR is essential. Some emerging evidence now indicates that pigment epithelium-derived factor (PEDF),  a multifunctional protein, can target multiple pathways to exert neurotropic, neuroprotective, anti-angiogenic, anti-vasopermeability, anti-inflammation, anti-thrombogenic, and anti-oxidative effects against DR. This review addresses the functions of PEDF in different pathways that could lead to potential therapeutics for the treatment of DR.

The purpose of this article is to report a case with rubeosis iridis treated by intravitreal aflibercept. A 61-year-old man had iris neovascularization and scanty vitreous hemorrhage secondary to proliferative diabetic retinopathy in the right eye. Neither neovascularization of angle nor elevation of intraocular pressure was found. Single intravitreal afl ibercept 2 mg injection was performed. Rubeosis iridis disappeared on the next day. Scattered retinal laser photocoagulation was added 1 week later. There was no recurrence after 3-month follow-up. Aflibercept may serve as another anti-vascular endothelial growth factor (anti-VEGF) for treating rubeosis iridis.

The purpose of this article is to report a case with rubeosis iridis treated by intravitreal aflibercept. A 61-year-old man had iris neovascularization and scanty vitreous hemorrhage secondary to proliferative diabetic retinopathy in the right eye. Neither neovascularization of angle nor elevation of intraocular pressure was found. Single intravitreal afl ibercept 2 mg injection was performed. Rubeosis iridis disappeared on the next day. Scattered retinal laser photocoagulation was added 1 week later. There was no recurrence after 3-month follow-up. Aflibercept may serve as another anti-vascular endothelial growth factor (anti-VEGF) for treating rubeosis iridis.

目的：探讨全视网膜光凝及术后应用羟苯磺酸钙治疗糖尿病视网膜病变的疗效。方法：选取96例患者，共175只眼，随机分为对照组(48例，86只眼)和研究组(48例，89只眼)。两组均予全视网膜激光光凝治疗，其中研究组术后再予羟苯磺酸钙继续12周治疗。12周后，观察两组患者治疗前后视力、血液流变学的变化。结果：治疗后研究组在视力>1.0范围的患者明显多于对照组(χ²=6.779，P=0.009)， 而2组在视力≤0.4，0.4~0.6，0.7~1.0范围患者视力差异比较分别为( χ²=0.003，P=0.955)，(χ²=1.640，P=0.200)，(χ²=2.148，P=0.143)。治疗后研究组患者的血浆粘度、红细胞压积、红细胞变形指数、纤维蛋白原改善均优于对照组(P<0.05)。研究组总有效率89.9%，对照组75.6%，两组差异比较(χ² =6.302，P=0.012)。结论：全视网膜激光光凝及术后应用羟苯磺酸钙治疗糖尿病性视网膜病，能有效提高视力及临床疗效，可能与改善患者血液流变相关。

Objective: To investigate the curative effect of the postoperative retinal laser photocoagulation and calcium dobesilate in the treatment of diabetic retinopathy. Methods: Selected 96 patients, 175 eyes, randomly divided into control group (48 cases, 86 eyes) and study group (48 cases, 89 eyes). Two groups were all given retinal laser photocoagulation treatment, while the study group continued to receive calcium dobesilate for 12 weeks after treatment. After 12 weeks, observed the eyesight, change of blood rheology of the two groups. Results: After the treatment, the patients with vision >1.0 in the study group were significantly more than the control group (χ² =6.779, P=0.009), in the vision range of ≤0.4, 0.4~0.6, 0.7~1.0, the difference between the two groups was (χ² =0.003, P=0.955), (χ² =1.640, P=0.200), (χ²=2.148, P=0.143), respectively. After treatment, plasma viscosity, erythrocyte deposited, erythrocyte deformation index, fibrinogen in the study group were better than those in the control group (P<0.05). The total effectiveness in the study group was 89.9%, in the control group was 75.6%, the difference was statistically significant (χ²=6.302, P=0.012). Conclusion: The whole retinal laser photocoagulation and postoperative application of calcium dobesilate in treating the diabetic retinopathy can effectively improve eyesight and clinical curative effect, which may be associated with improving blood rheology.

目的：探讨基质金属蛋白酶-3(matrix metalloproteinases-3，MMP-3)基因多态位点与承德地区人群2型糖尿病视网膜病变的遗传易感性的关系。方法：应用病例对照研究方法，选取195例糖尿病视网膜病变患者(DR组)，其中非增殖性糖尿病视网膜病变(non-proliferative diabetic retinopathy，NPDR)组(n=152)和增殖性糖尿病视网膜病变(proliferative diabetic retinopathy，PDR)组(n=43)，205例单纯糖尿病患者(DM组)和261例正常对照组(Control组)，采用限制性片段长度多态性(restrictive fragment length polymorphism，RFLP)-聚合酶链反应(polymerase chain reaction，PCR)方法检测MMP-3的基因多态性。结果：MMP-3-1171 5A/6A的等位基因及基因型频率分布在Control组，DM组和DR组之间差异无显著性(P=0.474和P=0.407)。MMP-3-1171 5A/6A的等位基因及基因型频率分布在NPDR和PDR组之间差异无显著性(P=0.724和P=0.820)。结论：MMP-3-1171 5A/6A基因多态性与2型糖尿病视网膜病变的遗传易感性无关。

目的：探讨基质金属蛋白酶-3(matrix metalloproteinases-3，MMP-3)基因多态位点与承德地区人群2型糖尿病视网膜病变的遗传易感性的关系。方法：应用病例对照研究方法，选取195例糖尿病视网膜病变患者(DR组)，其中非增殖性糖尿病视网膜病变(non-proliferative diabetic retinopathy，NPDR)组(n=152)和增殖性糖尿病视网膜病变(proliferative diabetic retinopathy，PDR)组(n=43)，205例单纯糖尿病患者(DM组)和261例正常对照组(Control组)，采用限制性片段长度多态性(restrictive fragment length polymorphism，RFLP)-聚合酶链反应(polymerase chain reaction，PCR)方法检测MMP-3的基因多态性。结果：MMP-3-1171 5A/6A的等位基因及基因型频率分布在Control组，DM组和DR组之间差异无显著性(P=0.474和P=0.407)。MMP-3-1171 5A/6A的等位基因及基因型频率分布在NPDR和PDR组之间差异无显著性(P=0.724和P=0.820)。结论：MMP-3-1171 5A/6A基因多态性与2型糖尿病视网膜病变的遗传易感性无关。

目的：分析湖南地区汉族人群中2型糖尿病患者的人口学特征及生化指标，寻找糖尿病视网膜病变的高危因素。方法：釆用病例对照研究，统计湖南地区正常人群、2型糖尿病但无视网膜病变患者、2型糖尿病视网膜病变患者的人口学特征及生化指标的相关数据，进行成组t检验及logistic回归分析，探讨分析糖尿病视网膜病发生的易感因素。所有研究对象均为汉族。结果：对照组[非糖尿病(non-diabetes mellitus，NDM)组]和2型糖尿病未合并视网膜病变[(non-diabetic retinopathy，NDR)]组之间性别分布、年龄分布、BMI、舒张压、HbA1c、总胆固醇、高密度脂蛋白(high-density lipoprotein，HDL)、尿酸及总胆红素差异无统计学意义(均P>0.05)。NDM组中腹围、收缩压、空腹血糖、三酰甘油、肌酐和低密度脂蛋白(low-density lipoprotein，LDL)值均低于NDR组，差异有统计学意义(均P<0.05)。NDM组中BMI、腹围、收缩压、舒张压、空腹血糖、HbA1c、总胆固醇、三酰甘油、肌酐和LDL值均低于2型糖尿病合并视网膜病变组(diabetic retinopathy，DR)组，差异有统计学意义(均P<0.05)。NDR组收缩压、舒张压、HbA1c、总胆固醇、三酰甘油和肌酐值均低于DR组，差异有统计学意义(均P<0.05)。结论：收缩压超过150 mmHg，舒张压超过90mmHg，糖化血红蛋白超过9%，血清肌酐超过100 μmol/L，三酰甘油超过3 mmol/L均为糖尿病患者发生视网膜病变的高危易感因素。

Objective: To analyze the demographic characteristics and biochemical indexes of type 2 diabetic patients in Han population in Hunan, and to find the high-risk factors of diabetic retinopathy. Methods: The data of demographic characteristics and biochemical indexes of normal population, type 2 diabetic patients but without retinopathy and type 2 diabetic retinopathy in Hunan were analyzed. Group t test and logistic regression analysis were used to analyze the susceptibility factors of diabetic retinopathy. All the subjects were Han population. Results: There were no significant differences in gender distribution, age distribution, BMI, diastolic blood pressure, HbA1c,total cholesterol, high-density lipoprotein, uric acid and total bilirubin between the control group [non-diabetes mellitus (NDM) group] and the type 2 diabetic without retinopathy group [non-diabetic retinopathy (NDR)group] (all P>0.05). The abdominal circumference, systolic blood pressure, fasting blood glucose, triglyceride,creatinine and low-density lipoprotein in NDM group were all lower than those in NDR group, and the differences were statistically significant (all P<0.05). BMI, abdominal circumference, systolic blood pressure, diastolic blood pressure, fasting blood glucose, HbA1c, total cholesterol, triglyceride, creatinine and LDL in NDM group were all lower than those in type 2 diabetic retinopathy (DR) group, and the differences were statistically significant (all P<0.05). The comparison between the NDR group and the DR group showed that the values of systolic blood pressure,diastolic blood pressure, HbA1c, total cholesterol, triglyceride and creatinine in the NDR group were all lower than those in the DR group, and the differences were statistically significant (all P<0.05). Conclusion: SBP ≥150 mmHg,DBP ≥90 mmHg, HbA1c ≥9%, serum creatinine ≥100 μmol/L, triglyceride ≥3 mmol/L are the high-risk factors of diabetic retinopathy.

目的：分析不同程度2型糖尿病视网膜病变的血清生化全套指标，探讨各生化指标与糖尿病性视网膜病变(diabetic retinopathy，DR)程度的相关性。方法：回顾性收集2018年5月至2020年10月在福建医科大学附属第二医院就诊的2型糖尿病患者。根据眼底情况分为3组：糖尿病不伴视网膜病变(non-diabetic retinopathy，NDR)组(17例)、糖尿病伴非增殖性视网膜病变(non-proliferative diabetic retinopathy，NPDR)组(29例)、糖尿病伴增殖期视网膜病变(proliferative diabetic retinopathy，PDR)组(34例)。采用SPSS 24.0分析比较3组血清生化全套各指标水平，对差异指标与DR相关性采用Pearson相关分析与多重线性回归分析。结果：3组年龄差异无统计学意义(P>0.05)；3组的总蛋白、白蛋白、白球比、钙浓度差异均有统计学意义(均P<0.05)。组间比较发现NPDR和PDR组总蛋白、白蛋白、白球比、钙浓度低于NDR组，差异有统计学意义(P<0.05)。Pearson相关分析显示总蛋白(r=?0.290)、白蛋白(r=?0.304)，钙浓度(r=?0.252)与DR呈负相关(均P<0.05)，多重线性回归提示总蛋白、白蛋白及血钙浓度是DR保护因素(P<0.05)。结论：血清指标总蛋白、白蛋白及血钙浓度与DR成负相关，在生理范围内将这些指标维持相对较高的水平，或许可以为糖尿病视网膜病变的防治提供新思路。

Objective: To analyze the serum biochemical indexes of different degrees of type 2 diabetic retinopathy, and the correlation between biochemical indexes and the degree of diabetic retinopathy (DR). Methods: Patients with type 2 diabetes admitted to the Fujian Medical University 2nd Affiliate Hospital from May 2018 to October 2020 were retrospectively collected. The patients were divided into 3 groups according to fundus conditions: non-diabetic retinopathy (NDR) group (n=17), diabetes with non-proliferative diabetic retinopathy (NPDR) group (n=29),diabetes with proliferative diabetic retinopathy (PDR) group (n=34). SPSS 24.0 was used to compare the levels of a complete set of serum biochemical indexes in the three groups. Pearson correlation analysis and multiple linear regression analysis were used for the correlation between the different indexes and DR. Results: There was no statistically significant difference in age between the three groups. The differences in total protein, albumin, white sphere ratio, and calcium concentration of the three groups were statistically significant (P<0.05). The comparison between the groups showed that the total protein, albumin, white sphere ratio, and calcium concentration in the NPDR and PDR groups were lower than those in the NDR group. The difference was statistically significant (P<0.05). Pearson correlation analysis showed that total protein (r=?0.290), albumin (r=?0.304), and

calcium concentration (r=?0.252) were negatively correlated with DR (all P<0.05). Multiple linear regression indicated total protein, albumin and blood calcium concentration were the protective factors of DR (P<0.05).Conclusion: This study found that serum levels of total protein, albumin, and blood calcium levels are negatively correlated with DR. Maintaining a relatively high level of these indexes within the physiological range may provide new ideas for the prevention and treatment of diabetic retinopathy.