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中华眼科医学杂志(电子版) ›› 2023, Vol. 13 ›› Issue (05) : 301 -305. doi: 10.3877/cma.j.issn.2095-2007.2023.05.009

综述

血脂异常与糖尿病视网膜病变的相关性研究进展
刘涵, 方晏红, 张蓝月, 李新星()   
  1. 402260 重庆大学附属江津医院眼科
  • 收稿日期:2023-09-01 出版日期:2023-10-28
  • 通信作者: 李新星
  • 基金资助:
    重庆市自然科学基金项目(cstc2020jcyj-msxmX0698、CSTB2023NSCQ-MSX0639); 重庆市江津区科学技术局项目(Y2023016)

Research progress of the correlation between dyslipidemia and diabetic retinopathy

Han Liu, Yanhong Fang, Lanyue Zhang, Xinxing Li()   

  1. Department of Ophthalmology, Chongqing University Jiangjin Hospital, Chongqing 402260, China
  • Received:2023-09-01 Published:2023-10-28
  • Corresponding author: Xinxing Li
引用本文:

刘涵, 方晏红, 张蓝月, 李新星. 血脂异常与糖尿病视网膜病变的相关性研究进展[J]. 中华眼科医学杂志(电子版), 2023, 13(05): 301-305.

Han Liu, Yanhong Fang, Lanyue Zhang, Xinxing Li. Research progress of the correlation between dyslipidemia and diabetic retinopathy[J]. Chinese Journal of Ophthalmologic Medicine(Electronic Edition), 2023, 13(05): 301-305.

糖尿病会引起糖尿病视网膜病变(DR)和糖尿病性黄斑水肿(DME)。两者均是成人失明和低视力的重要原因。血脂异常与DR及DME密切相关。传统血脂中,胆固醇、甘油三酯、极低密度脂蛋白及低密度脂蛋白可能是DR的危险因素,而高密度脂蛋白可能是其保护因素。非传统血脂中,载脂蛋白B、载脂蛋白C、载脂蛋白E、小而密低密度脂蛋白胆固醇及脂蛋白a可能是DR的危险因素,载脂蛋白A可能是其保护因素。血脂平衡和其比值有助于判断DR的发生与发展状态。多不饱和脂肪酸及其比值可能与DR的发病机制有关。他汀类和贝特类降脂药物均能在高糖环境下保护视网膜,并在抑制DR方面发挥潜在作用。本文中笔者对血脂异常与糖尿病视网膜病变的相关性研究进展进行综述。

Diabetes causes diabetic retinopathy (DR) and diabetic macular edema (DME), which are important causes of blindness and low vision in adults. The dyslipidemia is closely associated with DR and DME.Traditional blood lipids such as cholesterol, triglyceride, very low density lipoprotein and low-density lipoprotein may be risk factors for DR, while high-density lipoprotein may be protective. For non-traditional blood lipids, apolipoprotein B, C, E, small and dense low-density lipoprotein cholesterol and lipoprotein a may be risk factors for DR, while apolipoprotein A may be protective. Lipid balance/ratio is more helpful to determine the occurrence and progress of DR. Polyunsaturated fatty acids and their ratios may be related to the pathogenesis of DR. Lipid-lowering drugs statins and fibrates both protect the retina in high glucose environment and have a potential role in inhibiting DR.The correlation between blood lipids and DR was reviewed, aiming to provide a new strategy for DR integrated treatment.

表1 传统血脂、载脂蛋白及血脂平衡与糖尿病视网膜病变相关性的文献汇总表
类别 相关性 发表年份(年) 研究方法 病例数(例) 文献序号
传统血脂          
总胆固醇、高密度脂蛋白胆固醇 有关 2022 Meta分析 [8]
甘油三酯 有关 2022 横断面研究 131 [9]
低密度脂蛋白胆固醇 有关 2020 前瞻性病例对照研究 111例(176只眼) [10]
低密度脂蛋白胆固醇 有关 2020 病例对照研究 42 [11]
中间密度脂蛋白和极低密度脂蛋白 有关 2022 横断面研究 573 [12]
甘油三酯、总胆固醇和高密度脂蛋白胆固醇 无关 2018 Meta分析 [13]
整体血脂水平 无关 2013 回顾性研究 191 [14]
高密度脂蛋白、甘油三酯 无关 2022 临床随机试验 2468 [15]
低密度脂蛋白胆固醇 无关 2019 单样本随机对照试验 116 419 [7]
载脂蛋白          
载脂蛋白A-Ⅰ 负相关 2021 横断面研究 1027 [20]
载脂蛋白A-Ⅱ 负相关 2022 病例对照研究 157 [21]
载脂蛋白B 正相关 2021 病例对照研究 148 [22]
载脂蛋白C-Ⅰ 正相关 2018 蛋白质组学 [23]
载脂蛋白C-Ⅱ和C-Ⅲ 正相关 2023 蛋白质组学 [24]
载脂蛋白E 正相关 2017 动物实验 [26]
载脂蛋白E 正相关 2022 病例对照研究 667 [27]
血脂平衡/比值          
总胆固醇/低密度脂蛋白胆固醇、甘油三酯/高密度脂蛋白胆 固醇 危险因素 2017 横断面研究 1425 [37]
甘油三酯/高密度脂蛋白胆固醇 独立危险因素 2021 横断面研究 400 [38]
甘油三酯/高密度脂蛋白胆固醇 独立危险因素 2022 队列研究 420 [39]
载脂蛋白C-Ⅲ/载脂蛋白A-Ⅰ、载脂蛋白E/载脂蛋白A-Ⅰ 危险因素 2018 队列研究 1023 [40]
载脂蛋白B/载脂蛋白A-Ⅰ、载脂蛋白E/载脂蛋白C-Ⅱ、载 脂蛋白B/非高密度脂蛋白胆固醇 存在一定联系 2020 队列研究 1057 [29]
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