| 290 | 5 | 71 |
| 下载次数 | 被引频次 | 阅读次数 |
目的:评价口服非诺贝特治疗糖尿病视网膜病变(DR)的有效性及安全性。方法:检索PubMed、Cochrane Library、CKNI、万方等数据库中从建库至2020年5月20日关于口服非诺贝特预防及治疗DR的随机对照试验(RCTs)。对选取的文献进行严格的质量分析后,运用Revman5.3软件对所提取的数据进行分析。结果:本研究共纳入7项RCTs(n=16 712)。Meta分析结果显示,与对照组相比,口服非诺贝特首次需要激光治疗的次数明显减少(OR=0.68,95%CI:0.56～0.81,P<0.000 1),并有效延缓DR进展(OR=0.71,95%CI:0.59～0.87,P=0.000 7),此外,两组在视力改善方面无明显差异(OR=0.98,95%CI:0.86～1.11,P=0.72)。结论:非若贝特可有效减少首次激光治疗的需求,并有效延缓DR的进展。
Abstract：Objective:To assess the efficacy and safety of fenofibrate for diabetic retinopathy(DR).Methods:Randomized controlled trials(RCTs)of oral fenofibrate for the prevention and treatment of diabetic retinopathy(DR)was retrieved from PubMed,Cochrane Library,CKNI, Wanfang database with the deadline to May 20,2020.The quality of selected studies were strictly evaluated,and the data analyses were performed by Revman 5.3 software.Results:There were 7 RCTs including 16 712 cases enrolled.The results of meta-analysis indicated that oral fenofibrate decreased the number of laser treatment required for the first time(OR=0.68,95%CI:0.56 to 0.81,P <0.000 1),and alleviated the progression of DR effectively(OR=0.71,95%CI:0.59 to 0.87,P=0.000 7),when compared with the control group.In addition,there was no significant difference in vision improvement between the two groups(OR=0.98,95% CI:0.86 to 1.11,P =0.72).Conclusion:Fenofibrate could effectively reduce the need of laser treatment for the first time,and slow down the development of DR.
[1]Lee R,Wong T Y,Sabanayagam C,et al.Epidemiology of diabetic retinopathy,diabetic macular edema and related vision loss.Eye Vis(Lond)[J].Eye Vis(Lond),2015,30(2):17.
[2]Leasher J L,Bourne R R A,Flaxman S R,et al.Global estimates on the number of people blind or visually impaired by diabetic retinopathy:a meta-analysis from1990to 2010[J].Diabetes Care,2016,39(9):1643-1649.
[3]Jorge E C,Jorge E N,Botelho M,et al.Monotherapy laser photocoagulation for diabetic macular oedema[J].Cochrane Database Syst Rev,2018,10(10):CD010859.
[4]Mehta H,Hennings C,Gillies M C,et al.Anti-vascular endothelial growth factor combined with intravitreal steroids for diabetic macular oedema[J].Cochrane Database Syst Rev,2018,4(4):CD011599.
[5]Modjtahedi B S,Bose N,Papakostas T D,et al.Lipids and diabetic retinopathy[J].Semin Ophthalmol,2016,31(1-2):10-8.
[6]Wong T Y,SimóR,Mitchell P,et al.Fenofibrate-apotential systemic treatment for diabetic retinopathy[J].Am J Ophthalmol,2012,154(1):6-12.
[7]Walker A E,Kaplon R E,Lucking S M S,et al.Fenofibrate improves vascular endothlial function by reducing oxidative stress while increasing endothelial nitric oxide synthase in healthy normolipidemic older adults[J].Hypertension,2012,60(6):1517-1523.
[8]American Diabetes Association.Classification and diagnosis of diabetes:standards of medical care in diabetes-2018[J].Diabetes Care,2018,41(Suppl 1):S13-S27.
[9]Early Treatment Diabetic Retinopathy Study Research Group.Grading diabetic retinopathy from stereoscopic color fundus photographs——an extension of the modified airlie house classification.ETDRS report number 10[J].Ophthalmology,1991,98(5Suppl):786-806.
[10]Bailey I L,Lovie-Kitchin J E.Visual acuity testing from the laboratory to the clinic[J].Vision Res,2013,20(90):2-9.
[11]Chew E Y,Ambrosius W T,Howard L T,et al.Rationale,design,and methods of the action to control cardiovascular risk in diabetes eye study(ACCORD-EYE)[J].Am J Cardiol,2007,99(12A):103i-111i.
[12]Keech A C,Mitchell P,Summanen P A,et al.Effect of fenofibrate on the need for laser treatment for diabetic retinopathy(FIELD Study):a randomised controlled trial[J].Lancet,2007,370(9600):1687-1697.
[13]Chew C Y,Ambrosius W T,Davis M D,et al.Effects of medical therapies on retinopathy progression in type 2diabetes[J].N Engl J Med,2010,363(3):233-244.
[14]Chew E Y,Davis M D,Danis R P,et al.The effects of medical management on the progression of diabetic retinopathy in persons with type 2diabetes:the action to control cardiovascular risk in diabetes(ACCORD)eye study[J].Ophthalmology,2014,121(12):2443-2451.
[15]Chew E Y.Persistent effects of intensive glycemic control on retinopathy in type 2diabetes in the action to control cardiovascular risk in diabetes(ACCORD)follow-on study[J].Diabetes Care,2016,39(7):1089-1100.
[16]赵婷,徐倩.非诺贝特治疗糖尿病视网膜病变的临床研究[J].临床医学,2011,9(21):55-56.
[17]Massin P,Peto T,Ansquer J C,et al.Effects of fenofibric acid on diabetic macular edema:the macufen study[J].Ophthalmic Epidemiol,2014,21(5):307-317.
[18]Klaassen I,Noorden C J F V,Schlingemann R O,et al.Molecular basis of the inner blood-retinal barrier and its breakdown in diabetic macular edema and other pathological conditions[J].Prog Retin Eye Res,2013,34:19-48.
[19]Wang W,Lo A C Y.Diabetic retinopathy:pathophysiology and treatments[J].Int J Mol Sci,2018,19(6):1816.
[20]Klein R,Sharrett A R,Klein B E K,et al.The association of atherosclerosis,vascular risk factors,and retinopathy in adults with diabetes:the atherosclerosis risk in communities study[J].Ophthalmology,2002,109(7):1225-1234.
[21]Liew G,Gillies M,Wang J J,et al.Fenofibrate and diabetic retinopathy[J].Lancet,2008,371(9614):721.
[22]李燕云,徐宽枫,唐伟.非诺贝特对糖尿病视网膜病变治疗的有效性及安全性的Meta分析[J].中国糖尿病杂志,2013,21(9):817-821.
[23]Ju H B,Zhang F X,Wang S,et al.Effects of fenofibrate on inflammatory cytokines in diabetic retinopathy patients[J].Medicine(Baltimore),2017,96(31):e7671.
[24]Medina R J,O'Neill C L,Adrian B,et al.Devine the pleiotropic effects of simvastatin on retinal microvascular endothelium has important implications for ischaemic retinopathies[J].PLoS One,2008,3(7):e2584.
基本信息:
中图分类号:R587.2;R774.1
引用信息:
[1]陈丽华,熊梦婷,郑涛,等.基于Meta分析研究非诺贝特治疗糖尿病视网膜病变的有效性及安全性[J].巴楚医学,2020,3(03):84-89.
基金信息:
宜昌市医疗卫生科研项目(No:A17-301-17)
2020-06-08
2020
2020-08-18
2020
2020-07-21
1
2020-09-30
2020-09-30