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对于所有的眼科医生、糖尿病专家和基层医务人员而言,糖尿病性视网膜病变的治疗目的应该是良好的血糖、血压和血脂控制,这个治疗目标也是现代医疗管理的重要组成部分。涉及非诺贝特(fenofibrate)使用的最新数据,包括FIELD试验(the Fenofibrate Intervention and Event Lowering in Diabetes)和ACCORD试验(The Action to Control Cardiovascular Risk in Diabetes),都进行了眼科相关的探讨。FIELD试验的结果表明,非诺贝特(200mg/day)减少了糖尿病性视网膜病变患者的激光治疗需求,并防止了病情的进一步恶化。ACCORD试验结果表明,和使用单药辛伐他汀相比,非诺贝特(160mg/day)和辛伐他汀(simvastatin)联合用药,可使4年进展为视网膜病变的几率减少40%。同时,和安慰剂组相比,非诺贝特组患者的HDL-C(高密度脂蛋白胆固醇)水平增加和血清甘油三酯水平减少,这种改变独立于控制血糖。我们认为,非诺贝特可有效预防2型糖尿病患者的糖尿病性视网膜病变的进展,因此,对于存在增生前期糖尿病视网膜病变(PPDR)和/或糖尿病性黄斑病变的患者,特别是那些因黄斑水肿需要激光治疗的患者,应考虑使用非诺贝特。
The goal of treatment for diabetic retinopathy should be good for all ophthalmologists, diabetologists, and primary care physicians, and the goal of treatment is also an important part of modern medical management. Recent data related to the use of fenofibrate, including the Fenofibrate Intervention and Event Lowering in Diabetes and The Action to Control Cardiovascular Risk in Diabetes, are all discussed in the field of ophthalmology. The results of the FIELD trial showed that fenofibrate (200 mg / day) reduced the need for laser treatment in patients with diabetic retinopathy and prevented further deterioration of the condition. The ACCORD trial showed that the combination of fenofibrate (160 mg / day) and simvastatin reduced the 4-year progression to retinopathy by 40%, compared with monobasic simvastatin. Meanwhile, HDL-C (high density lipoprotein cholesterol) levels and serum triglyceride levels decreased in fenofibrate-treated patients compared with placebo, independent of glycemic control. We believe fenofibrate is effective in preventing the progression of diabetic retinopathy in patients with type 2 diabetes mellitus, and therefore, for patients with pre-proliferative diabetic retinopathy (PPDR) and / or diabetic maculopathy, particularly those with macular edema Patients who require laser treatment should consider using fenofibrate.