摘要
目的:糖尿病视网膜病变是1型和2型糖尿病患者常见的微血管并发症之一,可影响视力甚至造成失明,是糖尿病患者康复方面的重要问题。本文综述探讨肾素-血管紧张素系统和血压控制对治疗糖尿病视网膜病变的疗效和机制。资料来源:应用计算机检索Medline1990-01/2004-08的文章,检索词“diabetesmellitus,renin-angiotensinsystem,retinopathy”,并限定语言种类为英文。同时计算机检索万方数据资源系统与中国期刊全文数据库1995-01/2004-08的文章,限定文章语言种类为中文,检索词“糖尿病,视网膜病变,肾素-血管紧张素系统”。资料选择:对资料进行初审,选取研究中包括实验组和对照组的文献,筛除明显不随机的研究,对入选文献查找全文,进一步判断为随机对照研究。纳入标准为①随机对照研究,采用单盲,双盲或非盲法。②研究包含对照组。排除标准:排除重复性非随机对照临床研究。资料提炼:共筛选36篇关于糖尿病视网膜病变与肾素-血管紧张素系统及血压控制临床研究的文章,22个实验纳入标准,排除的14篇为重复性研究。资料综合:22个研究包括探讨高血压及肾素-血管紧张素系统与糖尿病视网膜病变发病之间的关系以及对治疗方法给予评价。发现糖尿病视网膜病变的发生除与代谢控制有关,还受到血压和肾素-血管紧张素系统的影响。严格降压,尤其是血管紧张素转化酶抑制剂和血管紧张素受体拮抗剂的应用可以减少糖尿病视网膜病变的发生和预防失明。结论:许多大型研究显示血压和肾素-血管紧张素系统系统对糖尿病视网膜病变有明确影响,但作用的具体机制仍不明了,需要更多的研究探索。
OBJECTIVE:Diabetic retinopathy is one of the chronic complications in type 1 and type 2 diabetic patients.Diabetic retinopathy plays a bad role in the rehabilitation of diabetes because of its harmful effect on vision.This article focuses on the efficacy and mechanism of blood pressure and rennin-angiotensin system control in treating diabetic retinopathy.DATA SOURCES:An online search of Medlin database was undertaken by using the Keywords of' diabetes mellitus,renin-angiotensin system and retinopathy' to identify the relevant articles published in English from January 1990 to August 2004.Meanwhile,wanfang database and Chinese journals full-text database were scanned with computer to search relevant articles published from January 1995 to August 2004,the keywords were ' diabetes mellitus,renin-angiotensin system and retinopathy' with language limited to Chinese.STUDY SELECTION:After the above search,the trials including treatment and control groups were selected,while the obvious non-randomized trials were excluded,and then the full text of the selected articles were searched for randomized controlled study.Inclusive criteria:① randomized controlled study with single-blind,double-blind or non-blind method;② experiments including control groups.The repetitive non-randomized controlled clinical studies were excluded.DATA EXTRACTION:Totally 36 papers about diabetic retinopathy,rennin angiotensin system and blood pressure control were selected,including 23 clinical trials and 4 reviews.DATA SYNTHESIS:The 23 clinical trial investigated the relation of hypertension and RAS with the occurrence of diabetic retinopathy,also assessed the therapeutic methods,and it was indicated that the diabetic retinopathy occurrence was related with the metabolic control,it was also affected by blood pressure and rennin-angiotensin system.The occurrence of diabetic retinopathy could be reduced and anopsia could be prevented by decompression,especially the application of angiotensin converting enzyme inhibitor or the angiotensin receptor blocker.CONCLUSION:It has been identified that rennin angiotensin system and blood pressure play a role in diabetic retinopathy by many clinical trials,but the mechanism in detail remains unknown,which needs more explorations.
出处
《中国临床康复》
CSCD
北大核心
2005年第19期160-162,共3页
Chinese Journal of Clinical Rehabilitation
