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目的通过观察非诺贝特治疗对糖尿病视网膜病变(diabetic retinopathy,DR)患者的血清脂蛋白相关磷脂酶A2(lipoprotein-associated phospholipase A2,Lp-PLA2)水平以及视力、眼底病变的影响,并探讨其在临床防治DR中的作用及机制。方法选取作者医院收治的非增殖期糖尿病视网膜病变(non-proliferative diabetic retinopathy,NPDR)患者67例(NPDR组,134只眼)和增殖期糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)患者42例(PDR组,84只眼)纳入研究,2组随机均分为非诺贝特治疗组与对照组。对照组给予常规降糖治疗,治疗组在对照组的基础上口服非诺贝特160 mg,1次/d,治疗12周。比较治疗前后血清Lp-PLA2、血管内皮生长因子(vascular endothelial growth factor,VEGF)水平的变化情况及视力、眼底病变的检查结果。结果与NPDR对照组比较,NPDR治疗组患者血清Lp-PLA2(P<0.01)、VEGF(P<0.05)水平均明显下降,患者的视力治疗有效率和眼底病变治疗有效率均明显提高(P<0.05)。与PDR对照组比较,PDR治疗组患者血清Lp-PLA2、VEGF水平均明显下降,组间比较差异具有统计学意义(P<0.05)。结论非诺贝特治疗可以明显降低NPDR和PDR患者血清Lp-PLA2、VEGF水平,提高NPDR患者视力,改善眼底病变,有效延缓DR的进展。
Objective To observe the effect of fenofibrate on the level of serum lipoprotein-associated phospholipase A2 (Lp-PLA2) and visual acuity and retinopathy in diabetic retinopathy (DR) In the prevention and treatment of DR in the role and mechanism. Methods Forty-two patients with proliferative diabetic retinopathy (PDR) and 67 patients with non-proliferative diabetic retinopathy (NPDR) (NPDR group, 134 eyes) were enrolled in the study. Group, 84 eyes) were included in the study, two groups were randomly divided into fenofibrate treatment group and control group. The control group was given routine hypoglycemic treatment. The treatment group was treated with fenofibrate 160 mg once daily for 12 weeks on the basis of the control group. The changes of serum Lp-PLA2 and vascular endothelial growth factor (VEGF) levels before and after treatment were compared with those of eyesight and fundus lesions. Results Compared with NPDR control group, the levels of serum Lp-PLA2 (P <0.01) and VEGF (P <0.05) in patients with NPDR were significantly decreased, and the visual acuity of patients with NPDR and the effective rate of fundus lesions were significantly increased (P < 0.05). Compared with PDR control group, the levels of serum Lp-PLA2 and VEGF in PDR-treated group were significantly decreased, the difference between the two groups was statistically significant (P <0.05). Conclusion Fenofibrate treatment can significantly reduce serum levels of Lp-PLA2 and VEGF in patients with NPDR and PDR, improve vision in patients with NPDR, improve fundus lesions, and effectively delay the progression of DR.