关键要点
- 维持血糖目标值至关重要，但研究表明，未得到控制的高血压、高胆固醇和肾功能障碍也会加速视网膜损伤。
- 监测和管理多种风险因素可显著改善眼部健康状况，延缓疾病进展。
- Systemic comorbidities like hypertension, dyslipidaemia, and kidney disease significantly influence the development and progression of diabetic retinopathy, not just glucose levels.
- 生活方式的改变和多学科护理能改善全身健康状况，进而促进视网膜健康并改善视力预后。
糖尿病视网膜病变 is one of the most common complications of diabetes and a leading cause of vision loss worldwide. It arises when chronic hyperglycaemia damages the small blood vessels in the retina, leading to leakage, swelling, and potentially vision-threatening complications.
虽然血糖控制长期以来一直是预防的基石，但越来越多的证据表明，管理全身性合并症对于延缓病情进展和减少长期损害同样重要。
了解这些相互关联的疾病如何影响眼睛，有助于患者采取更全面的方法来保护视力。
共病如何影响视网膜健康
Diabetes often occurs alongside other vascular conditions. Hypertension, dyslipidaemia, and kidney disease each affect the microcirculation throughout the body—including in the retina [1]. Elevated blood pressure increases mechanical stress on capillaries, making them more prone to leakage and rupture. Cholesterol abnormalities contribute to vascular plaque formation and can obstruct retinal blood flow.
尤其是肾脏疾病，其微血管病变机制与视网膜疾病高度相似。当肾小球受损时，视网膜毛细血管往往也会发生同样的病变过程。研究一致表明，慢性肾脏病患者的 糖尿病视网膜病变进展更快，这进一步强调了管理全身血管健康的重要性。
合并症与视网膜影响汇总表
| 合并症 | 对视网膜/DR进展的影响 | 建议管理措施 |
|---|---|---|
| 高血压 | Increases strain on retinal microvessels; promotes microaneurysms, haemorrhages, and macular oedema | 监测血压、服用降压药物、饮食控制、运动 |
| dyslipidaemia | 导致硬性渗出物形成；可能损害黄斑功能 | 监测血脂指标、他汀类药物、饮食及生活方式调整 |
| 肾脏疾病 | 微血管损伤与视网膜病变相呼应；加速病情进展 | Regular kidney function tests, optimise glycaemic and blood pressure control |
| hyperglycaemia | 损伤视网膜内皮细胞，刺激炎症和氧化应激 | 通过饮食、药物及生活方式改变实现严格血糖控制 |
| 吸烟 | 加速血管损伤；加重糖尿病视网膜病变严重程度 | Smoking cessation programmes |
| 肥胖/久坐生活方式 | 导致胰岛素抵抗和血管功能障碍 | 体重管理，规律体育活动 |
glycaemic Control: Still Foundational
血糖控制仍是预防和管理 糖尿病视网膜病变. Chronic hyperglycaemia damages endothelial cells, increases oxidative stress, and stimulates inflammation—each contributing to retinal vessel breakdown [2]. Glucose control alone cannot fully prevent deterioration, especially when systemic comorbidities remain unmanaged.
高血压及其对视网膜的影响
High blood pressure is a powerful accelerant of diabetic retinopathy. Elevated systolic or diastolic pressure increases strain within retinal microvessels, promoting microaneurysm formation, haemorrhages, and macular oedema [3]. Controlling blood pressure with medication, diet, and regular monitoring significantly reduces these risks.
当糖尿病与高血压得到联合管理时，对视网膜的保护作用比单独治疗任一疾病更为显著。血压保持稳定的患者，其视网膜疾病进展较慢，长期视力预后也更好。
Hyperlipidaemia: Cholesterol’s Role in Retinal Damage
dyslipidaemia contributes to the formation of hard exudates—lipid deposits that accumulate in retinal layers [4]. These deposits can impair visual function, particularly when they affect the macula.
Managing cholesterol through statins, dietary modifications, and lifestyle adjustments supports healthier blood vessels and lessens the retinal impact of abnormal lipids. Effective lipid control, combined with glycaemic and blood pressure management, strengthens the systemic vascular environment and lowers the risk of 不断恶化的糖尿病视网膜病变.
肾脏疾病与视网膜预后
糖尿病肾病与视网膜病变的恶化密切相关。影响肾功能的微血管损伤与视网膜所见的损伤如出一辙[5]。肾功能下降的患者出现晚期糖尿病视网膜病变（包括增生性病变和黄斑水肿）的几率更高。
Early detection of kidney disease—through regular monitoring of urine albumin, creatinine, and estimated glomerular filtration rate—allows timely interventions. When kidney health improves or stabilises, retinal outcomes often improve as well, highlighting the importance of systemic care.
生活方式干预及其保护作用
调整生活方式仍是降低系统性风险的关键环节。规律的体育活动可改善心血管功能、增强胰岛素敏感性，并促进视网膜灌注。富含全谷物、健康脂肪且限制加工糖分的均衡饮食，有助于更好地控制血糖、血脂和血压[6]。
戒烟尤为重要。吸烟会加速血管损伤，并加重 糖尿病视网膜病变的严重程度戒烟尤为重要。吸烟会加速血管损伤，并加重糖尿病视网膜病变的严重程度。体重管理进一步有助于维持代谢稳定，减轻视网膜微循环的负担。
药物管理与团队协作护理
控制合并症通常需要联合用药——例如抗高血压药、他汀类药物以及保护肾功能的药物。坚持治疗对维持稳定的全身健康至关重要，这直接影响视网膜预后。
多学科护理模式能显著改善整体管理效果。内分泌科、肾脏科、全科医生和眼科医生之间的协作，可制定出既针对全身性疾病又涵盖糖尿病眼部并发症的协调一致的护理方案。
这种协调一致的方法确保糖尿病视网膜病变的治疗不再孤立进行，而是作为更广泛健康状况的一部分来处理。
监测与定期眼科检查
即使全身控制状况极佳，定期的视网膜评估依然至关重要。全面的眼科检查——尤其是包含眼底摄影和光学相干断层扫描的检查——有助于早期识别细微的视网膜变化。
患有多种未控制合并症的患者可能需要更频繁的监测。早期发现可及时启动激光治疗或抗VEGF注射等治疗措施，从而降低永久性视力受损的风险。
全身健康的协同效益
Improved systemic health produces synergistic benefits across multiple organs. When blood glucose, blood pressure, and cholesterol are well controlled, the risk of cardiovascular events declines, kidney health stabilises, and the retina receives better oxygenation and blood flow.
这种整体治疗方法能增强眼部治疗的有效性，并减少长期并发症。全身健康的稳定性直接影响糖尿病视网膜病变的进展轨迹。
患者教育与赋能
Patient understanding is essential for long-term disease management. When individuals recognise how systemic factors influence their eyes, they are more likely to adhere to medication, lifestyle adjustments, and follow-up schedules.
Support groups and educational programmes help patients navigate complex medical decisions and maintain motivation. Empowering patients strengthens engagement and improves both systemic outcomes and rates of progression for diabetic retinopathy.
结论
全身健康与糖尿病视网膜病变的病程之间存在明确关联。有效管理血糖、血压、血脂及肾功能，可显著降低视力丧失的风险并改善整体健康状况。
多学科护理、生活方式调整、药物依从性以及定期视网膜检查共同构成了保护长期视力的综合方案。通过综合应对糖尿病及其相关并发症，患者能够延缓疾病进展、保持生活自理能力，并为未来多年的视力健康提供保障。
参考文献
- Wong, T. Y., & Cheung, C. M. G. (2016). 糖尿病视网膜病变与全身性血管危险因素之间的关联。《柳叶刀·糖尿病与内分泌学》, 4(5), 389–400. https://pubmed.ncbi.nlm.nih.gov/27779095/
- Antonetti, D. A., Klein, R., & Gardner, T. W. (2012). 糖尿病视网膜病变。新英格兰医学杂志, 366, 1227–1239. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5432556/
- StatPearls. (2025). 糖尿病视网膜病变。StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK560805/
- Li, Z., Yuan, Y., Qi, Q., et al. (2023). Relationship between dyslipidaemia and diabetic retinopathy in type 2 diabetes mellitus: A systematic review and meta‑analysis. 有系统的评价，12, 148. https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-023-02321-2
- 孙，H.，严，L.，& 刘，W. (2024). 2型糖尿病中糖尿病视网膜病变与糖尿病肾病的关系。PubMed. https://pubmed.ncbi.nlm.nih.gov/38344659/
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