摘要
视网膜脉络膜新生血管性疾病是当前在世界范围内导致中、重度视力损害最为主要的原因之一。它包括视网膜新生血管性疾病和脉络膜新生血管性疾病两种。前者以糖尿病视网膜病变、早产儿视网膜病变及视网膜中央静脉阻塞为主;后者主要有湿性老年黄斑变性、病理性高度近视。视网膜新生血管性疾病主要由于各种原因所致的视网膜组织缺氧诱导细胞内缺氧诱导因子(HIF-1)浓度增高,刺激其下游的血管内皮细胞生长因子(VEGF)、血小板源性生长因子-B(PDGF-B)、胎盘生长因子以及其他与缺氧有关的基因产物表达增高,比如angiopoietin-2。在脉络膜新生血管性疾病中,虽然HIF-1作用相对次要,但同样存在相应组织内HIF-1浓度增高,缺氧诱导的基因起到一定的促进作用。临床研究发现,抗VEGF药物在治疗视网膜新生血管性疾病和脉络膜新生血管性疾病中取得了不错疗效,而联合抗VEGF及PDGF更是具有光明的前景。在不久的将来,会有更多针对缺氧诱导基因的药物逐步进入临床试验。也有研究直接以HIF-1为拮抗靶点,或者尝试通过转基因方法实现在体内稳定表达抗新生血管生成蛋白。虽然近年视网膜脉络膜新生血管性疾病的诊治有了长足进步,但仍会有更多药物可以被开发用于视网膜及脉络膜血管性疾病的治疗。
Retinal and choroidal neovascularization diseases are the main causes of moderate and severe visual impairment in the world. The main kinds of retinal neovaseularization diseases are diabetic retinopathy, retinopathy of promaturity and central retinal vein occlusion. The main kinds of choroidal neovascularization diseases are wet age-related macular degeneration and pathological myopia. Retinal neovaseularization diseases are mainly caused by increased expres- sion of vascular endothelial growth factor （VEGF）, platelet-derived growth factor-B （PDGF-B）, placental growth factor and other hypoxia related gone products. These factors express more when the concentration of hypoxia-indueible factor （HIF-1） in the cell increase which is induced by hypoxia of retina tissue. Although HIF-1 play a relatively secondary role on the formation of choroidal neovascularization diseases, it has a high concentration in relevant tissue because of the auxo-action by hypoxia-indueible factor gene. Clinical research found that anti-VEGF drugs got good curative effect of treatment on retinal and choroidal neovascularization diseases and combination use of anti-VEGF and anti-PDGF has a brighter prospect. In the near future, more drugs aiming at HIF-1 will start clinical trials gradually. Even some studies directly make HIF-1 as the target of antagonism action or use the transgenic technology to realize stable expression of anti-VEGF proteins in the body. With the great progress in recent years, more drugs will be developed to treat the Retinal and choroidal neovascularization diseases in the future.
出处
《西部医学》
2016年第9期1328-1332,F0003,共6页
Medical Journal of West China
基金
国家自然科学基金面上项目(81271020)
关键词
新生血管
血管内皮细胞生长因子
缺血性视网膜病变
老年性黄斑变性
Neovascularization Vascular endothelial growth factor Ischemic retinopathyl Age-related macular degeneration
