目的：探讨非诺贝特联合23G微创玻璃体切割手术在糖尿病视网膜病变(DR)治疗中的临床应用价值。

方法：选取2015-10/2017-11在我院接受治疗的DR患者102例102眼为研究对象，按照随机数字表法分为观察组和对照组，每组51例51眼，两组患者均行23G微创玻璃体切割术，术后第1d起，对照组给予常规降糖、降压及改善微循环治疗，观察组在对照组的治疗基础上联合非诺贝特治疗，均连续治疗3mo。对比两组患者术中及术后基本情况(手术用时、术中出血量、围手术期并发症发生率、住院时间)、术前和术后3mo血脂\〖总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)\〗及血清相关因子\〖脂蛋白相关磷脂酶A2(Lp-PLA2)、血管内皮生长因子(VEGF)\〗水平，随访至术后6mo，比较两组患者视网膜病变复发率。

结果：两组患者手术用时、术中出血量、围手术期并发症发生率及住院时间比较，差异均无统计学意义(P>0.05)。术前两组患者TC、TG、LDL-C、HDL-C水平比较，差异均无统计学意义(P>0.05)； 术后3mo观察组患者TC、TG、LDL-C水平均低于对照组，HDL-C水平高于对照组，差异均有统计学意义(P<0.05)。术前两组患者血清Lp-PLA2、VEGF水平比较，差异均无统计学意义(P>0.05)； 术后3mo观察组患者血清Lp-PLA2、VEGF水平均低于对照组，差异均有统计学意义(P<0.05)。术前两组患者视功能生存质量问卷活动受限、感觉适应、心理、社交各项评分及总分比较，差异均无统计学意义(P>0.05)； 术后3mo观察组患者视功能生存质量问卷各项评分及总分均低于对照组，差异均有统计学意义(P<0.05)。术后随访6mo，观察组无复发，对照组复发率为5.9%(3/51)，组间比较差异无统计学意义(P>0.05)。

结论：非诺贝特联合23G微创玻璃体切割术治疗DR，可有效纠正患者术后脂质代谢紊乱、降低血清Lp-PLA2及VEGF水平，有利于改善患者视功能生存质量，但对降低术后复发率尚无有效数据支持。

METHODS: Totally 102 DR patients(102 patients)treated in our hospital from October 2015 to November 2017 were selected and divided into observation group and control group according to random number table, 51 cases in each group. The 23G minimally invasive vitrectomy was performed in all patients. From the 1^st day after operation, the two groups were treated with related treatment, and the control group was given conventional hypoglycemic, antihypertensive and improved microcirculation treatment. On the basis of the above, the observation group was treated with fenofibrate treatment. Both groups were treated for 3mo. The operation and postoperative basic conditions(operative time, intraoperative blood loss, complication rate, length of stay), the level of blood lipid \〖total cholesterol(TC), triglyceride(TG), low density lipoprotein cholesterol(LDL-C), high density lipoprotein cholesterol(HDL-C)\〗, and the serum levels of related factors \〖lipoprotein associated phospholipase A2(Lp-PLA2), vascular endothelial growth factor(VEGF)\〗 before and after 3mo of operation of two groups were compared. Following up for 6mo after operation, the recurrence rate of two groups of retinopathy was statistically compared.

RESULTS: There was no significant difference in operative time, intraoperative blood loss, incidence of complications and length of stay between the two groups(P>0.05). There was no significant difference in the levels of TC, TG, LDL-C and HDL-C between the two groups before operation(P>0.05). After 3mo, the levels of TC, TG and LDL-C in the observation group were lower than those in the control group, and the level of HDL-C was higher than that in the control group, and the difference was statistically significant(P<0.05). There was no significant difference in serum levels of Lp-PLA2 and VEGF between the two groups before operation(P>0.05). The serum levels of Lp-PLA2 and VEGF in the observation group were lower than those in the control group 3mo after operation, and the difference was statistically significant(P<0.05). There was insignificant difference in visual function and quality of life, sensory adjustment, psychological and social scores and total scores between the two groups before surgery(P>0.05). At 3mo after operation, the scores of visual function and life quality in the observation group were lower than those in the control group, and the difference was statistically significant(P<0.05). After follow-up for 6mo, no recurrence occurred in the observation group. The recurrence rate in the control group was 5.9%(3/51), and there was no significant difference between the two groups(P>0.05).

CONCLUSION: The combination of fenofibrate and 23G minimally invasive vitrectomy for the treatment of DR can effectively correct the disorder of lipid metabolism, reduce the level of serum Lp-PLA2 and VEGF, so it is beneficial to improve the visual function and quality of life of the patients, but there is no effective data support for reducing the postoperative recurrence rate.