胰高血糖素样肽-1受体激动剂与非动脉炎性前部缺血性视神经病变风险的当前综述

文献信息

中文摘要

背景： 新出现的数据已发现胰高血糖素样肽-1受体激动剂（GLP-1RAs）与非动脉炎性前部缺血性视神经病变（NAION）之间可能存在关联，后者是一种通常突然、无痛且不可逆的视神经介导的视力丧失原因。本综述综合了当前将基于GLP-1RA的治疗与NAION风险联系起来的临床、流行病学及潜在机制，为平衡的风险评估和跨学科临床决策提供信息。方法：使用包括“GLP-1受体激动剂”、“司美格鲁肽”、“利拉鲁肽”、“替尔泊肽”和“非动脉炎性前部缺血性视神经病变”在内的术语，以及NAION危险因素，包括高危视盘解剖、2型糖尿病、阻塞性睡眠呼吸暂停、高血压、高脂血症、肾脏疾病和缺血性心脏病，进行了结构化PubMed检索。结果：小杯盘比（“高危视盘”）被发现是NAION最稳健的解剖学预测因素。全身性微血管疾病（糖尿病、高血压、高脂血症）以及阻塞性睡眠呼吸暂停和终末期肾病等状况也与视神经头缺血的易感性增加有关。尽管来自电子健康记录、国家登记处和药物警戒分析的数据提示NAION的绝对发病率非常低，但使用GLP-1RAs显示出与NAION发生的统计学显著关联，相对风险估计值在1.2至4.3之间。结论：目前，GLP-1RA治疗与NAION之间的潜在关联应被解释为安全性信号而非禁忌症。在开始治疗前，可能有必要筛查高危视盘解剖、考虑既往NAION病史，并就急性视觉症状对患者进行咨询。随着证据的发展，内分泌科医生与眼科医生之间的合作对于支持安全有效的患者护理将至关重要。

英文摘要

Emerging data has identified a potential association between glucagon-like peptide-1 receptor agonists (GLP-1RAs) and nonarteritic anterior ischemic optic neuropathy (NAION), a typically sudden, painless, and irreversible cause of optic nerve-mediated vision loss. This review synthesizes the current clinical, epidemiologic, and potential mechanism linking GLP-1RA-based therapies to NAION risk, informing balanced risk assessment and interdisciplinary clinical decision-making. A structured PubMed search was performed using terms including "GLP-1 receptor agonist," "semaglutide," "liraglutide," "tirzepatide," and "nonarteritic anterior ischemic optic neuropathy," in addition to NAION risk factors, including disc-at-risk anatomy, type 2 diabetes, obstructive sleep apnea, hypertension, hyperlipidemia, renal disease, and ischemic heart disease. A small cup-to-disc ratio ("disc-at-risk") was found to be the most robust anatomical predictor of NAION. Systemic microvascular disease (diabetes, hypertension, hyperlipidemia) and conditions such as obstructive sleep apnea and end-stage renal disease were also linked to increased susceptibility to optic nerve head ischemia. Although data across electronic health records, national registries, and pharmacovigilance analyses suggest a very low absolute incidence of NAION, the use of GLP-1RAs demonstrates a statistically significant association with NAION development, yielding relative risk estimates between 1.2 and 4.3. At this time, the potential association between GLP-1RA therapy and NAION should be interpreted as a safety signal rather than a contraindication. Screening for disc-at-risk anatomy, consideration of prior NAION history, and patient counseling regarding acute visual symptoms may be warranted prior to initiation of therapy. As evidence evolves, collaboration between endocrinologists and ophthalmologists will be essential to support safe and effective patient care.