摘要
背景:糖尿病性心肌病是指糖尿病患者在没有冠心病、高血压、瓣膜病等其他原因的情况下,出现舒张或收缩期心功能不全的特征。糖尿病影响身体的每个器官,心血管疾病占糖尿病人口死亡率的三分之二。糖尿病相关心脏病以冠心病(CAD)、心脏自主神经病变(DC)的形式出现.心力衰竭在糖尿病人群中的患病率较高,DC是糖尿病心力衰竭的常见原因,但被低估。糖尿病和心力衰竭之间的紧密联系推动了人类和动物的深入研究,旨在确定糖尿病性心肌病的发病机制。尽管取得了重大进展,但糖尿病心肌病的确切发病机制尚未明确。高血糖、血脂异常和炎症在活性氧或氮的产生中起着关键的作用,而活性氧或氮的生成又与高血糖、血脂异常和炎症有关。方法:我们回顾了关于这些问题的最新科学文献.结果:DC心肌间质发生改变,收缩功能异常。在疾病的早期阶段,舒张功能障碍是唯一的异常,但收缩功能障碍发生在晚期与左室射血分数受损。二尖瓣超声心动图通常用于评估舒张功能障碍,但组织多普勒成像和心脏磁共振成像正越来越多地用于DC的早期诊断。有微血管并发症的糖尿病患者显示糖尿病与心肌病的相关性最强,这种联系与高血糖的持续时间和严重程度平行。结论:DC的治疗涉及生活方式的改善、血糖和血脂异常的控制以及高血压和冠心病的治疗。
关键词: 心肌病,糖尿病,血糖失调,心力衰竭,药物治疗。
Current Medicinal Chemistry
Title:Clinical Approach to Diabetic Cardiomyopathy: A Review of Human Studies
Volume: 25 Issue: 13
关键词: 心肌病,糖尿病,血糖失调,心力衰竭,药物治疗。
摘要: Background: Diabetic Cardiomyopathy (DC) has been defined as a distinct entity characterized by the presence of diastolic or systolic cardiac dysfunction in a diabetic patient in the absence of other causes for Cardiomyopathy, such as coronary artery disease (CAD), hypertension (HTN), or valvular heart disease. Diabetes affects every organ in the body and cardiovascular disease accounts for two-thirds of the mortality in the diabetic population. Diabetes-related heart disease occurs in the form of coronary artery disease (CAD), cardiac autonomic neuropathy or DC. The prevalence of cardiac failure is high in the diabetic population and DC is a common, but underestimated cause of heart failure in diabetes. The strong association between diabetes and heart failure has fueled intense human and animal research aimed at identifying the mechanisms underlying diabetic myocardial disease. Despite significant progress made, the precise pathogenesis of diabetic Cardiomyopathy is yet to be clearly defined. Hyperglycemia, dyslipidemia and inflammation are thought to play key roles in the generation of reactive oxygen or nitrogen species which are in turn involved.
Methods: We have reviewed the up-to-date scientific literature addressing these issues.
Results: The myocardial interstitium undergoes alterations resulting in abnormal contractile function noted in DC. In the early stages of the disease, diastolic dysfunction is the only abnormality, but systolic dysfunction supervenes in the later stages with impaired left ventricular ejection fraction. Transmitral Doppler echocardiography is usually used to assess diastolic dysfunction, but tissue Doppler Imaging and Cardiac Magnetic Resonance Imaging are being increasingly used for early detection of DC. Diabetic patients with microvascular complications show the strongest association between diabetes and Cardiomyopathy, an association that parallels the duration and severity of hyperglycemia.
Conclusion: The management of DC involves improvement in lifestyle, control of glucose and lipid abnormalities, together with treatment of hypertension and CAD, if present.
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Cite this article as:
Clinical Approach to Diabetic Cardiomyopathy: A Review of Human Studies, Current Medicinal Chemistry 2018; 25 (13) . https://dx.doi.org/10.2174/0929867324666170705111356
DOI https://dx.doi.org/10.2174/0929867324666170705111356 |
Print ISSN 0929-8673 |
Publisher Name Bentham Science Publisher |
Online ISSN 1875-533X |
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