我们的网站为什么显示成这样？

可能因为您的浏览器不支持样式，您可以更新您的浏览器到最新版本，以获取对此功能的支持，访问下面的网站，获取关于浏览器的信息：

|本期目录/Table of Contents|

糖尿病心肌病临床诊疗新进展

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2018年第5期
页码:
604-608
栏目:
综述
出版日期:
2018-06-25

文章信息/Info

Title:
New progress of diabetic cardiomyopathy from clinical diagnosis to treatment
作者:
杨兴军; 李 飞
（空军军医大学第一附属医院心内科，陕西 西安 710032）
Author(s):
YANG Xing-jun;  LI Fei
(Department of Cardiology, First affiliated hospital of air force military medical university, Xi’an 710032, Shaanxi, China)
关键词:
糖尿病心肌病; 早期诊断; 治疗
Keywords:
Diabetic cardiomyopathy;  early diagnosis;  treatment
分类号:
R587.2
DOI:
-
文献标识码:
A
摘要:
糖尿病心肌病（DC）最初描述为糖尿病患者在除外高血压、冠心病、瓣膜性疾病及先天性心脏病等存在的情况下发生心力衰竭。目前认为DC是线粒体功能紊乱、能量代谢障碍、脂毒性、晚期糖基化终产物形成、内皮细胞受损、微循环障碍、内质网应激、RAAS激活、自噬功能减退、心脏自主神经病变、miRNA调节异常等多种因素相互协同、共同作用，导致心肌细胞凋亡、胶原沉积、基质增生、间质纤维化，微血管病变及冠状动脉病变。早期可发生舒张功能障碍或心脏纵向应变能力减退等亚临床DC表现，随着病程进展，晚期射血分数逐渐下降，心功能严重受损。临床可通过使用超声、磁共振成像、核素显像早期发现心脏舒缩功能参数或结构的异常，尤其是组织多普勒超声、磁共振T1-mapping技术及心肌细胞外体积测定等方法近年来逐步引人重视。此外，还发现某些生物学标志物与DC相关。目前关于DC的治疗还未形成共识，缺乏有效的治疗手段。因此还需进一步的基础及临床研究提供更明确的诊疗方向。
Abstract:
Diabetic cardiomyopathyv (DC) has been defined as progressing heart failing, which is presence of abnormal myocardial performance or structure remodeling, without hypertension, epicardial coronary artery disease, valvular disease or congenital heart disease. DC is described as a complicated distinct entity, composed of metabolism disorder, energy metabolism abnormality, lipid toxicity, advanced glycosylation end product formation, microcirculation dysfunction,endoplasmic reticulum stress, the activation of RAAS, cardiac autonomic neuropathy, and miRNA dysregulation. These factors interact with each other, and induce the presence of myocardium apoptosis, collagen deposition, matrix proliferation, fibrosis, microvascular lesions and coronary artery disease. With Doppler echocardiography, magnetic resonance imaging (MRI), radionuclide imaging, we can detect at early stages abnormal cardiac diastolic function parameters and/or structure remodeling in clinical practice. In addition to newer techniques, some biomarkers have been associated with DC. However, it has yet to reach consensus regarding therapy for DC. Therefore, further research is warranted.

参考文献/References

[1]张 琦，吴 迪，范煜东，等.组织多普勒指标E/E与B型钠尿肽在舒张性心力衰竭诊断中的临床意义[J].中国心血管病研究,2014,12:(10):923-927.

[2]Di Bonito P,Moio N,Cavuto L,et al.Early detection of diabetic cardiomyopathy:usefulness of tissue Doppler imaging[J].Diabet Med,2005,22(12):1720-1725.

[3]Enomoto M,Ishizu T,Seo Y,et al.Myocardial dysfunction identified by three-dimensional speckle tracking echocardiography in type 2 diabetes patients relates to complications of microangiopathy[J].J Cardiol,2016,68(4):282-287.

[4]Hensel KO,Grimmer F,Roskopf M,et al.Subclinical Alterations of Cardiac Mechanics Present Early in the Course of Pediatric Type 1 Diabetes Mellitus:A Prospective Blinded Speckle Tracking Stress Echocardiography Study[J].J Diabetes Res,2016,2016:2583747.

[5]王欣欣，陈 明.心肌超声造影在冠状动脉疾病诊治中的应用[J].南昌大学学报(医学版),2014,54:(5):90-93.

[6]Lorenzo-Almoros A,Tunon J,Orejas M,et al.Diagnostic approaches for diabetic cardiomyopathy[J].Cardiovasc Diabetol,2017,16(1):28.

[7]徐 磊，刘宏宇.心肌超声造影评价存活心肌的应用进展[J].中国胸心血管外科临床杂志,2012,19:(5):551-554.

[8]Chung J,Abraszewski P,Yu X,et al.Paradoxical increase in ventricular torsion and systolic torsion rate in type I diabetic patients under tight glycemic control[J].J Am Coll Cardiol,2006,47(2):384-390.

[9]曾 牧，范占明.MRI检测糖尿病心肌病研究进展[J].中国医学影像技术,2014,30:(12):1917-1920.

[10]Shang Y,Zhang X,Chen L,et al.Assessment of Left Ventricular Structural Remodelling in Patients with Diabetic Cardiomyopathy by Cardiovascular Magnetic Resonance[J].J Diabetes Res,2016,2016:4786925.

[11]Radenkovic D Weing Rtner S,Ricketts L,et al.T1 mapping in cardiac MRI[J].Heart Fail Rev,2017,22(4):415-430.

[12]Bhuva AN,Treibel TA,Fontana M,et al.T1 mapping: non-invasive evaluation of myocardial tissue composition by cardiovascular magnetic resonance[J].Expert Rev Cardiovasc Ther,2014,12(12):1455-1464.

[13]Parsai C,O’Hanlon R,Prasad SK,et al.Diagnostic and prognostic value of cardiovascular magnetic resonance in non-ischaemic cardiomyopathies[J].J Cardiovasc Magn Reson,2012,14:54.

[14]Jellis C,Wright J,Kennedy D,et al.Association of Imaging Markers of Myocardial Fibrosis With Metabolic and Functional Disturbances in Early Diabetic Cardiomyopathy[J].Cir Cardiovasc Imaging,2011,4(6):693-702.

[15]Moon JC,Messroghli DR,Kellman P,et al.Myocardial T1 mapping and extracellular volume quantification:a Society for Cardiovascular Magnetic Resonance(SCMR)and CMR Working Group of the European Society of Cardiology consensus statement[J].J Cardiovasc Magn Reson,2013,15(1):92.

[16]Haaf P,Garg P,Messroghli DR,et al.Cardiac T1 Mapping and Extracellular Volume(ECV)in clinical practice:a comprehensive review[J].J Cardiovasc Magn Reson,2017,18(1):89.

[17]Sado DM,Flett AS,Banypersad SM,et al.Cardiovascular magnetic resonance measurement of myocardial extracellular volume in health and disease[J].Heart,2012,98(19):1436-1441.

[18]Wong TC,Piehler KM,Kang IA,et al.Myocardial extracellular volume fraction quantified by cardiovascular magnetic resonance is increased in diabetes and associated with mortality and incident heart failure admission[J].Eur Heart J,2014,35(10):657-664.

[19]Larghat AM,Swoboda PP,Biglands JD,et al.The microvascular effects of insulin resistance and diabetes on cardiac structure,function, and perfusion:a cardiovascular magnetic resonance study[J].Eur Heart J Cardiovasc Imaging,2014,15(12):1368-1376.

[20]Ouwens DM,Sell H,Greulich S,et al.The role of epicardial and perivascular adipose tissue in the pathophysiology of cardiovascular disease[J].J Cell Mol Med,2010,14(9):2223-2234.

[21]Blumensatt M,Greulich S,Herzfeld DWD,et al.Activin A impairs insulin action in cardiomyocytes via up-regulation of miR-143[J].Cardiovasc Res,2013,100(2):201-210.

[22]Chen WJY,Greulich S,van der Meer RW,et al.Activin A is associated with impaired myocardial glucose metabolism and left ventricular remodeling in patients with uncomplicated type 2 diabetes[J].Cardiovasc Res,2013,12(1):150.

[23]Ruiz-Hurtado G,Gómez-Hurtado N,Fernández-Velasco M,et al.Cardiotrophin-1 induces sarcoplasmic reticulum Ca2+ leak and arrhythmogenesis in adult rat ventricular myocytes[J].Cardiovasc Res,2012,96(1):81-89.

[24]Hung H,Lu F,Ou H,et al.Increased cardiotrophin-1 in subjects with impaired glucose tolerance and newly diagnosed diabetes[J].Int J Cardiol,2013,169(3):e33-e34.

[25]Gamella-Pozuelo L,Fuentes-Calvo I,Gómez-Marcos MA,et al.Plasma Cardiotrophin-1 as a Marker of Hypertension and Diabetes-Induced Target Organ Damage and Cardiovascular Risk[J].Medicine,2015,94(30):e1218.

[26]Hoffmann U,Espeter F,Weiβ C,et al.Ischemic biomarker heart-type fatty acid binding protein(hFABP)in acute heart failure-diagnostic and prognostic insights compared to NT-proBNP and troponin I[J].BMC Cardiovasc Disor,2015,15:50.

[27]Akbal E,Ozbek M,Gunes F,et al.Serum heart type fatty acid binding protein levels in metabolic syndrome[J].Endocrine,2009,36(3):433-437.

[28]Ruan W,Lai M.Insulin-like growth factor binding protein:a possible marker for the metabolic syndrome?[J].Acta Diabetol,2010,47(1):5-14.

[29]Gandhi PU,Gaggin HK,Sheftel AD,et al.Prognostic usefulness of insulin-like growth factor-binding protein 7 in heart failure with reduced ejection fraction:a novel biomarker of myocardial diastolic function?[J].Am J Cardiol,2014,114(10):1543-1549.

[30]Guo R,Nair S.Role of microRNA in diabetic cardiomyopathy:From mechanism to intervention[J].BBA Mol Basis Dis,2017,1863(8):2070-2077.

[31]Garcia-Rua V,Otero MF,Lear PV,et al.Increased expression of fatty-acid and calcium metabolism genes in failing human heart[J].PLoS One,2012,7(6):e37505.

[32]Tan SM,Zhang Y,Wang B,et al.FT23, an orally active antifibrotic compound,attenuates structural and functional abnormalities in an experimental model of diabetic cardiomyopathy[J].Clin Exp Pharmacol Physiol,2012,39(8):650-656.

[33]Acar E,Ural D,Bildirici U,et al.Diabetic cardiomyopathy[J].Anadolu Kardiyol Der,2011,11(8): 732-737.

[34]von Bibra H,St JSM.Impact of diabetes on postinfarction heart failure and left ventricular remodeling[J].Curr Heart Fail Rep,2011,8(4):242-251.

[35]Trachanas K,Sideris S,Aggeli C,et al.Diabetic cardiomyopathy:from pathophysiology to treatment[J].Hellenic J Cardiol,2014,55(5):411-421.

[36]Mccormick LM,Heck PM,Ring LS,et al.Glucagon-like peptide-1 protects against ischemic left ventricular dysfunction during hyperglycemia in patients with coronary artery disease and type 2 diabetes mellitus[J]. Cardiovasc Diabetol,2015,14(1).

[37]Zhou Y,Wu W.The Sodium-Glucose Co-Transporter 2 Inhibitor,Empagliflozin, Protects against Diabetic Cardiomyopathy by Inhibition of the Endoplasmic Reticulum Stress Pathway[J].Cell Physiol Biochem,2017,41(6):2503-2512.

[38]Symeonides P,Koulouris S,Vratsista E,et al.Both ramipril and telmisartan reverse indices of early diabetic cardiomyopathy:a comparative study[J].Eur J Echocardiogr,2007,8(6):480-486.

[39]Aneja A,Tang WH,Bansilal S,et al.Diabetic cardiomyopathy:insights into pathogenesis,diagnostic challenges,and therapeutic options[J].Am J Med,2008,121(9):748-757.

[40]Kawasaki D,Kosugi K,Waki H,et al.Role of activated renin-angiotensin system in myocardial fibrosis and left ventricular diastolic dysfunction in diabetic patients--reversal by chronic angiotensin II type 1A receptor blockade[J].Circ J,2007,71(4):524-529.

[41]王宪娟.贝那普利治疗糖尿病心肌病的临床疗效观察[J].临床合理用药杂志,2016,9(11):33-34.

[42]Mandavia CH,Aroor AR,Demarco VG,et al.Molecular and metabolic mechanisms of cardiac dysfunction in diabetes[J].Life Sci,2013,92(11):601-608.

[43]Leung M,Wong VW,Heritier S,et al.Rationale and design of a randomized trial on the impact of aldosterone antagonism on cardiac structure and function in diabetic cardiomyopathy[J].Cardiovasc Diabetol,2013,12:139.

备注/Memo

备注/Memo:
收稿日期：2017-09-13.通讯作者：李飞，副教授，主要从事冠心病基础和临床研究 Email：lifei01@fmmu.edu.cn 作者简介：杨兴军，硕士生 Email：442599383@qq.com
更新日期/Last Update: 1900-01-01