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|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.

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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