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糖尿病心肌病(DCM)是一种特异性心肌病,是指不伴有高血压病、冠状动脉疾病及其他有意义的血管疾病的、糖尿病(DM)患者存在的任何心脏结构和功能的异常。临床表现为心脏收缩和(或)舒张功能障碍。其发病机制还不清楚,包括高血糖及游离脂肪酸代谢异常。研究认为高血糖是DCM发病的中心环节,目前缺乏特异性诊断方法,2D超声心动图、心脏核磁共振显像、脉冲多普勒超声心动图、磁共振光谱学等可早期发现心肌结构、功能及代谢的异常。DCM早期无明显临床症状且缓慢进展,运用合适的筛选试验早期诊断并及时采取适宜的防治措施可改善预后。有证据表明控制血糖可改善心脏代谢及心肌功能,针对心功能不全的神经内分泌抑制治疗β受体阻滞剂和ACEI亦可改善DM患者的心脏功能,降低病死率。本文旨在阐述DCM发病机制、诊断方法和治疗的新进展。
Diabetic cardiomyopathy (DCM) is a specific cardiomyopathy that refers to any abnormality in cardiac structure and function in patients with diabetes mellitus (DM) who are not associated with hypertension, coronary artery disease, and other significant vascular diseases. Clinical manifestations of systolic and (or) diastolic dysfunction. Its pathogenesis is unclear, including hyperglycemia and free fatty acid metabolism. Studies suggest that hyperglycemia is the central link in the pathogenesis of DCM. Currently there is no specific diagnostic method. 2D echocardiography, cardiac magnetic resonance imaging, pulsed Doppler echocardiography, magnetic resonance spectroscopy and other early detection of myocardial structure, function and Abnormal metabolism. Early DCM no obvious clinical symptoms and slow progress, the use of appropriate screening tests early diagnosis and timely take appropriate preventive measures can improve the prognosis. There is evidence that glycemic control improves cardiac metabolism and myocardial function, and that neuroleptics for cardiac dysfunction in treating beta-blockers and ACEI may improve cardiac function and reduce mortality in DM patients. This article aims to elucidate the pathogenesis of DCM, diagnosis and treatment of new progress.