糖尿病心肌微血管的病理变化

Pathology of diabetic myocardiac microangiopathy

目的探讨糖尿病患者高心血管病病死率的原因。方法应用形态定量的方法比较了２１例２型糖尿病患者和１２例对照组的冠状动脉和心肌病理检查结果。结果发现糖尿病患者的冠状动脉粥样硬化病变与对照组无显著差异。心肌纤维数，心肌纤维直径和毛细血管直径亦无显著差异。但糖尿病患者的心肌毛细血管数量，毛细血管数／肌纤维数与对照组比较明显减少，Ｐ＜０．０１。基底膜明显增厚，Ｐ＜０．０１。结论糖尿病患者心肌毛细血管数量的减少及基底膜的增厚可能会增加心肌对缺血缺氧的易损性，这可能是糖尿病患者心肌病变高危险性的基础。

Objective To determine why diabetes mellitus has an high cardiovascular mortality. Methods Sections from autopsied coronary arteries and myocardium of 21 type 2 diabetes mellitus and 12 controls were used for morphometric studies. Results The coronary atherosclerosis severity in type 2 diabetes mellitus was no different from control group. The myofibre number, myofibre diamters and capillary diamters also seemed no different. But the capillary density and the ratio of capillary to myofibre in type 2 diabetes mellitus were reduced remarkably compared with cotrol group (P<0.01). The capillary basement membrance in type 2 diabetes mellitus was thicker (P<0.01). Conclusion The decreased capillaries and thicker basement membrane could increase myocardial vulnerability by further ischamic injury, which may be the background of high mortality in patients with diabetic myocardiosis.