低血糖后葡萄糖再灌注脑损伤相关机制及预防

Mechanism and prevention of brain injury induced by glucose reperfusion after hypoglycemia

糖尿病发病率越来越高,已成为全球性问题,随着强化控糖观念的提出及胰岛素的广泛应用,糖尿病相关的低血糖发生率也逐渐增加。持续低血糖会导致各种急性心脑血管疾病,然而新近研究发现胰岛素诱导低血糖后,给予葡萄糖升高血糖后出现了比低血糖状态时更严重的心脑血管损害,尤其是对脑的损伤尤为显著,类似于缺血再灌注,因此人们提出“葡萄糖再灌注损伤”的概念。目前关于葡萄糖再灌注性脑损伤的机制尚不清楚,考虑与氧化应激、自噬、钙离子超载、钙蛋白酶的激活、聚腺苷酸二磷酸核糖转移酶-1等有关。

The incidence of diabetes is getting higher and higher,and it has become a global problem.With the introduction of the concept of strengthening glucose control and the wide application of insulin,the incidence of diabetes-related hypoglycemia has increased gradually.Sustained hypoglycemia will lead to various acute cardiovascular and cerebrovascular diseases.However,recent studies have found that after insulin induced hypoglycemia,increased blood sugar by exogenous glucose will lead to more serious cardiovascular and cerebrovascular damage than the hypoglycemia state,especially to the brain.Similar to ischemia-reperfusion injury,the concept of“glucose reperfusion injury”is proposed.However,the mechanism of cerebral injury caused by glucose reperfusion remains unclear,and it may be related to oxidative stress,autophagy,calcium ion overload,activation of calpain,and polyadenylic acid diphosphate ribose transferase-1,etc.