冠脉微血管功能障碍在糖尿病性心肌病发病中的作用

Role of coronary microvascular dysfunction in the pathogenesis of diabetes mellitus-induced cardiomyopathy

冠状动脉微血管功能障碍(coronary microvascular dysfunction,CMD)为近年来心血管病领域的热点研究问题之一,其主要指内径<300μm的心肌微血管发生的结构或功能障碍。导致CMD的病因很多,其中的主要病因之一为2型糖尿病(type2 diabetes mellitus,T2DM)。另外,T2DM也是糖尿病性心肌病(diabetes mellitus-related cardiomyopathy,DMCM)的根本原因,由T2DM进展为DMCM的发病机制比较复杂。研究显示,糖尿病前期、T2DM和DMCM阶段均存在不同程度的CMD,而且其发生机制复杂。CMD可能不仅是T2DM发生冠脉微循环障碍和T2DM进展为DMCM的主要原因,其不断进展和加重也可能是糖尿病前期-T2DM-DMCM这一疾病链逐步恶化,甚至向心衰进展的主要原因。因此,延缓T2DM和T2DM进展至DMCM过程中的CMD进展和对其早期检测、评价和治疗显得非常重要。

Coronary microvascular dysfunction(CMD),a research focus in the field of cardiovascular disease in recent years,mainly refers to the structural and functional abnormality that happened in the coronary micro-vessels,of which the diameter is less than 300μm. One of the main reasons for CMD includes the type 2 diabetes mellitus(T2DM). At the same time,T2 DM is the basic reason of diabetes mellitus-related cardiomyopathy(DMCM). The pathogenesis progressing from T2 DM to DMCM is complicated. Studies show that there are different levels of CMD in patients with T2 DM or DMCM and the pathogenetic mechanism of CMD is complex. CMD may not only be the main reason for T2 DM induced CMD and the progressing from T2 DM to DMCM;its continuous development may be the main cause of the progressive deterioration of pro-T2DM-T2DM-DMCM disease chain,and even the main cause of the DMCMinduced heart failure. Therefore,it is very important to detect earlier,to evaluate and to treat of CMD for the delayed development of CMD and DMCM in patients with T2 DM.