医学假说:糖尿病的心血管并发症——从葡萄糖到胰岛素再回来。

Diabete & metabolisme Pub Date : 1994-09-01
D Giugliano, R Acampora, F D'Onofrio
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摘要

血管并发症如动脉粥样硬化、高血压和大血管病变是糖尿病患者发病和死亡的主要原因。将高胰岛素血症与高血压和动脉粥样硬化联系起来的流行病学和临床数据并不一致。高血糖是糖尿病的显著特征,似乎是糖尿病患者心血管疾病前景不佳的可能原因。高血糖可导致体外培养的人内皮细胞选择性损伤内皮依赖性松弛,延迟细胞复制时间。高血糖的这些影响可以被一些抗氧化剂逆转,包括超氧化物歧化酶、过氧化氢酶和谷胱甘肽。内皮依赖性血管舒张功能受损在1型和2型糖尿病患者中均有报道。氧源性自由基在血管性糖尿病并发症发病机制中的作用的证据可以概括为:1)葡萄糖可以自动氧化生成氧源性自由基;2)糖尿病动物和患者的红细胞、血浆和视网膜中氧源性自由基水平升高,与代谢控制有关;3)糖尿病组织和血液中内源性抗氧化剂均降低;4)用不同的抗氧化剂治疗可能会改善糖尿病患者中发生的许多代谢异常。使用抗氧化剂来降低糖尿病患者冠心病的风险应该等待这些药物在冠心病一级和二级预防中的随机试验结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Medical hypothesis: cardiovascular complications of diabetes mellitus-from glucose to insulin and back.

Vascular complications such as atheroma, hypertension and macroangiopathy are the leading causes of morbidity and mortality in diabetic patients. Epidemiological and clinical data linking hyperinsulinaemia to both hypertension and atherosclerosis are inconsistent. Hyperglycaemia is the distinguishing feature of diabetes and it seems a likely candidate for the poor cardiovascular outlook of diabetic patients. High blood glucose levels cause selective impairment of endothelium-dependent relaxation and delay cell replication time of cultured human endothelial cells. These effects of hyperglycaemia are reversed by a number of antioxidants, including superoxide dismutase, catalase and glutathione. Impaired endothelium-dependent vasodilation has been reported both in Type 1 and Type 2 diabetic patient. The evidence for a role of oxygen-derived free radicals in the pathogenesis of vascular diabetic complications can be summarized as follows: 1) glucose can auto-oxidize generating oxygen derived free radicals; 2) elevated levels of oxygen derived free radicals are found in red blood cells, plasma and retina of diabetic animals and patients, and correlate with metabolic control; 3) endogenous antioxidants are all decreased in diabetic tissues and blood; and 4) treatment with different antioxidants may improve many of the metabolic abnormalities reported to occur in diabetic patients. The use of antioxidants to reduce the risk of coronary heart disease in diabetes should await the results of randomized trials with these drugs in the primary and secondary prevention of coronary disease.

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