糖尿病心肌病发病机制的研究进展.pdf

生理科学进展 2010年第 41卷第 1 期# 31#
# 生理科学与临床#
糖尿病心肌病发病机制的研究进展*
黄娅茜王宪孔炜
(北京大学医学部生理学与病理生理学系, 北京 100191)
摘要糖尿病心肌病是一种特异性心肌病, 病理表现为心肌肥厚和心肌纤维化。其发病机制复杂,
可能涉及代谢紊乱(如葡萄糖转运子活性下降、游离脂肪酸增加、钙平衡调节异常、铜代谢紊乱、胰
岛素抵抗)、心肌纤维化(与高血糖、心肌细胞凋亡、血管紧张素Ò、胰岛素样生长因子 21、炎性细胞
因子和基质金属蛋白酶等有关)、心脏自主神经病变和干细胞等多种因素。本文对近年来国内外
有关糖尿病心肌病机制研究的进展予以综述, 以期为临床有效防治提供依据。
关键词糖尿病心肌病; 发病机制; 心肌纤维化
中图分类号 R33
D iabetic C ard iom yopa thy HUANG Ya2Q ian, WANG X ian, KONG W ei (D epa rtm ent of Physiology
and Pa thophysiology, P eking Un iversity H ea lth Science Center, Be ijing 100191, China)
Abstr act D iabetic cardiomyopathy is characterized by myocard ia l hypertrophy and fibrosis independen t
of hypertension, coronary artery d isease or other id iopath ic heart d iseases. The underlying mechan isms of
diabetic card iomyopathy are still e lusive. Previous stud ies have h ighlighted the importance of metabolic
disturbances ( dysfunction of glucose transporters, increased free fatty ac ids, abnormal changes in ca lci2
um homeostasis, d isordered coppermetabolism, insulin resistance), myocardia l fibrosis ( assoc iation w ith
hyperglycem ia, myocyte apoptosis, increases in angiotensinÒ, IGF21, and pro2inflamm atory cytokines,
changes in matrix m etalloproteinases activity etc. ), cardiac autonom ic neuropathy, and stem cell in the
evolution of diabetic cardiomyopathy. The current overview w ill focus on