Otter Wolfgang, Standl Eberhard, Schnell Oliver
Abteilung für Kardiologie, Pulmologie und Intensivmedizin, Medizinische Klinik 2, Krankenhaus Schwabing, München, Deutschland.
Herz. 2004 Aug;29(5):524-31. doi: 10.1007/s00059-004-2613-1.
Atherogenesis is characterized by a chronic process, which commences years before diabetes mellitus becomes overt. Each step of the pathogenetic cascade is accompanied by inflammation. The degree of inflammation is a key determinant for the process of atherogenesis. C-reactive protein is elevated by inflammatory processes, correlates with the atherosclerotic prognosis and is therefore an important marker of inflammation. It denotes early cardiovascular damages and is elevated in acute coronary syndromes. Cardiovascular risk is excessively elevated in diabetic patients and inflammatory mechanisms are predominant in this group. Preventive interventions and therapeutic strategies based on pathophysiological processes are necessary. The importance of treatment of inflammation increases. Glitazones have been demonstrated to act via antiinflammatory effects. They do not only improve glucose utilisation, but also have pleiotropic effects, which target the increased cardiovascular risks in diabetic patients.
动脉粥样硬化形成的特点是一个慢性过程，在糖尿病明显出现之前数年就已开始。发病机制级联反应的每一步都伴有炎症。炎症程度是动脉粥样硬化形成过程的关键决定因素。C反应蛋白因炎症过程而升高，与动脉粥样硬化预后相关，因此是炎症的重要标志物。它表示早期心血管损伤，在急性冠状动脉综合征中会升高。糖尿病患者的心血管风险过度升高，且炎症机制在该群体中占主导地位。基于病理生理过程的预防性干预和治疗策略是必要的。炎症治疗的重要性日益增加。已证明格列酮类药物通过抗炎作用发挥功效。它们不仅能改善葡萄糖利用，还具有多效性作用，可针对糖尿病患者增加的心血管风险。
