Barnett A H
University of Birmingham, United Kingdom.
Am J Med. 1991 Jun 24;90(6A):67S-73S. doi: 10.1016/0002-9343(91)90421-s.
Major susceptibility factors for diabetic microangiopathy include duration of disease and probably quality of metabolic control. The mechanism of development of microangiopathy is incompletely understood but appears to involve functional abnormalities within the microcirculation, enhanced glucose metabolism, hemostatic abnormality, and genetic susceptibility. This article reviews the factors believed to be involved in pathogenesis and attempts to draw these together by suggesting a sequence of pathogenic interactions that could result in the microvascular changes seen in susceptible target organs. Possibilities for therapeutic intervention based on these pathogenic mechanisms are discussed. A small pilot trial of an oral hypoglycemic agent, gliclazide, is reported, providing evidence for a specific action of this drug on thromboxane synthesis and platelet aggregation. This is independent of glycemic control and may in part be mediated by a fall in lipid peroxides.
糖尿病微血管病变的主要易感因素包括病程以及可能的代谢控制质量。微血管病变的发生机制尚未完全明确，但似乎涉及微循环内的功能异常、葡萄糖代谢增强、止血异常和遗传易感性。本文回顾了被认为与发病机制有关的因素，并试图通过提出一系列可能导致易感靶器官微血管变化的致病相互作用，将这些因素整合起来。基于这些致病机制的治疗干预可能性也将进行讨论。本文报道了一项关于口服降糖药格列齐特的小型试点试验，为该药物对血栓素合成和血小板聚集的特定作用提供了证据。这一作用独立于血糖控制，可能部分是由脂质过氧化物的减少介导的。
