Chair of Endocrinology, University of Udine, Italy.
Diabetes Res Clin Pract. 2009 Dec;86 Suppl 1:S2-6. doi: 10.1016/S0168-8227(09)70002-6.
Large randomized studies have established that early intensive glycaemic control reduces the risk of diabetic complications, both micro and macrovascular. However, epidemiological and prospective data support a long-term influence of early metabolic control on clinical outcomes. This phenomenon has recently been defined as "metabolic memory". Potential mechanisms for propagating this "memory" are the non-enzymatic glycation of cellular proteins and lipids, and an excess of cellular reactive oxygen and nitrogen species, in particular originated at the level of glycated-mitochondrial proteins, perhaps acting in concert with one another to maintain stress signaling. Furthermore, the emergence of this "metabolic memory" suggests the need of a very early aggressive treatment aiming to "normalize" the metabolic control and the addition of agents which reduce cellular reactive species and glycation in addition to normalizing glucose levels in diabetic patients in order to minimize long-term diabetic complications.
大型随机研究已经证实，早期强化血糖控制可以降低微血管和大血管糖尿病并发症的风险。然而，流行病学和前瞻性数据支持早期代谢控制对临床结局的长期影响。这种现象最近被定义为“代谢记忆”。传播这种“记忆”的潜在机制是细胞蛋白质和脂质的非酶糖基化，以及细胞活性氧和氮物种的过剩，特别是在糖化线粒体蛋白质水平产生，可能彼此协同作用以维持应激信号。此外，这种“代谢记忆”的出现表明需要非常早期的积极治疗，旨在“使代谢控制正常化”，并添加除了使糖尿病患者的血糖水平正常化之外还可以减少细胞活性物质和糖基化的药物，以最大程度地减少长期糖尿病并发症。
