Department of Physiology and Internal Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon.
Diabetes Res Clin Pract. 2010 Sep;89(3):201-8. doi: 10.1016/j.diabres.2010.05.022.
The cardiorenal syndrome in patients with diabetes mellitus represents a systemic condition that affects both the cardiovascular and renal systems. Diabetes is a well established risk factor for cardiovascular disease (CVD), and a significant proportion of diabetic patients go on to develop clinically significant nephropathy. In the diabetic state the kidney is involved by progressive sclerosis/fibrosis and proteinuria, due most likely to overactivity of the transforming growth factor-beta system and, to some extent, the vascular endothelial growth factor system, respectively. The pathogenesis of CVD in diabetes is multifactorial, involving hemodynamic forces, humoral/metabolic factors, and oxidative stress. Additionally, it has been suggested that endothelial dysfunction may lead to simultaneous development and progression of renal and cardiac pathology in diabetes. The risk of microvascular complications can be reduced by intensive glycemic control in patients with type 1 and type 2 diabetes mellitus whereas benefit to the cardiovascular system is less clear. However, intensified intervention involving other CVD risk factors like hypertension and dyslepidemia and interception of the rennin-angiotensin-aldosterone system in patients with type 2 diabetes have been shown to be associated with significant reduction in the risk for renal disease progression that was paralleled by a significant reduction in cardiovascular disease burden.
糖尿病患者的心肾综合征代表了一种影响心血管和肾脏系统的全身性疾病。糖尿病是心血管疾病（CVD）的一个明确的危险因素，相当一部分糖尿病患者会发展为临床显著的肾病。在糖尿病状态下，肾脏会出现进行性硬化/纤维化和蛋白尿，这主要归因于转化生长因子-β系统的过度活跃，在一定程度上也归因于血管内皮生长因子系统。糖尿病患者 CVD 的发病机制是多因素的，涉及血流动力学因素、体液/代谢因素和氧化应激。此外，有人认为内皮功能障碍可能导致糖尿病患者的肾脏和心脏病理同时发生和进展。通过强化血糖控制可以降低 1 型和 2 型糖尿病患者微血管并发症的风险，而对心血管系统的益处则不太明确。然而，在 2 型糖尿病患者中，强化干预其他 CVD 风险因素，如高血压和血脂异常，以及阻断肾素-血管紧张素-醛固酮系统，已被证明与肾脏疾病进展风险的显著降低相关，同时也显著降低了心血管疾病负担。
