Mount Sinai Heart, Mount Sinai School of Medicine, One Gustave Levy Place, New York, NY 10029, USA.
Atherosclerosis. 2011 Sep;218(1):13-8. doi: 10.1016/j.atherosclerosis.2011.06.029. Epub 2011 Jun 23.
Population studies suggest a link between albuminuria, reduced glomerular filtration rate (GFR) and retinopathy and macrovascular events in type 2 diabetes. The aim of this review was to investigate whether this association extended to the presence of any diabetic microvascular complication.
PUBMED was searched from 1999 to 2010 using the terms 'albuminuria', 'nephropathy', 'chronic kidney disease', 'estimated GFR', 'retinopathy', 'autonomic neuropathy', 'peripheral neuropathy', or 'microvascular' and 'cardiovascular disease', 'stroke', 'coronary heart disease' or 'peripheral vascular disease' and 'type 2 diabetes' and MESH equivalents. Prospective studies with at least 200 type 2 diabetes subjects that evaluated hard cardiovascular endpoints were selected. In 25 studies (n=54,117) included in the review there was evidence of an association between microvascular complications (notably retinopathy or nephropathy) and cardiovascular events. Diabetic retinopathy was associated with ∼ 1.7-fold increased risk for cardiovascular events, and albuminuria or reduced GFR associated with ∼ two-fold increased risk for cardiovascular events. In the presence of more than one complication, this risk was accentuated. These associations remained even after adjustment for conventional cardiovascular risk factors, diabetes duration and glycaemic control. These data suggest that similar mechanisms may be relevant to the pathogenesis of both micro- and macrovascular disease in type 2 diabetes. It is likely that endothelial dysfunction, low-grade inflammation and rheological abnormalities are common mechanistic denominators.
This review highlights the association between micro- and macrovascular disease in type 2 diabetes, underlining the importance of early detection of microangiopathy for vascular risk assessment in type 2 diabetes.
人群研究表明，在 2 型糖尿病患者中，白蛋白尿、肾小球滤过率（GFR）降低以及视网膜病变和大血管事件之间存在关联。本综述的目的是研究这种关联是否扩展到任何糖尿病微血管并发症的存在。
使用术语“白蛋白尿”、“肾病”、“慢性肾脏病”、“估计的 GFR”、“视网膜病变”、“自主神经病变”、“周围神经病变”或“微血管”和“心血管疾病”、“中风”、“冠心病”或“外周血管疾病”以及“2 型糖尿病”和 MESH 等价物，从 1999 年至 2010 年在 PUBMED 上进行了搜索。选择了至少有 200 例 2 型糖尿病患者且评估了硬性心血管终点的前瞻性研究。在综述中纳入的 25 项研究（n=54117）中，有证据表明微血管并发症（特别是视网膜病变或肾病）与心血管事件之间存在关联。糖尿病视网膜病变与心血管事件的风险增加约 1.7 倍相关，而白蛋白尿或 GFR 降低与心血管事件的风险增加约 2 倍相关。在存在多种并发症的情况下，这种风险会加剧。即使在调整了传统心血管危险因素、糖尿病病程和血糖控制后，这些关联仍然存在。这些数据表明，类似的机制可能与 2 型糖尿病中微血管和大血管疾病的发病机制有关。内皮功能障碍、低度炎症和流变学异常很可能是常见的机制共同特征。
本综述强调了 2 型糖尿病中微血管和大血管疾病之间的关联，强调了早期检测微血管病变对 2 型糖尿病血管风险评估的重要性。
