Ura Nobuyuki, Takizawa Hideki, Sasaki Haruki
Department of General Internal Medicine, Teine Keijinkai Hospital.
Nihon Rinsho. 2012 Sep;70(9):1593-8.
Recently renin-angiotensin-aldosterone system (RAAS) including angiotensin converting enzyme (ACE) 2-angiotensin (Ang)-(1-7) system may concern both pancreatic insulin secretion and insulin resistance (IR). Actually, Ang II introduces pancreatic beta-cell apoptosis and suppresses insulin signal transduction by modulation of adipokines. Ang II also suppresses GLUT4 expression and AMP kinase activity. All of them introduce new onset diabetes mellitus and various kinds of diabetic complications. RAAS suppression by using not only ACE inhibitor, Ang II receptor blockade (ARB) but also aldosterone receptor blockade improved insulin secretion and IR. Clinically, ACE inhibitor and ARB suppress new onset diabetes mellitus and diabetic complications. In this review we will focus on the recent findings related RAAS and glucose metabolism and diabetic complications with special reference to ACE2-Ang-(1-7) system.
最近,包括血管紧张素转换酶(ACE)2 - 血管紧张素(Ang) - (1 - 7)系统在内的肾素 - 血管紧张素 - 醛固酮系统(RAAS)可能与胰腺胰岛素分泌和胰岛素抵抗(IR)均有关。实际上,Ang II会导致胰腺β细胞凋亡,并通过调节脂肪因子来抑制胰岛素信号转导。Ang II还会抑制葡萄糖转运蛋白4(GLUT4)的表达和AMP激酶活性。所有这些都会引发新发糖尿病和各种糖尿病并发症。使用不仅包括ACE抑制剂、Ang II受体阻滞剂(ARB),还包括醛固酮受体阻滞剂来抑制RAAS,可改善胰岛素分泌和胰岛素抵抗。临床上,ACE抑制剂和ARB可抑制新发糖尿病和糖尿病并发症。在本综述中,我们将重点关注与RAAS和葡萄糖代谢以及糖尿病并发症相关的最新研究发现,特别提及ACE2 - Ang - (1 - 7)系统。