Bjornstad Petter, Maahs David M
Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, United States ; Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, Colorado, United States.
Curr Pediatr Rep. 2015 Jun 1;3(2):177-186. doi: 10.1007/s40124-015-0081-0. Epub 2015 Apr 4.
A major challenge in preventing vascular complications in diabetes is the inability to identify high-risk patients at an early stage, emphasizing the importance of discovering new risk factors, technologies and therapeutic targets to reduce the development and progression of complications. Promising biomarkers which may improve risk stratification and serve as therapeutic targets, include: uric acid, insulin sensitivity, copeptin, SGLT-2 and Klotho/FGF-23. Non-invasive measures of macrovasuclar disease in youth, include: 1) pulse wave velocity to examine arterial stiffness; 2) carotid intima-media thickness to evaluate arterial thickness; 3) cardiac MRI to investigate cardiac function and structure. Novel microvascular measures include: GFR by iohexol clearance using filter paper to directly measure GFR, retinal vascular geometry to predict early retinal changes and corneal confocal microscopy to improve detection of early nerve loss to better predict diabetic neuropathy. Herein we will review technologies, novel biomarkers, and therapeutic targets in relation to vascular complications of diabetes.
预防糖尿病血管并发症的一个主要挑战是无法在早期识别高危患者，这凸显了发现新的风险因素、技术和治疗靶点以减少并发症发生和发展的重要性。有望改善风险分层并作为治疗靶点的生物标志物包括：尿酸、胰岛素敏感性、 copeptin、SGLT-2和Klotho/FGF-23。青少年大血管疾病的非侵入性测量方法包括：1）脉搏波速度以检查动脉僵硬度；2）颈动脉内膜中层厚度以评估动脉厚度；3）心脏磁共振成像以研究心脏功能和结构。新型微血管测量方法包括：使用滤纸通过碘海醇清除率直接测量肾小球滤过率（GFR）、视网膜血管几何形状以预测早期视网膜变化以及角膜共聚焦显微镜检查以改善早期神经损伤的检测，从而更好地预测糖尿病神经病变。在此，我们将综述与糖尿病血管并发症相关的技术、新型生物标志物和治疗靶点。
