Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy.
Division of Geriatrics, Department of Translational Medical Sciences, Federico II University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy.
Aging Clin Exp Res. 2019 Mar;31(3):321-330. doi: 10.1007/s40520-018-0973-2. Epub 2018 Jun 1.
Diabetes mellitus (DM) and heart failure (HF) are frequent comorbidities among elderly patients. HF, a leading cause of mortality and morbidity worldwide, is characterized by sympathetic nervous system hyperactivity. The prevalence of diabetes mellitus (DM) is rapidly growing and the risk of developing HF is higher among DM patients. DM is responsible for several macro- and micro-angiopathies that contribute to the development of coronary artery disease (CAD), peripheral artery disease, retinopathy, neuropathy and diabetic nephropathy (DN) as well. Independently of CAD, chronic kidney disease (CKD) and DM increase the risk of HF. Individuals with diabetic nephropathy are likely to present a distinct pathological condition, defined as diabetic cardiomyopathy, even in the absence of hypertension or CAD, whose pathogenesis is only partially known. However, several hypotheses have been proposed to explain the mechanism of diabetic cardiomyopathy: increased oxidative stress, altered substrate metabolism, mitochondrial dysfunction, activation of renin-angiotensin-aldosterone system (RAAS), insulin resistance, and autonomic dysfunction. In this review, we will focus on the involvement of sympathetic system hyperactivity in the diabetic nephropathy.
糖尿病（DM）和心力衰竭（HF）是老年患者常见的合并症。HF 是全球死亡率和发病率的主要原因，其特征是交感神经系统过度活跃。糖尿病（DM）的患病率迅速增长，DM 患者发生 HF 的风险更高。DM 可导致多种大血管和微血管病变，从而导致冠状动脉疾病（CAD）、外周动脉疾病、视网膜病变、神经病变和糖尿病肾病（DN）等的发生。独立于 CAD 之外，慢性肾脏病（CKD）和 DM 增加 HF 的风险。患有糖尿病肾病的个体可能会出现一种独特的病理状况，即糖尿病性心肌病，即使没有高血压或 CAD，其发病机制也只是部分已知。然而，已经提出了几种假说来解释糖尿病性心肌病的发病机制：氧化应激增加、底物代谢改变、线粒体功能障碍、肾素-血管紧张素-醛固酮系统（RAAS）激活、胰岛素抵抗和自主神经功能障碍。在这篇综述中，我们将重点讨论交感神经系统过度活跃在糖尿病肾病中的作用。
