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糖尿病与颈动脉疾病:一篇叙述性综述。

Diabetes and carotid artery disease: a narrative review.

作者信息

Katsiki Niki, Mikhailidis Dimitri P

机构信息

Diabetes Center, Division of Endocrinology and Metabolism, First Department of Internal Medicine, AHEPA University Hospital, Medical School Aristotle University of Thessaloniki, Thessaloniki, Greece.

Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London, UK.

出版信息

Ann Transl Med. 2020 Oct;8(19):1280. doi: 10.21037/atm.2019.12.153.

Abstract

Diabetes mellitus (DM) has been linked to an increased prevalence and severity of carotid artery disease, as well as polyvascular disease. Carotid disease is also associated with obesity and abnormal peri-organ and intra-organ fat (APIFat) deposition (i.e., excess fat accumulation in several organs such as the liver, heart and vessels). In turn, DM is associated with APIFat. The coexistence of these comorbidities confers a greater risk of vascular events. Clinicians should also consider that carotid bruits may predict cardiovascular risk. DM has been related to a greater risk of adverse outcomes after carotid endarterectomy or stenting. Whether modifying risk factors (e.g., glycaemia and dyslipidaemia) in DM patients can improve the outcomes of these procedures needs to be established. Furthermore, DM is a risk factor for contrast-induced acute kidney injury (CI-AKI). The latter should be recorded in DM patients undergoing carotid stenting since it can influence both short- and long-term outcomes. From a pathophysiological perspective, functional changes in the carotid artery may precede morphological ones. Furthermore, carotid plaque characteristics are increasingly being studied in terms of vascular risk stratification and monitoring short-term changes attributed to treatment. The present narrative review discusses the recent (2019) literature on the associations between DM and carotid artery disease. Physicians and vascular surgeons looking after patients with carotid disease and DM should consider these links that may influence outcomes. Further research in this field is also needed to optimise the treatment of such patients.

摘要

糖尿病(DM)与颈动脉疾病以及多血管疾病的患病率增加和病情严重程度相关。颈动脉疾病还与肥胖以及器官周围和器官内异常脂肪(APIFat)沉积有关(即肝脏、心脏和血管等多个器官中脂肪过度积聚)。反过来,糖尿病与APIFat有关。这些合并症的共存会带来更大的血管事件风险。临床医生还应考虑到颈动脉杂音可能预示心血管风险。糖尿病与颈动脉内膜切除术或支架置入术后出现不良后果的风险更高有关。在糖尿病患者中改变风险因素(如血糖和血脂异常)是否能改善这些手术的结果尚有待确定。此外,糖尿病是造影剂诱导的急性肾损伤(CI-AKI)的一个危险因素。在接受颈动脉支架置入术的糖尿病患者中应记录后者,因为它会影响短期和长期结果。从病理生理学角度来看,颈动脉的功能变化可能先于形态学变化。此外,越来越多地从血管风险分层和监测治疗引起的短期变化方面研究颈动脉斑块特征。本叙述性综述讨论了近期(2019年)关于糖尿病与颈动脉疾病之间关联的文献。照顾患有颈动脉疾病和糖尿病患者的内科医生和血管外科医生应考虑这些可能影响治疗结果的联系。该领域还需要进一步研究以优化此类患者的治疗。

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