Cohen A
Service de cardiologie, hôpital Saint-Antoine, Paris.
Arch Mal Coeur Vaiss. 1995 Apr;88(4):479-86.
Type I and type II diabetes is associated with increased cardiovascular complications, the most common of which are ischaemic cardiomyopathy and left ventricular dysfunction. The existence of an independent disease, diabetic cardiomyopathy, was suggested by initial anatomic studies, experimental models, and, more recently, by epidemiological studies. The exact cause of this ventricular dysfunction is not known: several mechanisms have been proposed, such as metabolic abnormalities of glucose transport, cellular overload in fatty acid metabolites, alteration of calcium uptake by the sarcoplasmic reticulum leading to cellular calcium overload, coronary microangiopathy, structural collagen abnormalities, interstitial and perivascular fibrosis or the presence of an autonomic neuropathy. The condition is characterised by abnormal left ventricular filling suggesting poor compliance or prolongation of left ventricular relaxation. Left ventricular systolic function is usually normal at rest but abnormally decreased on effort. The value of strict metabolic control and the place of drug therapy, especially calcium antagonists which oppose cellular calcium overload, has yet to be established. The natural history of diabetic cardiomyopathy should be defined by clinical studies taking care to differentiate it from the cardiovascular consequences of hypertension or obesity which aggravate or stimulate this condition.
I型和II型糖尿病与心血管并发症增加相关，其中最常见的是缺血性心肌病和左心室功能障碍。最初的解剖学研究、实验模型以及最近的流行病学研究表明存在一种独立的疾病——糖尿病性心肌病。这种心室功能障碍的确切原因尚不清楚：已经提出了几种机制，如葡萄糖转运的代谢异常、脂肪酸代谢产物中的细胞超载、肌浆网钙摄取改变导致细胞钙超载、冠状动脉微血管病变、结构性胶原异常、间质和血管周围纤维化或存在自主神经病变。该病症的特征是左心室充盈异常，提示顺应性差或左心室舒张延长。左心室收缩功能通常在静息时正常，但在用力时异常降低。严格代谢控制的价值以及药物治疗的地位，尤其是对抗细胞钙超载的钙拮抗剂，尚未确定。糖尿病性心肌病的自然病史应由临床研究来界定，要注意将其与加重或刺激这种病症的高血压或肥胖的心血管后果区分开来。
