Bell D S
University of Alabama at Birmingham School of Medicine, USA.
Diabetes Care. 1995 May;18(5):708-14. doi: 10.2337/diacare.18.5.708.
The increased incidence of congestive heart failure and the increased mortality and morbidity in the diabetic patient following myocardial infarction or coronary artery bypass graft can be explained by the presence of diabetic cardiomyopathy. Noninvasive studies in young diabetic patients show no cardiac abnormality, but in older diabetic patients mild cardiac diastolic dysfunction is detectable. This mild cardiomyopathy can become clinically detectable in the presence of hypertension and can be severe in the presence of myocardial ischemia. Microvascular disease is unlikely to cause diabetic cardiomyopathy. Cellular changes, including defects in calcium transport and fatty acid metabolism, may lead to myocellular hypertrophy and myocardial fibrosis, initially causing diastolic dysfunction that may advance to systolic dysfunction. Glycemic control, energetic detection and treatment of hypertension with appropriate antihypertensive agents, and early detection and treatment of ischemic heart disease are essential in preventing and treating diabetic cardiomyopathy.
充血性心力衰竭发病率的增加，以及糖尿病患者在心肌梗死或冠状动脉搭桥术后死亡率和发病率的上升，可归因于糖尿病性心肌病的存在。对年轻糖尿病患者的非侵入性研究显示心脏无异常，但在老年糖尿病患者中可检测到轻度心脏舒张功能障碍。这种轻度心肌病在高血压存在时可在临床上被检测到，而在心肌缺血存在时可能会很严重。微血管疾病不太可能导致糖尿病性心肌病。细胞变化，包括钙转运和脂肪酸代谢缺陷，可能导致心肌细胞肥大和心肌纤维化，最初引起舒张功能障碍，进而可能发展为收缩功能障碍。血糖控制、积极检测并用适当的抗高血压药物治疗高血压，以及早期检测和治疗缺血性心脏病，对于预防和治疗糖尿病性心肌病至关重要。
