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首页> 外文期刊>Experimental and clinical endocrinology and diabetes: Official journal, German Society of Endocrinology [and] German Diabetes Association >Heart disease in diabetes mellitus: a challenge for early diagnosis and intervention.
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Heart disease in diabetes mellitus: a challenge for early diagnosis and intervention.

机译：糖尿病中的心脏病：早期诊断和干预的挑战。

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Most people with diabetes die from thrombotic complications superimposed to degenerative arterial vascular lesions, mostly myocardial infarction. Diabetes is a risk factor per se for such complications, but often clusters with dyslipoproteinemia, hypertension and obesity. In NIDDM (Type-II) patients this is referred to as "metabolic syndrome" and often operates on a genetically programmed susceptibility which accelerates the pathogenesis of coronary artery disease in front of a much wider diabetes specific cardiopathy. From a pathophysiological point of view none of these associated risk factors explains the pathogenetic series of events leading to the precipitation of an occlusive thrombus at sites of complicated coronary plaques. In patients with diabetes the coagulation system is switched towards a prethrombotic state, involving increased plasmatic coagulation, diminished fibrinolysis, decreased endothelial thromboresistance and predominantly platelet hyperreactivity ("diabetic thrombocytopathy"). Some of these factors are associated with an increased coronary risk (e.g. fibrinogen, PAI-1, platelets), but are also directly linked to the pathogenesis of "atherothrombosis". Altered cardiac remodelling together with adhesion and coagulation mechanisms appears suitable to explain decreased functional performance of infarcted organs, decreased success of acute (reduced fibrinolytic response, reperfusion injury) and longterm intervention strategies (PTCA, CABG) in diabetes. Glucose adjustment alone will not adequately neutralize these complex mechanisms. Particularly in diabetes a multidimensional interventional repertoire is required including antihypertensive, antidyslipoproteinemic and antithrombotic drugs, customized according to the individual patients needs as assessed by early diagnostic measures ("early secondary prevention").
机译：大多数糖尿病患者死于血栓并发症，并伴有退行性动脉血管病变，主要是心肌梗塞。糖尿病本身就是引起此类并发症的危险因素，但通常合并有脂蛋白异常，高血压和肥胖。在NIDDM（II型）患者中，这被称为“代谢综合征”，通常以遗传程序易感性起作用，从而在更广泛的糖尿病特异性心脏病发生之前加速了冠状动脉疾病的发病机理。从病理生理学的观点来看，这些相关的危险因素均不能解释导致复杂冠状动脉斑块部位闭塞性血栓沉淀的一系列致病因素。在糖尿病患者中，凝血系统切换到血栓形成前状态，包括血浆凝结增加，纤维蛋白溶解减少，内皮血栓形成抗性降低和主要是血小板反应性过强（“糖尿病血栓形成性病变”）。这些因素中的一些与冠心病风险增加有关（例如纤维蛋白原，PAI-1，血小板），但也与“动脉粥样硬化血栓形成”的发病机理直接相关。改变的心脏重塑以及粘附和凝血机制似乎可以解释梗塞器官的功能下降，急性成功（降低的纤溶反应，再灌注损伤）和长期干预策略（PTCA，CABG）的降低。单靠葡萄糖调节不能充分中和这些复杂的机制。尤其是在糖尿病患者中，需要进行多维介入治疗，包括降压药，抗脂蛋白血症药和抗血栓药，这些药物应根据患者的早期诊断措施（“早期预防”）进行评估，根据患者的需求进行定制。

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