糖尿病相关脑微血管病变研究进展

李媛+曾克武+王学美

[摘要] 糖尿病是一种慢性代谢障碍性疾病，随着发病率的逐年增高，已成为人类健康的主要威胁之一。脑微血管病变是糖尿病的特征性病理改变，是糖尿病脑部慢性并发症的病理基础，主要见于阿尔茨海默症和腔隙性脑梗死患者，是导致糖尿病患者致死致残的主要原因之一。其致病机制复杂，涉及多元醇代谢异常、糖化反应亢进、氧化应激、β淀粉样蛋白跨血脑屏障的异常转运、蛋白激酶C激活等多个方面，以发病机制为靶点的治疗可能会为预防和延缓糖尿病脑微血管病变的发生发展带来新的希望。目前，对糖尿病脑微血管病变的机制、诊断和治疗方法的研究较为广泛，已成为医学研究的一大热点。该文拟对糖尿病诱发的脑微血管病变的发病机制，临床诊断与治疗策略方面的研究进行综述，以期为糖尿病脑微血管病变的预防和治疗提供新的思路。

[关键词] 糖尿病； 脑微血管病变； 发病机制； 诊断； 治疗方法

[Abstract] Diabetes mellitus， a kind of chronic metabolic disease， has become one of major threats to human health with an increasing incidence. As a basic pathology of chronic complications related to diabetes mellitus， cerebral microangiopathy is mainly found in patients with Alzheimer′s disease and lacunar infarction， and becomes one of the main reasons of death and disability in diabetic patients. The pathogenesis of cerebral microangiopathy is complicated， involving such signal pathways as metabolic abnormalities of polyol， saccharification hyperactivity， oxidative stress， abnormal transport of amyloid-β across blood-brain barrier and protein kinase C activation. Treatment targeting at related pathogenesis may bring a new hope to prevention and delay of the occurrence and development of cerebral microangiopathy of diabetes mellitus. Currently， pathogenesis， diagnosis and therapies for cerebral microangiopathy of diabetes mellitus have become hot topics in medical studies. This article reviews pathogenesis， clinical diagnosis and treatment for cerebral microangiopathy of diabetes mellitus， in order to provide new ideas for the prevention and treatment of cerebral microangiopathy of diabetes mellitus.

[Key words] diabetes mellitus； cerebral microangiopathy； pathogenesis； diagnosis； therapy

糖尿病是一组由胰岛素分泌绝对或相对不足引起的，以糖、脂肪和蛋白质等一系列营养物质代谢紊乱为特征的慢性代谢性障碍疾病。随着糖尿病的发病率逐年增高，已成为继癌症、心血管疾病后的第三大威胁人类健康的疾病。据世界卫生组织预计，到2025年，全球成人糖尿病患者人数将增至3亿，而我国糖尿病患者人数将超过4 000万。脑微血管和大血管病变是糖尿病常见的并发症。糖尿病大血管病变是指中等以上动脉的粥样硬化，主要有高血压、冠心病、脑血管病变和下肢血管病变。……