摘要
糖尿病大血管疾病的成因主要與動脈粥狀硬化有關，因其影響之器官不同而臨床上有腦中風、缺血性心臟病、和下肢壞疽等表現。胰島素在1921年被萃取出來並使用於人體後，糖尿病的死因由先前的急性昏迷轉變為以大血管疾病為主。早在1920年代開始就有研究者從屍體解剖的研究發現糖尿病患者的動脈粥狀硬化病灶較無糖尿病者多而廣泛。一九六0年代以後研究者開始在人口族群中進行大規模的流行學追蹤研究。這些研究結果證實糖尿病為心臟血管疾病的危險因子，且女性糖尿病患者的相對危險性較男性糖尿病患者高。胰島素依賴型糖尿病病人發生大血管疾病的原因與其血糖控制不良引其脂質代謝異常， 或是併發高血壓，或長期胰島素治療引起高胰島素血症有關。非胰島素依賴型糖尿病病人的大血管疾病除了控制不良所產生的代謝異常外，亦可能與胰島素阻抗症候群有關。糖尿病病人發生大血管疾病後，其預後事相當不好的。目前有研究顯示透過控制血壓、治療高膽固醇血症、給於抗血小板擬集藥物、及戒菸等方式可以預防冠狀動脈疾病與腦中風的死亡，亦可預防總死亡。這些作用在糖尿病者比無糖尿病者更能能有效達成，而戒菸對總死亡的成效尤為卓重，因此禁煙運動實在值得吾人倡導。
並列摘要
Macrovascular diseases in diabetes mellitus are related to atherosclerosis. Clinical manifestations of these complications include stroke, coronary artery disease, and gangrene. Before the insulin era, most diabetic patients died of acute coma. Nowaday, the main causes of death in diabetic patients are related to atherosclerosis. Early in 1920s, diabetic patients were found to have more atherosclerotic lesions, and the lesions were more extensive than non-diabetic subjects in various autopsy studies. Since 1960s, several large population-based epidemiologic studies were carried out. Diabetes mellitus has been confirmed to be a major cardiovaslular risk factor, and the relative risk in diabetic women seemed to be higher than the diabetic men. The development of macrovascular disease in insulin-dependent diabetes mellitus is closely related to abnormalities in lipid metabolism secondary to poor glycemic control, hypertension, or hyperinsulinemia associated with insulin therapy. The pathogenesis of macrovascular disease in non-insulin-dependent diabetes mellitus is not only related to lipid abnormalities, but also to insulin resistance. The prognosis of diabetic patients after onset of macro vascular disease is poor. Intervention studies showed that mortality of coronary heart disease and stroke, and total mortality in diabetic patients could be prevented by control of blood pressure, therapy of hypercholesterolemia, taking aspirin, and smoking cessation. Smoking cessation seems to be the most effective method in reducing cardiovascular risk in the diabetic patients, and should be vigorously 4advocated.
被引用紀錄
延伸閱讀
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- Shan, P. F., Li, Q., Khamaisi, M., & Qiang, G. F. (2017). Type 2 Diabetes Mellitus and Macrovascular Complications. International Journal of Endocrinology, 2017(), 1-2. https://doi.org/10.1155/2017/4301461