新陳代謝記憶：糖尿病治療的新挑戰

Metabolic Memory: New Challenge for Diabetic Management

吳崇榮(Chung-Jung Wu)

《內科學誌》 20卷3期 (2009/06) Pp. 220-225

https://doi.org/10.6314/JIMT.2009.20(3).04

摘要

糖尿病是一個國人常見的慢性疾病之一，疾病本身常常會引發諸如冠狀動脈心臟病和腦中風等等的大血管疾病併發症，以及諸如視網膜、腎臟和神經等的小血管疾病併發症等，當然上述的併發症都可藉由嚴格的血糖控制獲得改善或降低其發生機率。然而，近來的研究證據顯示，糖尿病患者併發症的發生或嚴重程度，即使在血糖控制達到或趨近正常血糖值後，依舊和早期的高血糖息息相關，這些發現和論點也浮現出新的觀點「新陳代謝記憶」。而此新的觀點在於強調，糖尿病患者早期的高血糖狀況若沒有好好控制住，即使往後血糖好好控制到接近正常值時，先前的高血糖似乎對生物體的組織器官會有印記或記憶現象存在，而此現象正說明了爲何在血糖控制穩定後，其相關的糖尿病併發症依舊會繼續進展而無法緩解其發生。而此「新陳代謝記憶」似乎和粒腺體中醣化終極產物的形成量和氧化游離基息息相關，本文即在探討此一新的觀點和其對糖尿病治療所帶來的衝擊。

關鍵字

新陳代謝記憶 ； 糖尿病 ； 糖尿病血管併發症 ； 醣化作用 ； 氧化壓力 ； 游離基

並列摘要

Diabetes is associated with increased macrovascular complications, such as coronary artery disease and strokes, and microvascular complications, such as retinopathy, nephropathy and neuropathy. Clinical trials suggest that better control of blood glucose reduced diabetes-associated complications. However, recent evidences showed that the risk of diabetic complications was linked to previous hyperglycemia even when it had been achieved to near-normal glycemic control after aggressive treatment. These raised the concept of 'metabolic memory' that was referred to the continuing progression of microvascular damage after correction of chronic hyperglycemia in diabetic patients who had initial poor glycemic control. The metabolic memory may be related to the level of glycation of mitochondrial proteins and the production of reactive oxidative species. We will briefly review this concept and discuss future therapeutic applications.

並列關鍵字

Metabolic memory ； Diabetes mellitus ； Diabetic vascular complication ； Nonenzymatic glycation ； Oxidative stress ； Free radicals