摘要
糖尿病性心肌病(DCM)是糖尿病患者发生心功能不全或心力衰竭,却不能用缺血性心肌病、高血压性心脏病及其他心肌组织病变解释的心肌疾病。该病为2型糖尿病(T2DM)的主要并发症之一,也是晚期糖尿病心力衰竭和死亡的主要原因之一。该病在广泛微血管病变和代谢紊乱基础上出现广泛心肌组织的灶性坏死,逐渐出现亚临床心功能障碍,并逐渐进展至心律失常、心力衰竭及心源性休克,重症患者甚至发生猝死。其机制尚不明确,也没有特异的治疗方法。外泌体是一种直径为30~150 nm的小囊泡,含有多种RNA和蛋白质,现如今,外泌体特指盘状囊泡,直径在40~100 nm。多囊泡体是外泌体的主要来源,其是由细胞内的溶酶体微粒通过内陷而形成,其外膜与细胞膜融合以后释放到细胞外基质。外泌体存在于自身的体液中,能从一些可培养的细胞分泌出来。外泌体作为一种特异性分泌出来的膜泡,可以作为细胞间通讯的一种工具。外泌体中的某些生物成分可能在DCM的发生、发展中起着重要作用,且对DCM的治疗有着一定作用。现主要从糖尿病性心肌病的危险因素、病理生理机制、外泌体在DCM治疗中的进展等方面进行综述,以期为DCM的治疗提供新的方向。
Diabetic cardiomyopathy(DCM)is a myocardial disease in which diabetic patients develop cardiac insufficiency or heart failure,but cannot be explained by ischemic cardiomyopathy,hypertensive heart disease,and other cardiac lesions.The disease is one of the major complications of type 2 diabetes mellitus(T2DM)and one of the leading causes of heart failure and death in advanced diabetes.On the basis of extensive microangiopathy and metabolic disorders,the disease appears extensive myocardial necrosis,gradually appears subclinical cardiac dysfunction,and gradually progresses to heart failure,arrhythmia and cardiogenic shock,and even sudden death in critically ill patients.The mechanism is not clear,and there is no specific treatment.Exosomes refer to small membrane vesicles(30-150 nm)containing complex RNAs and proteins,and nowadays,they specifically refer to discoid vesicles with a diameter of 40-100 nm.A variety of cells can secrete exosomes under both normal and pathological conditions.Exosomes are mainly derived from multivesicular bodies formed by intracellular lysosomal particle invagination,which are released into the extracellular matrix after fusion of the extracorporeal membrane of vesicles with the cell membrane.All cultured cell types can secrete exosomes,which are naturally present in body fluids,including blood,saliva,urine,cerebrospinal fluid,and milk.Exosomes are currently regarded as specifically secreted membrane vesicles involved in intercellular communication.Some biological components in exosomes may play an important role in the occurrence and development of DCM,and play a role in the treatment of DCM.This study mainly reviews the risk factors,pathophysiological mechanisms of diabetic cardiomyopathy,and the latest progress of exosomes in the treatment of DCM,to provide a new direction for the treatment of DCM.
作者
张志强
张洪生
张金国
尉希清
ZHANG Zhiqiang;ZHANG Hongsheng;ZHANG Jinguo;WEI Xiqing(School of Clinical Medicine,Jining Medical University,Jining 272000,China;Department of Cardiology,Affiliated Hospital of Jining Medical University,Jining 272000,China)
出处
《中国现代医生》
2022年第10期189-192,共4页
China Modern Doctor
基金
山东省中医药科技发展计划项目(2019-0481)
济宁医学院贺林院士新医学临床转化工作站科研金项目(JYHL2018FMS02)。
