糖尿病性心肌病知多少！
<p></p><section data-mpa-powered-by="yiban.io"></section><section data-support="96编辑器" data-style-id="31585" style="outline: 0px;font-family: -apple-system, BlinkMacSystemFont, Helvetica Neue, PingFang SC, Hiragino Sans GB, Microsoft YaHei UI, Microsoft YaHei, Arial, sans-serif;letter-spacing: 0.544px;white-space: normal;"><section style="margin-top: 10px;margin-bottom: 10px;outline: 0px;"><section style="margin-left: auto;outline: 0px;width: 2em;"><br data-filtered="filtered" style="outline: 0px;"/></section><section style="margin-top: -30px;margin-right: 10px;padding: 14px;outline: 0px;background-color: rgb(251, 235, 235);border-radius: 0px 20px 0px 0px;box-sizing: border-box;"><section style="outline: 0px;line-height: 1.75em;letter-spacing: 2px;font-size: 15px;transform: rotateZ(0deg);-webkit-transform: rotateZ(0deg);-moz-transform: rotateZ(0deg);-ms-transform: rotateZ(0deg);-o-transform: rotateZ(0deg);"><p style="outline: 0px;letter-spacing: 1px;line-height: 2.5em;"><span style="font-size: 16px;"> 《中国心血管健康与疾病报告2020》指出，我国心血管患病率持续上升阶段，推算心血管病现患人数约3.3亿，目前中国心血管病死亡占城乡居民总死亡原因的首位，农村为46.66%，城市为43.81%。据统计，我国18岁及以上糖尿病糖尿病患病率为11.2%。众所周知，<span style="color: rgb(255, 76, 65);">糖尿病本身不可怕，可怕的是糖尿病导致的慢性并发症</span>，30-40%的患者在糖尿病患病10年左右发生至少一种糖尿病慢性并发症。高血糖造成的脏器损害其实在症状出现前就早已开始，而并发症一旦显现就难以用药物逆转。糖尿病性心肌病是糖尿病患者较为严重的慢性并发症之一。</span></p></section></section></section></section><section><section><section><section data-support="96编辑器" data-style-id="35623"><section><section><section><section><section><section data-support="96编辑器" data-style-id="35605"><section style="text-align: left;padding-top: 10px;padding-bottom: 30px;box-sizing: border-box;"><section style="display:inline-block;height:34px;"><section style="background-color:#f00;"><section style="display: flex;align-items:center;margin-left:10px;"><section style="border-width: 1px;border-style: solid;border-color: #f9b7b7;border-radius: 50%;padding: 4px;box-sizing: border-box;"><section style="background-color: #f9b7b7;width: 8px;height: 8px;border-radius: 50%;box-sizing: border-box;"><br/></section></section><section style="color: #ffffff;font-size: 18px;letter-spacing: 2px;padding: 5px12px;box-sizing: border-box;"><p><span style="letter-spacing: 1px;"><strong><span style="font-size: 16px;">什么是糖尿病性心肌病呢？</span></strong></span><strong><span style="font-size: 16px;"></span></strong></p></section><section style="width:19px;height:1px;background-color:#f9b7b7;"><br/></section></section></section></section><section style="width:100%;height:1px;background-color:#f9b7b7;margin-top: -23px;" data-width="100%"><br/></section></section></section></section></section></section></section></section></section></section></section><section data-support="96编辑器" data-style-id="31585" style="outline: 0px;font-family: -apple-system, BlinkMacSystemFont, Helvetica Neue, PingFang SC, Hiragino Sans GB, Microsoft YaHei UI, Microsoft YaHei, Arial, sans-serif;letter-spacing: 0.544px;white-space: normal;"><section style="margin-top: 10px;margin-bottom: 10px;outline: 0px;"><section style="margin-left: auto;outline: 0px;width: 2em;"><br data-filtered="filtered" style="outline: 0px;"/></section><section style="margin-top: -30px;margin-right: 10px;padding: 14px;outline: 0px;background-color: rgb(251, 235, 235);border-radius: 0px 20px 0px 0px;box-sizing: border-box;"><section style="outline: 0px;line-height: 1.75em;letter-spacing: 2px;font-size: 15px;transform: rotateZ(0deg);-webkit-transform: rotateZ(0deg);-moz-transform: rotateZ(0deg);-ms-transform: rotateZ(0deg);-o-transform: rotateZ(0deg);"><p style="outline: 0px;letter-spacing: 1px;line-height: 2.5em;"><span style="font-size: 16px;"> 糖尿病性心肌病是指发生在糖尿病患者中的排除高血压性心脏病、冠状动脉粥样硬化性心脏病及其心脏病变来解释的心肌疾病。</span></p></section></section></section></section><section><section><section data-support="96编辑器" data-style-id="35623"><section><section><section><section><section><section data-support="96编辑器" data-style-id="35605"><section style="padding-top: 10px;padding-bottom: 30px;box-sizing: border-box;"><section style="display:inline-block;height:34px;"><section style="background-color:#f00;"><section style="display: flex;align-items:center;margin-left:10px;"><section style="border-width: 1px;border-style: solid;border-color: rgb(249, 183, 183);border-radius: 50%;padding: 4px;box-sizing: border-box;"><section style="background-color: rgb(249, 183, 183);width: 8px;height: 8px;border-radius: 50%;box-sizing: border-box;"><br/></section></section><section style="color: rgb(255, 255, 255);font-size: 18px;letter-spacing: 2px;padding: 5px 12px;box-sizing: border-box;"><p><span style="letter-spacing: 1px;"><strong><span style="font-size: 16px;">糖尿病性心肌病的发病机制是什么样呢 ?</span></strong></span></p></section><section style="width:19px;height:1px;background-color:#f9b7b7;"><br/></section></section></section></section><section style="width:100%;height:1px;background-color:#f9b7b7;margin-top: -23px;" data-width="100%"><br/></section></section></section></section></section></section></section></section></section></section></section><section data-support="96编辑器" data-style-id="31585" style="outline: 0px;font-family: -apple-system, BlinkMacSystemFont, Helvetica Neue, PingFang SC, Hiragino Sans GB, Microsoft YaHei UI, Microsoft YaHei, Arial, sans-serif;letter-spacing: 0.544px;white-space: normal;"><section style="margin-top: 10px;margin-bottom: 10px;outline: 0px;"><section style="margin-left: auto;outline: 0px;width: 2em;"><br data-filtered="filtered" style="outline: 0px;"/></section><section style="margin-top: -30px;margin-right: 10px;padding: 14px;outline: 0px;background-color: rgb(251, 235, 235);border-radius: 0px 20px 0px 0px;box-sizing: border-box;"><section style="outline: 0px;line-height: 1.75em;letter-spacing: 2px;font-size: 15px;transform: rotateZ(0deg);-webkit-transform: rotateZ(0deg);-moz-transform: rotateZ(0deg);-ms-transform: rotateZ(0deg);-o-transform: rotateZ(0deg);"><p style="outline: 0px;letter-spacing: 1px;line-height: 2.5em;"><span style="font-size: 16px;"> 糖尿病性心肌病是在代谢紊乱及微血管病变基础上引发的心肌广泛性坏死。具体来讲主要包括以下几方面的原因。</span></p><p style="outline: 0px;letter-spacing: 1px;line-height: 2.5em;"><span style="font-size: 16px;"> 一是糖尿病患者的收缩蛋白或钙调节蛋白经蛋白激酶C（PKC）和一氧化氮（NO）等第二信使的介导发生糖基化，导致功能异常。</span></p><p style="outline: 0px;letter-spacing: 1px;line-height: 2.5em;"><span style="font-size: 16px;"> 二是高血糖症降低葡萄糖清除率，糖异生增加，长期慢性高血糖导致晚期终末产物的产生，从而使活性氧（ROS）产生过多，内皮抗氧化屏障失衡导致了氧化应激的产生，ROS增加加速了糖尿病性心肌病的发展进程。</span></p><p style="outline: 0px;letter-spacing: 1px;line-height: 2.5em;"><span style="font-size: 16px;"> 三是糖尿病病人脂肪酸代谢异常，糖尿病性心肌病患者中葡萄糖氧化利用率下降，同时脂肪酸氧化速率加快。再者，心肌细胞钙转运失调也是重要的原因。心肌细胞钙稳态的精细调节是保证心脏收缩功能的核心环节。心肌细胞外葡萄糖水平的升高直接引起细胞内钙离子浓度的改变。在2型糖尿病的心肌细胞中，钠钙交换功能受抑制，而肌浆网Ca泵正常，逐渐使Ca浓聚于肌浆网，Ca超负荷的心肌肌浆网可增加自发性Ca2+的释放，心肌舒张时张力增高，心脏的顺应性下降。</span></p><p style="outline: 0px;letter-spacing: 1px;line-height: 2.5em;"><span style="font-size: 16px;"> 此外，糖尿病微血管病变致心肌供血减少，加重纤维化形成，最终引起心肌纤维化，心脏舒张功能降低。</span></p></section></section></section></section><section><section><section><section><section data-support="96编辑器" data-style-id="35623"><section><section><section><section><section><section data-support="96编辑器" data-style-id="35605"><section style="padding-top: 10px;padding-bottom: 30px;box-sizing: border-box;"><section style="display:inline-block;height:34px;"><section style="background-color:#f00;"><section style="display: flex;align-items:center;margin-left:10px;"><section style="border-width: 1px;border-style: solid;border-color: rgb(249, 183, 183);border-radius: 50%;padding: 4px;box-sizing: border-box;"><section style="background-color: rgb(249, 183, 183);width: 8px;height: 8px;border-radius: 50%;box-sizing: border-box;"><br/></section></section><section style="color: rgb(255, 255, 255);font-size: 18px;letter-spacing: 2px;padding: 5px 12px;box-sizing: border-box;"><p><span style="letter-spacing: 1px;"><strong><span style="font-size: 16px;">哪些情况要考虑糖尿病性心肌病呢？</span></strong></span><strong><span style="font-size: 16px;"></span></strong></p></section><section style="width:19px;height:1px;background-color:#f9b7b7;"><br/></section></section></section></section><section style="width:100%;height:1px;background-color:#f9b7b7;margin-top: -23px;" data-width="100%"><br/></section></section></section></section></section></section></section></section></section></section></section></section></section><section data-support="96编辑器" data-style-id="31585" style="outline: 0px;font-family: -apple-system, BlinkMacSystemFont, Helvetica Neue, PingFang SC, Hiragino Sans GB, Microsoft YaHei UI, Microsoft YaHei, Arial, sans-serif;letter-spacing: 0.544px;white-space: normal;"><section style="margin-top: 10px;margin-bottom: 10px;outline: 0px;"><section style="margin-left: auto;outline: 0px;width: 2em;"><br data-filtered="filtered" style="outline: 0px;"/></section><section style="margin-top: -30px;margin-right: 10px;padding: 14px;outline: 0px;background-color: rgb(251, 235, 235);border-radius: 0px 20px 0px 0px;box-sizing: border-box;"><section style="outline: 0px;line-height: 1.75em;letter-spacing: 2px;font-size: 15px;transform: rotateZ(0deg);-webkit-transform: rotateZ(0deg);-moz-transform: rotateZ(0deg);-ms-transform: rotateZ(0deg);-o-transform: rotateZ(0deg);"><p style="outline: 0px;letter-spacing: 1px;line-height: 2.5em;"><span style="font-size: 16px;"> 糖尿病患者尤其是血糖控制不良的患者出现反复心慌、胸闷、气促甚至是心律失常、体位性低血压等表现，体格检查和心脏彩超、胸片、心电图等都提示有左心室扩大，且收缩功能减退，心肌顺应性降低，冠脉造影检查不支持冠心病改变，心肌核素扫描提示存在心肌病变但能排除如风心病、扩心病的心肌病变。</span></p></section></section></section></section><section><section><section data-support="96编辑器" data-style-id="35623"><section><section><section><section><section><section data-support="96编辑器" data-style-id="35605"><section style="padding-top: 10px;padding-bottom: 30px;box-sizing: border-box;"><section style="display:inline-block;height:34px;"><section style="background-color:#f00;"><section style="display: flex;align-items:center;margin-left:10px;"><section style="border-width: 1px;border-style: solid;border-color: rgb(249, 183, 183);border-radius: 50%;padding: 4px;box-sizing: border-box;"><section style="background-color: rgb(249, 183, 183);width: 8px;height: 8px;border-radius: 50%;box-sizing: border-box;"><br/></section></section><section style="color: rgb(255, 255, 255);font-size: 18px;letter-spacing: 2px;padding: 5px 12px;box-sizing: border-box;"><p><span style="letter-spacing: 1px;"><strong><span style="font-size: 16px;">糖尿病性心肌病是如何进展的呢？</span></strong></span><strong><span style="font-size: 16px;"></span></strong></p></section><section style="width:19px;height:1px;background-color:#f9b7b7;"><br/></section></section></section></section><section style="width:100%;height:1px;background-color:#f9b7b7;margin-top: -23px;" data-width="100%"><br/></section></section></section></section></section></section></section></section></section></section></section><section data-support="96编辑器" data-style-id="31585" style="outline: 0px;font-family: -apple-system, BlinkMacSystemFont, Helvetica Neue, PingFang SC, Hiragino Sans GB, Microsoft YaHei UI, Microsoft YaHei, Arial, sans-serif;letter-spacing: 0.544px;white-space: normal;"><section style="margin-top: 10px;margin-bottom: 10px;outline: 0px;"><section style="margin-left: auto;outline: 0px;width: 2em;"><br data-filtered="filtered" style="outline: 0px;"/></section><section style="margin-top: -30px;margin-right: 10px;padding: 14px;outline: 0px;background-color: rgb(251, 235, 235);border-radius: 0px 20px 0px 0px;box-sizing: border-box;"><section style="outline: 0px;line-height: 1.75em;letter-spacing: 2px;font-size: 15px;transform: rotateZ(0deg);-webkit-transform: rotateZ(0deg);-moz-transform: rotateZ(0deg);-ms-transform: rotateZ(0deg);-o-transform: rotateZ(0deg);"><p style="outline: 0px;letter-spacing: 1px;line-height: 2.5em;"><span style="font-size: 16px;"> 糖尿病性心肌病的进展可分为三期：</span></p><p style="outline: 0px;letter-spacing: 1px;line-height: 2.5em;"><span style="font-size: 16px;"> 1、出现心脏结构变化，但无舒张功能改变，左心室射血分数正常，此时为亚临床状态。</span></p><p style="outline: 0px;letter-spacing: 1px;line-height: 2.5em;"><span style="font-size: 16px;"> 2、心脏结构变化加重，出现心室肥厚，心肌纤维化，心脏功能方面出现心室舒张功能下降，逐渐出现收缩功能异常，左心室射血分数＜50%。</span></p><p style="outline: 0px;letter-spacing: 1px;line-height: 2.5em;"><span style="font-size: 16px;"> 3、心脏结构变化进一步加重，出现心脏微血管改变，心室肥厚与心肌纤维化进一步加重，出现全心舒张、收缩障碍。</span></p></section></section></section></section><section><section><section><section data-support="96编辑器" data-style-id="35623"><section><section><section><section><section><section data-support="96编辑器" data-style-id="35605"><section style="padding-top: 10px;padding-bottom: 30px;box-sizing: border-box;"><section style="display:inline-block;height:34px;"><section style="background-color:#f00;"><section style="display: flex;align-items:center;margin-left:10px;"><section style="border-width: 1px;border-style: solid;border-color: rgb(249, 183, 183);border-radius: 50%;padding: 4px;box-sizing: border-box;"><section style="background-color: rgb(249, 183, 183);width: 8px;height: 8px;border-radius: 50%;box-sizing: border-box;"><br/></section></section><section style="color: rgb(255, 255, 255);font-size: 18px;letter-spacing: 2px;padding: 5px 12px;box-sizing: border-box;"><p><span style="letter-spacing: 1px;"><strong><span style="font-size: 16px;">糖尿病性心肌病如何治疗呢？</span></strong></span><strong><span style="font-size: 16px;"></span></strong></p></section><section style="width:19px;height:1px;background-color:#f9b7b7;"><br/></section></section></section></section><section style="width:100%;height:1px;background-color:#f9b7b7;margin-top: -23px;" data-width="100%"><br/></section></section></section></section></section></section></section></section></section></section></section></section><section data-support="96编辑器" data-style-id="31585" style="outline: 0px;font-family: -apple-system, BlinkMacSystemFont, Helvetica Neue, PingFang SC, Hiragino Sans GB, Microsoft YaHei UI, Microsoft YaHei, Arial, sans-serif;letter-spacing: 0.544px;white-space: normal;"><section style="margin-top: 10px;margin-bottom: 10px;outline: 0px;"><section style="margin-left: auto;outline: 0px;width: 2em;"><br data-filtered="filtered" style="outline: 0px;"/></section><section style="margin-top: -30px;margin-right: 10px;padding: 14px;outline: 0px;background-color: rgb(251, 235, 235);border-radius: 0px 20px 0px 0px;box-sizing: border-box;"><section style="outline: 0px;line-height: 1.75em;letter-spacing: 2px;font-size: 15px;transform: rotateZ(0deg);-webkit-transform: rotateZ(0deg);-moz-transform: rotateZ(0deg);-ms-transform: rotateZ(0deg);-o-transform: rotateZ(0deg);"><p style="outline: 0px;letter-spacing: 1px;line-height: 2.5em;"><span style="font-size: 16px;color: rgb(255, 76, 65);"> 目前尚无糖尿病性心肌病特效治疗药物</span><span style="font-size: 16px;color: rgb(255, 76, 65);">。</span><span style="font-size: 16px;">预防才是王道，预防大于治疗，早发现，早治疗，是应对糖尿病心肌病的关键所在。纠正糖、脂代谢紊乱、控制血压是治疗DCM的关键环节。当患者出现心功能不全时根据收缩功能或舒张功能障碍的严重程度给予相应心衰治疗。建议<span style="color: rgb(255, 76, 65);">戒烟、限酒、控制盐摄入、合理膳食和适量运动，积极控制血糖并维持血糖平稳。</span></span></p></section></section></section></section></section><section data-support="96编辑器" data-style-id="31585" style="outline: 0px;font-family: -apple-system, BlinkMacSystemFont, Helvetica Neue, PingFang SC, Hiragino Sans GB, Microsoft YaHei UI, Microsoft YaHei, Arial, sans-serif;letter-spacing: 0.544px;white-space: normal;"><section><section><section><p style="outline: 0px; max-width: 100%; font-family: -apple-system, BlinkMacSystemFont, Helvetica Neue, PingFang SC, Hiragino Sans GB, Microsoft YaHei UI, Microsoft YaHei, Arial, sans-serif; white-space: normal; background-color: rgb(255, 255, 255); letter-spacing: 1px; line-height: 2em; box-sizing: border-box !important; overflow-wrap: break-word !important; text-align: center;"></p><p style="outline: 0px; max-width: 100%; font-family: -apple-system, BlinkMacSystemFont, Helvetica Neue, PingFang SC, Hiragino Sans GB, Microsoft YaHei UI, Microsoft YaHei, Arial, sans-serif; white-space: normal; background-color: rgb(255, 255, 255); letter-spacing: 1px; line-height: 2em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span style="letter-spacing: 0.544px; font-size: 12px; text-align: right;">来源：文章转载自健康心血管</span></p></section></section></section></section><section style="white-space: normal;font-family: -apple-system, BlinkMacSystemFont, Helvetica Neue, PingFang SC, Hiragino Sans GB, Microsoft YaHei UI, Microsoft YaHei, Arial, sans-serif;letter-spacing: 0.544px;"><section><section style="letter-spacing: 0.544px;text-align: right;font-size: 12px;"><section style="letter-spacing: 0.544px;"><p><span style="letter-spacing: 0.544px;font-size: 17px;text-align: justify;"></span></p></section></section></section></section><p></p><h2 style="font-weight: bold; white-space: normal; line-height: 1.6em; 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