Pathology of Human Coronary and Carotid Artery Atherosclerosis and Vascular Calcification in Diabetes Mellitus.
Pathology of Human Coronary and Carotid Artery Atherosclerosis and Vascular Calcification in Diabetes Mellitus.
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糖尿病中人类冠状动脉和颈动脉动脉粥样硬化和血管钙化的病理学。
DOI：
10.1161/atvbaha.116.306256
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发表时间：
2017-02
期刊：
影响因子：
--
通讯作者：
Virmani R
中科院分区：
文献类型：
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作者：
Yahagi K;Kolodgie FD;Lutter C;Mori H;Romero ME;Finn AV;Virmani R
一般人群中糖尿病患病率的持续增加预计将导致心血管疾病的发病率升高。虽然糖尿病相关动脉粥样硬化进展的机制尚不完全清楚，但在临床和病理水平上，这些受试者的疾病负担增加和动脉钙化水平升高。糖尿病患者冠状动脉斑块的坏死核心通常比非糖尿病患者更大，主要由巨噬细胞和T淋巴细胞组成的炎症明显更大。此外，1型糖尿病（T1D）和2型糖尿病（T2D）患者的心脏愈合斑块破裂和正重构发生率更高，表明动脉粥样硬化过程更活跃。冠状动脉、颈动脉及其他动脉床的病变钙化也更为广泛。虽然冠状动脉钙化在识别心血管疾病和预测其结果中的作用是不可否认的，但我们对与糖尿病相关的关键激素和生理改变（如胰岛素抵抗和高血糖）如何影响血管钙化过程的理解仍在继续增长。糖尿病患者动脉粥样硬化钙化的重要驱动因素包括氧化应激、内皮功能障碍、矿物质代谢改变、炎症细胞因子产生增加以及骨髓中骨祖细胞释放到循环中。我们的综述将集中于T1D和t2d相关血管疾病的病理生理学，特别是冠状动脉和颈动脉粥样硬化钙化。
The continuing increase in the prevalence of diabetes in the general population is predicted to result in a higher incidence of cardiovascular disease. Although the mechanisms of diabetes associated progression of atherosclerosis are not fully understood, at clinical and pathological level, there is an appreciation of increased disease burden and higher levels of arterial calcification in these subjects. Plaques within the coronary arteries of patients with diabetes generally exhibit larger necrotic cores and significantly greater inflammation consisting mainly of macrophages and T lymphocytes relative to patients without diabetes. Moreover, there is a higher incidence of healed plaque ruptures and positive remodeling in hearts from subjects with type 1 diabetes (T1D) and type 2 diabetes (T2D), suggesting a more active atherogenic process. Lesion calcification in the coronary, carotid and other arterial beds is also more extensive. While the role of coronary artery calcification in identifying cardiovascular disease and predicting its outcome is undeniable, our understanding of how key hormonal and physiological alterations associated with diabetes such as insulin resistance and hyperglycemia influence the process of vascular calcification continues to grow. Important drivers of atherosclerotic calcification in diabetes include oxidative stress, endothelial dysfunction, alterations in mineral metabolism, increased inflammatory cytokine production, and release of osteoprogenitor cells from the marrow into the circulation. Our review will focus on the pathophysiology of T1D- and T2D-associated vascular disease with particular focus on coronary and carotid atherosclerotic calcification.