CLINICAL AND MORPHOLOGICAL FEATURES OF HUMAN HYPERTENSIVE-DIABETIC CARDIOMYOPATHY
CLINICAL AND MORPHOLOGICAL FEATURES OF HUMAN HYPERTENSIVE-DIABETIC CARDIOMYOPATHY
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DOI：
10.1016/0002-8703(80)90379-8
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发表时间：
1980-01-01
影响因子：
4.8
通讯作者：
SONNENBLICK, EH
中科院分区：
文献类型：
--
作者：
FACTOR, SM;MINASE, T;SONNENBLICK, EH
继发于糖尿病的特殊心肌病的存在是有争议的。在2年的时间内，9例糖尿病患者进行了尸检，临床上有严重的充血性心力衰竭和轻微的壁外冠状动脉粥样硬化。9例患者均为高血压。研究了这组患者的临床和形态学特征，并与年龄匹配的单纯高血压、单纯糖尿病或无心脏病的尸检结果进行了比较。对高血压糖尿病心脏的研究显示严重的间质纤维化、局灶性或融合性瘢痕和广泛的肌细胞溶解活性。与糖尿病组、高血压组和正常组相比，在间质性和局灶性瘢痕形成程度以及肌细胞溶解的存在方面存在统计学显著差异。只有高血压组有轻微的间质瘢痕。尽管高血压和高血压糖尿病患者主观上病情更严重，但4组之间的小血管变化无统计学差异。糖尿病和高血压的关联在没有显著冠状动脉粥样硬化的情况下可能导致严重的心肌病。虽然这种综合征的心肌衰竭的病因尚不确定，但心肌纤维化的程度和可能与儿茶酚胺超敏反应相关的肌细胞溶解性病变的频率是潜在的解释。几项研究表明，高血压对糖尿病有不良影响，高血压-糖尿病心肌病动物模型支持以下结论：糖尿病相关心肌病是一种特定的实体，可能继发于糖尿病和高血压对心肌的联合作用。
The existence of a specific cardiomyopathy secondary to diabetes mellitus is controversial. During a 2 yr period, 9 diabetic patients were examined at autopsy who had clinically severe congestive heart failure and minimal extramural coronary artery atherosclerosis. All 9 patients were hypertensive. The clinical and morphological features of this group were studied and compared to findings of age-matched autopsied subjects with isolated hypertension, isolated diabetes mellitus or no heart disease. The study of the hypertensive-diabetic hearts revealed severe interstitial fibrosis, focal or confluent scars and extensive myocytolytic activity. Comparison with the diabetic, hypertensive and normal groups showed statistically significant differences in regard to the degree of interstitial and focal scarring, and the presence of myocytolysis. Only the hypertensive group had minimal interstitial scarring. There were no statistical differences in the small vessel changes between the 4 groups, although subjectively the hypertensive and hypertensive-diabetic patients had more severe disease. The association of diabetes mellitus and hypertension in the absence of significant coronary artery atherosclerosis may lead to a severe cardiomyopathy. Although the etiology of myocardial failure in this syndrome is uncertain, the degree of myocardial fibrosis and the frequency of myocytolytic lesions possibly related to catecholamine hypersensitivity are potential explanations. Several studies suggesting that hypertension has adverse consequences in diabetes and an animal model of hypertensive-diabetic cardiomyopathy support the conclusion that cardiomyopathy associated with diabetes mellitis is a specific entity which may be secondary to the combined effects of diabetes and hypertension on the myocardium.