2型糖尿病的系统性血管保护治疗策略

在最新研究发现的系统性血管保护的优化治疗策略表明,血管损伤机制与胰岛素抵抗、糖尿病肾病及外周动脉疾病(PAD)的发病机理相关。胰岛素抵抗机制在血管损伤方面主要表现为大血管和微血管病变。系统性动脉硬化性疾病的及时诊断和干预是至关重要的。并且,治疗方面不仅仅是改善现有疾病状况,也应注意减少心血管事件的风险。这些努力有助于降低心血管事件的风险和死亡率。PAD的治疗包括药物治疗、血管内治疗和血管重建,以及运动疗法。经典治疗药物包括血管舒张剂,如贝前列素和抗血小板药物。值得注意的是,贝前列素除血管舒张活性外还有几个其他治疗作用,包括保护血管内皮、抗血小板和抗炎作用。最近的前期临床研究表明,贝前列素不仅通过其舒张血管活性改善四肢缺血,同时改善了影响血管内皮功能的胰岛素抵抗。贝列前素的应用,在早期疾病阶段维持血管内皮功能,减少血管事件的发生率,发挥其系统性血管保护作用。这样,贝列前素最终将有助于改善患者的生存质量并可能增加PAD患者的寿命。

Treatment Strategy for Type 2 Diabetes fromthe Perspective of Systemic Vascular Protection

Recent clinical findings indicate that the mechanisms of vascular impairment associated with insulin resistance and the pathogenesis of diabetic nephropathy and peripheral artery disease (PAD). The pivotal role played by insulin resistance in the mechanism of vascular impairment manifests as macroangiopathy and microangiopathy. Timely diagnosis and intervention is critical in patients with systemic arteriosclerotic disease. Therefore, treatment strategies are aimed not only at targeting the presenting pathology, but also at reducing the risk of cardiovascular events. These efforts can help reduce the risk of both cardiovascular events and mortality. Treatment for PAD includes pharmacotherapy, endovascular treatment, and vascular reconstruction,along with exercise therapy. Typical drug approaches include use of vasodilators, eg, beraprost, and antiplatelet agents. Of note, beraprost has several therapeutic properties, including vascular endothelial protection, and antiplatelet and anti-inflammatory effects, in addition to vasodilatory activity. Recent preclinical findings indicate that beraprost improves not only ischemic extremities through its vasodilatory properties, but also reduces the insulin resistance which affects vascular endothelium. The use of beraprost, which are capable of resulting vascular endothelial function at an earlier disease stage, reducing the incidence of systemic vascular events, and contributing to an overall systemic vascular protective action. In this way, beraprost may ultimately contribute to improve the quality of life and may increasing the life expectancy of patients with PAD.