脂肪酸代谢异常与糖尿病性心肌肥厚_吴豪杰

可作为糖尿病心肌病诊断及筛检的指标之一。另外BNP 水平的升高,可激活c GMP 信号途径、对抗TGF -β、抑制交感神经的传出冲动和降低血压,防止糖尿

病心肌病变的发生。其不依赖于内皮功能的特点更有利于糖尿病心肌病的治疗。关于B NP 与糖尿病心肌病之间的关系有待进一步研究。

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(收稿日期:2004-07-10)

作者单位:400016重庆医科大学附属第一医院内分泌科

脂肪酸代谢异常与糖尿病性心肌肥厚

吴豪杰综述　周波　张素华审校

【摘要】　正常心肌能量来源以脂肪酸为主,糖尿病时血中游离脂肪酸升高,心肌摄取脂肪酸也增加,开始时摄取的脂肪酸激活过氧化物酶体增殖物激活受体(PPAR )α调节的心肌脂肪酸代谢相关酶的活性和表达,增加心脏对脂肪酸的利用。而后由于心脏失代偿使相关酶的表达下调,脂肪酸β氧化减少;而同时糖尿病心肌糖代谢的异常也可抑制脂肪酸β氧化,使脂质中间代谢产物沉积,损害心脏的结构和功能,促进心肌肥厚的发生。

【关键词】　糖尿病性心肌病;心肌肥厚;脂肪酸;过氧化物酶体增殖物激活受体α

由糖尿病引起的心肌肥厚,进而发展为充血性心力衰竭是世界范围内糖尿病患者致残和致死的重要原因之一。既往大多数有关糖尿病性心肌肥厚和心力衰竭病理生理变化的基础研究主要集中于血流动力学、神经内分泌、细胞因子和信号转导等方面,近年来研究发现,糖尿病不仅可引起心肌肥厚,而且可阻碍脂肪酸β氧化,不能充分氧化的脂质在心脏

沉积,导致心肌功能障碍或心肌肥厚,同时心脏糖的利用也可能参与脂肪酸代谢异常引起的心肌肥厚。1　正常心肌脂肪酸代谢

胎儿心脏在相对缺氧的宫体内,主要以葡萄糖和丙酮酸为底物,通过无氧酵解获取ATP ,出生后,哺乳动物心脏以脂肪酸为主要能量来源[1,2],这种改变使其可以产生更多的ATP 以适应成年心脏高能消耗。产生这种能量底物差异表达的主要原因是在胎儿阶段脂肪酸氧化酶基因的表达水平较低,出