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題 名 | 糖尿病的大血管病變=Macrovascular Diseases in Diabetes Mellitus |
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作 者 | 曾慶孝; | 書刊名 | 內科學誌 |
卷 期 | 9:4 1998.12[民87.12] |
頁 次 | 頁162-168 |
分類號 | 415.668 |
關鍵詞 | 糖尿病大血管疾病; 屍體解剖; 流行病學; 危險因子; 胰島素阻抗性; Diabetic macrovascular disease; Autopsy; Epidemiology; Risk factor; Insulin resistance; |
語 文 | 中文(Chinese) |
中文摘要 | 糖尿病大血管疾病的成因主要與動脈粥狀硬化有關,因其影響之器官不同而臨床 上有腦中風、缺血性心臟病、和下肢壞疽等表現。胰島素在 1921 年被萃取出來並使用於人 體後,糖尿病的死因由先前的急性昏迷轉變為以大血管疾病為主。早在 1920 年代開始就有 研究者從屍體解剖的研究發現糖尿病患者的動脈粥狀硬化病灶較無糖尿病者多而廣泛。一九 六○年代以後研究者開始在人口族群中進行大規模的流行病學追蹤研究。這些研究結果證實 糖尿病為心臟血管疾病的危險因子,且女性糖尿病患者的相對危險性較男性糖尿病患者高。 胰島素依賴型糖尿病病人發生大血管疾病的原因與其血糖控制不良引起脂質代謝異常,或是 併發高血壓,或長期胰島素治療引起高胰島素血症有關。非胰島素依賴型糖尿病病人的大血 管疾病除了控制不良所產生的代謝異常外,亦可能與胰島素阻抗症候群有關。糖尿病病人發 生大血管疾病後,其預後是相當不好的。目前有研究顯示透過控制血壓、治療高膽固醇血症 、給予抗血小板凝集藥物、及戒菸等方式可以預防冠狀動脈疾病與腦中風的死亡,亦可預防 總死亡。這些作用在糖尿病者比無糖尿病者更能有效達成,而戒菸對總死亡的成效尤為卓著 ,因此禁菸運動實在值得吾人倡導。 |
英文摘要 | Macrovascular diseases in diabetes mellitus are related to atherosclerosis. Clinical manifestations of these complications include stroke, coronary artery disease, and gangrene. Before the insulin era, most diabetic patients died of acute coma. Nowaday, the main causes of death in diabetic patients are related to atherosclerosis. Early in 1920s, diabetic patients were found to have more atherosclerotic lesions, and the lesions were more extensive than non-diabetic subjects in various autopsy studies. Since 1960s, several large population-based epidemiologic studies were carried out. Diabetes mellitus has been confirmed to be a major cardiovascular risk factor, and the relative risk in diabetic women seemed to be higher than the diabetic men. The development of macrovascular disease in insulin-dependent diabetes mellitus is closely related to abnormalities in lipid metabolism secondary to poor glycemic control, hypertension, or hyperinsulinemia associated with insulin therapy. The pathogenesis of macrovascular disease in non-insulin-dependent diabetes mellitus is not only related to lipid abnormalities, but also to insulin resistacne. The prognosis of diabetic patients after onset of macrovascular disease is poor. Intervention studies showed that mortality of coronary heart disease and stroke, and total mortality in diabetic patients could be prevented by control of blood pressure, therapy of hypercholesterolemia, taking aspirin, and smoking cessation. Smoking cessation seems to be the most effective method in reducing cardiovascular risk in the diabetic patients, and should be vigorously advocated. |
本系統中英文摘要資訊取自各篇刊載內容。