Vascular complications in diabetes mellitus: the role of endothelial dysfunction

被引:489
作者
Schalkwijk, CG
Stehouwer, CDA
机构
[1] Maastricht Univ, Dept Internal Med, NL-6202 AZ Maastricht, Netherlands
[2] Univ Maastricht, Cardiovasc Res Inst, NL-6200 MD Maastricht, Netherlands
关键词
diabetes mellitus; endothelial dysfunction; hyperglycaemia; insulin resistance; metabolic syndrome; oxidative stress; vascular complication;
D O I
10.1042/CS20050025
中图分类号
R-3 [医学研究方法]; R3 [基础医学];
学科分类号
1001 ;
摘要
The endothelium is a complex organ with a multitude of properties essential for control of vascular functions. Dysfunction of the vascular endothelium is regarded as an important factor in the pathogenesis of diabetic micro- and macro-angiopathy. Endothelial dysfunction in Type I and 11 diabetes complicated by micro- or macro-albuminuria is generalized in that it affects many aspects of endothelial function and occurs not only in the kidney. The close linkage between micro-albuminuria and endothelial dysfunction in diabetes is an attractive explanation, for the fact that microalbuminuria is a risk marker for atherothrombosis. In Type I diabetes, endothelial dysfunction precedes and may cause diabetic microangiopathy, but it is not clear whether endothelial dysfunction is a feature of the diabetic state itself. In Type 11 diabetes, endothelial function is impaired from the onset of the disease and is strongly related to adverse outcomes. It is not clear whether impaired endothelial function is caused by hyperglycaemia or by other factors. Impaired endothelial function is closely associated with and may contribute to insulin resistance regardless of the presence of diabetes. Endothelial dysfunction in diabetes originates from three main sources. Hyperglycaemia and its immediate biochemical sequelae directly alter endothelial function or influence endothelial cell functioning indirectly by the synthesis of growth factors, cytokines and vasoactive agents in other cells. Finally, the components of the metabolic syndrome can impair endothelial function.
引用
收藏
页码:143 / 159
页数:17
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