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糖尿病是因胰岛素分泌不足或对胰岛素作用抵抗或不敏感而引起的血糖升高的代谢性疾病。2017年,全球糖尿病的发病人数约为4.25亿,预计到2045年,这一数字将增加到6.29亿[1]。根据国际糖尿病联合会2015年收集的糖尿病流行病学数据和世界卫生组织的一般卫生支出数据,糖尿病给全世界带来了沉重的经济和医疗负担[2]。糖尿病主要分为1型糖尿病(type 1 diabetes mellitus,T1DM)和2型糖尿病(type 2 diabetes mellitus,T2DM)。T1DM是由免疫介导的胰岛β细胞破坏导致的胰岛素绝对缺乏的自身免疫性疾病,其占糖尿病的5%~10%;T2DM是以胰岛素抵抗或胰岛β细胞功能失调为特征的慢性代谢性疾病,其占糖尿病的90%以上[1]。大量研究结果显示,遗传易感性和环境因素在T1DM和T2DM的发病机制中起着重要作用。T1DM和T2DM的发病机制与胰岛β细胞功能受损或数量减少有关。目前,对糖尿病的预防和治疗都集中在维持胰岛β细胞的数量及功能上。因此,对胰岛β细胞进行显像有助于明确和监测糖尿病的进展,评估糖尿病治疗的疗效,并对患者进行个体化治疗[3]。
糖尿病患者可能发生许多并发症,其中最具破坏性的并发症是血管并发症。血管并发症分为微血管病变(小血管损伤)和大血管病变(动脉损伤),微血管病变包括视网膜病变、肾脏血管病变和神经病变,而大血管病变包括会导致心肌梗死的心血管疾病和以卒中为表现的脑血管疾病[4]。糖尿病还会增加阿尔茨海默病和帕金森病等慢性神经退行性疾病发病的风险[5]。
糖尿病及其并发症严重影响患者的健康,给患者及其家庭和社会带来沉重的负担。因此,需要更加有效的技术对糖尿病的发病机制进行研究,并提供精准的早期诊断。分子显像技术如PET和SPECT等与提供解剖学信息的传统诊断成像技术相比,可以利用特殊的分子探针或显像剂来检测疾病。这些显像技术已被广泛研究,并在临床前和临床研究中用于糖尿病的诊断和治疗监测[3]。我们对分子显像在糖尿病患者胰岛β细胞的功能监测和并发症的早期诊断中的应用研究进展进行综述。
分子显像在糖尿病及其并发症中的应用研究进展
Application research progress of molecular imaging in diabetes mellitus and diabetic complications
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摘要: 糖尿病是一种慢性代谢性疾病,全球有超过4亿的糖尿病患者。1型糖尿病和2型糖尿病的发病机制与胰岛β细胞的减少和功能受损相关。糖尿病患者若长时间高血糖,则会导致心血管疾病、神经病变、糖尿病足及其他并发症。笔者就不同种类的PET或SPECT分子显像在糖尿病患者的胰岛β细胞的功能监测以及冠状动脉病变、心肌病、自主神经病变、大脑异常和糖尿病足的早期精准诊断中的应用研究进展进行综述。
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关键词:
- 糖尿病 /
- 糖尿病并发症 /
- 分子显像 /
- 正电子发射断层显像术 /
- 体层摄影术,发射型计算机,单光子
Abstract: Diabetes mellitus is a chronic and metabolic disease affecting more than 400 million people in the world. The pathogenesis of type 1 and type 2 diabetes mellitus is associated with the decrease or functional impairment of pancreatic β cells. With long-term hyperglycemia, diabetic patients will develop cardiovascular disease, neuropathy, diabetic foot and other complications. This paper reviews the application research progress of different types of PET and SPECT molecular imaging in the function monitoring of pancreatic β cells, and early diagnosis of diabetic complications such as coronary artery disease, cardiomyopathy, autonomic neuropathy, brain abnormalities and diabetic foot in diabetic patients. -
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