糖尿病合并心肌病变：被低估的糖尿病并发症

doi:10.16138/j.1673-6087.2026.02.14

内科理论与实践 ›› 2026, Vol. 21 ›› Issue (02): 188-193.doi: 10.16138/j.1673-6087.2026.02.14

糖尿病合并心肌病变：被低估的糖尿病并发症

许若仪¹^,², 杨昱¹, 孙洪平³, 刘超³, 王昆¹^,²()

^1. 南京医科大学附属江宁医院内分泌科，江苏南京　211100
^2. 南京医科大学，江苏南京　211100
^3. 南京中医药大学附属中西医结合医院内分泌科，江苏南京　210028

收稿日期:2025-07-28 修回日期:2025-09-30 接受日期:2025-10-15 出版日期:2026-04-25 发布日期:2026-06-15
通讯作者: 王昆 E-mail:doc_kunwang@163.com
作者简介:作者贡献/Authors’ Contributions许若仪负责文献检索、文献整理与论文初稿撰写；杨昱、孙洪平负责论文修改与编辑；刘超、王昆负责论文整体构思、论文审阅与定稿。

Diabetic cardiomyopathy: an underrecognized complication of diabetes mellitus

XU Ruoyi¹^,², YANG Yu¹, SUN Hongping³, LIU Chao³, WANG Kun¹^,²()

^1. Department of Endocrinology, the Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing 211100, China
^2. Nanjing Medical University, Nanjing 211100, China
^3. Department of Endocrinology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210028, China

Received:2025-07-28 Revised:2025-09-30 Accepted:2025-10-15 Online:2026-04-25 Published:2026-06-15

摘要/Abstract

摘要：

糖尿病合并心肌病变最初指在没有冠心病、高血压和/或肥胖的情况下，出现与2型糖尿病（type 2 diabetes mellitus，T2DM）相关的心肌结构或功能异常。然而，能够确诊为糖尿病合并心肌病变的T2DM患者相对较少，限制了临床诊断及治疗的及时性，这是该并发症“被低估”的重要原因。欧洲心脏病学会工作组于2024年发布最新共识声明，建议糖尿病合并心肌病变的定义为在存在糖尿病的情况下出现心肌收缩和（或）舒张功能障碍。然而，临床医师对糖尿病心肌疾病的认识不足，故本文将重点阐述其病理生理机制、最新定义及临床意义、诊断标准与鉴别诊断难点以及风险评估策略，旨在提高临床医师认识，为识别和管理糖尿病并发症提供参考。

关键词: 糖尿病合并心肌病变, 2型糖尿病, 心力衰竭

Abstract:

Diabetic cardiomyopathy initially referred to myocardial structural or functional abnormalities associated with type 2 diabetes mellitus (T2DM) in the absence of coronary heart disease, hypertension and/or obesity. However, relatively few T2DM patients can be diagnosed with diabetic cardiomyopathy, which limits the timeliness of clinical diagnosis and treatment, and is an important reason why this complication is underrecognized. In 2024, the European Society of Cardiology Working Group released the latest consensus statement suggesting that diabetic cardiomyopathy be defined as myocardial systolic and/or diastolic dysfunction in the presence of diabetes mellitus. Nevertheless, clinicians have insufficient understanding of diabetic cardiomyopathy. Therefore, this article will focus on elaborating its pathophysiological mechanisms, the latest definition and clinical significance, diagnostic criteria and difficulties in differential diagnosis, as well as risk assessment strategies, aiming to enhance clinicians’ awareness and provide a reference for the identification and management of diabetic complications.

Key words: diabetic cardiomyopathy, type 2 diabetes mellitus, heart failure

许若仪, 杨昱, 孙洪平, 刘超, 王昆. 糖尿病合并心肌病变：被低估的糖尿病并发症[J]. 内科理论与实践, 2026, 21(02): 188-193.

XU Ruoyi, YANG Yu, SUN Hongping, LIU Chao, WANG Kun. Diabetic cardiomyopathy: an underrecognized complication of diabetes mellitus[J]. Journal of Internal Medicine Concepts & Practice, 2026, 21(02): 188-193.

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糖尿病合并心肌病变：被低估的糖尿病并发症

Diabetic cardiomyopathy: an underrecognized complication of diabetes mellitus

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