糖尿病合并心肌病变：被低估的糖尿病并发症
收稿日期: 2025-07-28
修回日期: 2025-09-30
录用日期: 2025-10-15
网络出版日期: 2026-06-15
版权
Diabetic cardiomyopathy: an underrecognized complication of diabetes mellitus
Received date: 2025-07-28
Revised date: 2025-09-30
Accepted date: 2025-10-15
Online published: 2026-06-15
Copyright
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。
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 . DOI: 10.16138/j.1673-6087.2026.02.14
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
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