糖尿病治疗的选择是否改变阿尔茨海默病的自然病程

Emina Karahmet, B. Prnjavorac, Asja Sejranic, Esma Karahmet, A. Mujaković, K. Krajina, Amela Hasanović-Gogić, N. Delic
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摘要

阿尔茨海默病(AD)在世界范围内很常见,几乎所有病例都有合并症。AD最常见的合并症之一是糖尿病(DM),伴或不伴代谢综合征。这两种疾病都影响神经组织,成功治疗将改善患者的状况。在阿尔茨海默病患者的糖尿病治疗中,治疗可能对AD有害,因为高胰岛素摄入量。这可能导致阿尔茨海默病的进展。胰岛素被认为是糖尿病的最佳治疗方法,但胰岛素治疗可能增加AD的合并症。目前还没有针对AD的特异性治疗方法,因此由于DM是AD最重要的风险之一,因此应非常仔细地计划DM的伴随治疗。应考虑糖尿病治疗的各种选择,并优先考虑不同机制的抗糖尿病药物。阿尔茨海默病的治疗较为复杂,存在代谢综合征。任何炎症都会引起局部组织损伤,包括AD期间的脑组织。在脂肪因子瘦素存在的情况下,白细胞介素的释放,主要是TNF-α, IL-6, IL-1β,维持局部脑组织的慢性炎症状态。因此,今后应考虑低剂量免疫抑制剂治疗阿尔茨海默病。延缓神经组织细胞凋亡,增强脑和神经组织对自由基的防御能力,改善代谢状态。
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Does the Choice of Treatment of Diabetes Mellitus Change Natural Course of Alzheimer Disease
Alzheimer disease (AD) is common worldwide and almost every case has comorbidities. One of the most common comorbidities of AD is Diabetes mellitus (DM), with or without metabolic syndrome. Both diseases effect nerve tissue and successful treatment would improve the status of the patient. In patients with Alzheimer disease treatment of DM, the treatment could be harmful to the AD, because of that high insulin intake. This may lead to progression of AD. Insulin is considered the best treatment for DM, but insulin therapy could increase comorbidity with AD. No specific therapy for AD is known up to date, so because of that DM is one of the most important risk for AD, concomitant therapy for DM should be planned very carefully. All options of DM therapy should be considered, and different mechanisms of anti-diabetic drugs are preferable. Treatment of AD is more complex metabolic syndrome is present. Any inflammation causes local tissue damage, including brain tissue during AD. Release of interleukins, primarily TNF-α, IL-6, IL-1β in the presence of adipokine leptin, maintains chronic inflammatory status in local brain tissue. Thus, low doses of immunosuppressant therapy should be considered for treatment of AD in future. To delay apoptosis of nerve tissue cells, brain and nerve tissue defend against free oxygen radicals and improve metabolic status.
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