血糖異常與心血管疾病

407 3 160

ၡāāࢋ

( dysglycemia ) (diabetes mellitus) ( impaired glucose tolerance )

( cardiovascular disease )

( acute myocardial infarction )

( unstable angina pectoris ) ( cerebrovascular disease )

2 ( ESC, European Society of Cardiology ) ( EASD, European Association for the Study of Diabetes )

ᙯᔣෟĈ۩ཛҕᎤઐ੼ ( Impaired fasting glucose ) ཬ෈Ꭴε࡝ ( Impaired glucose tolerance ) ᎤԌঽ݈ഇ ( Pre-diabetes )

͕ҕგ়ঽ ( Cardiovascular disease ) ཝҕგ়ঽ ( Cerebrovascular disease )

݈֏

ॲፂ౵ܕԧ઼኎Ϡཌ̳ٙҶ۞઼ˠ 2005 ѐ

˩̂ѪЯĂ׎̚ᎤԌঽ(diabetes mellitus)Κ઼ˠ

˩̂ѪЯ۞ௐαҜĂΚշّ˩̂ѪЯௐ̣ҜĂ҃

дّ̃˩̂ѪЯ̏̚ΚௐˬҜ˞

Ąέ៉۞ᎤԌ

ঽˠᇴດֽດкĂᎤԌঽ۞஽ҖதдБ͵ࠧ˵Ӕ ன ు ѐ ᆧ ΐ ۞ ᔌ ๕ Ă ॲ ፂ ࡁ տ ௚ ࢍ Ă д Ҙ ̮ 2 0 0 3 ѐБ͵ࠧࡗѣ˘ᆆˣ˼˝Ѻ༱ᎤԌঽଈĂ

࿰ҤдҘ̮ 2025 ѐॡĂБ͵ࠧᎤԌঽଈ۞ᇴϫ

૟෹࿅ˬᆆ˟˼αѺ༱ˠĂᆧΐ˞ 7 2 % Ă఺׎

̚ࡗѣ˘Η۞ᎤԌঽଈإϏజ෧ᕝ΍ֽ

Ą၁ᅫ

˯ĂᎤԌঽଈ۞ᇴณᅈ෹࿅˞࿰ҤĄ

ᎤԌঽଈ଀ז͕ҕგ়ঽ ( cardiovascular dis- ease ) ۞፟ົߏܧᎤԌঽଈ۞ 2~5 ࢺ

Ă҃ͷˬ̶

̝˟۞ᎤԌঽଈѪЯߏ໚ٺ͕ҕგ়ঽĂ͕ҕგ

়ঽߏБ͵ࠧᇴѺ༱ᎤԌঽଈ࿅ѝѪ˸۞͹ࢋࣧ

Я

ĄѩγĂΞਕѣՀкˠ۞ҕᎤ̬ٺϒ૱ᄃᎤ Ԍঽ̝มĂ׎Ϗֽ଀זᎤԌঽ׶͕ҕგ়ঽ۞፟

ົ˵ͧҕᎤϒ૱۞ˠ੼

Ą࿅Ν۞ࡁտᙋፂពϯ ҕᎤள૱ ( dysglycemia ) ᄃ͕ҕგ়ঽ۞൴Ϡѣ ព඾࠹ᙯĂ͍׎ᐠޢҕᎤྫྷ͕ҕგ়ঽ۞ᙯܼ̈́

׎ࢦࢋّՀߏᅈ෹࿅ԧࣇٙຐည۞

Ąధк̂ݭ

۞ࡁտт DECODE ( Diabetes Epidemiology:

Collaborative Analysis Of Diagnostic Criteria in Europe ) ׶ Whitehall study ౌ޽΍ҕᎤ۞ள૱ົᆧ ΐᎮଈ͕ҕგ়ঽ׶͕ҕგ়ঽѪ˸۞ࢲᐍĂ͍

׎ᐠޢҕᎤ۞̿੼ົព඾ᆧΐ఺͞ࢬ۞ࢲᐍ

Ą ᎤԌঽ׶͕ҕგ়ঽಶтТ˘វ۞׌ࢬĂᎤ ԌঽଈᎮଈ݄ېજਔ͕᝙়ঽ ( coronary heart dis- ease ) ۞ࢲᐍඈТٺ̏ѣ͕ҕგ়ঽঽΫଈ۰Ă

҃̏གྷᎮଈ݄ېજਔ͕᝙়ঽ۞ଈ۰̚Ăధкˠ జ൴னᎮଈᎤԌঽٕ׎ҕᎤ̏གྷѣள૱ĄТॡᎮ ଈᎤԌঽ׶͕ҕგ়ঽଈ۰Ăົព඾ᆧΐ͕ҕგ

়ঽ۞Ѫ˸த

Ą

ϫ݈̙ኢߏ઼̰ٕߏ઼γĂ੫၆ᎤԌঽ۞ڼ

ᒚĂ̏ࢎؠ˞࠹ᙯ۞ڼᒚᇾ໤׶޽͔Ă̙ኢߏͽ Ϡ߿͞ё۞Լតăྻજă฼ࢴଠטٕᘽۏֽ࿰֨

ٕڼᒚௐ 2 ݭᎤԌঽ ( type 2 diabetes mellitus ) ౌ ѣ׎˘ؠ۞ड़ڍ

Ą൒҃ܜഇ੠ᖸࡁտពϯᚑ ॾ۞ҕᎤଠטᔵ൒Ξͽځព۞ࢫҲ̈ҕგঽត ( microvascular complications ) тᎤԌঽෛშቯঽ ត ( diabetic retinopathy ) ׶ඪঽត ( diabetic nephropa- thy)ඈ۞൴ϠĂҭд̂ҕგঽត ( macrovascular complications ) т݄ېજਔ͕᝙়ঽ׶ཝҕგ়

ঽ ( cerebrovascular disease ) ۞൴Ϡ׶Ѫ˸த͞ࢬ Ϊѣᒔ଀ొЊ۞Լච

Ą

дώ͛̚Ăԧࣇ૟̶ҾͽҕᎤள૱ᄃ͕ҕგ

়ঽ۞៍ᕇֽଣ੅׌۰̝ม۞ᙯܼĂ֭ಶҕᎤள

૱ᄃ͕ҕგ়ঽ۞ڼᒚ೩΍౵າ۞ޙᛉĄ

ңᏜҕᎤள૱ ( dysglycemia )

ңᏜҕᎤள૱ĉҕᎤள૱Β߁۩ཛҕᎤઐ੼

( impaired fasting glucose )ăཬ෈Ꭴε࡝ ( impaired glucose tolerance ) ׶ᎤԌঽ ( diabetes mellitus )Ă

҃۩ཛҕᎤઐ੼׶ཬ෈Ꭴε࡝˫ჍࠎᎤԌঽ݈ഇ ( pre-diabetes )

Ą

ҌٺҕᎤள૱۞ؠཌྷ ( ܑ˘ )Ă઼࡚ᎤԌঽ ጯົ ( ADA, American Diabetes Association ) ׶͵

ࠧ኎Ϡ௡ᖐ ( WHO, World Health Organization ) ̈́

ܑ˘Ĉཬ෈Ꭴ࡝צ̶ّഇ

̶ഇ ۩ཛҕልཬ෈Ꭴࣃ ˾ڇ 75 ҹཬ෈Ꭴ࡝צྏរ׌̈ॡޢ۞ҕልཬ෈Ꭴࣃ

(mg/dl) (mg/dl)

ϒ૱ཬ෈Ꭴ࡝צّ Ŵ 100(ADA) Ŵ 140

Ŵ 110(WHO&IDF) Ŵ 140

۩ཛҕᎤઐ੼ Ÿ 100 & Ŵ 126(ADA) Ŵ 200(ADA)(ࡶѣീ)

(impaired fasting glucose) Ÿ 110 & Ŵ 126(WHO&IDF) Ŵ 140(WHO&IDF)(ࡶѣീ)

Isolated IFG Ÿ 100 & Ŵ 126(ADA) Ŵ 140(ADA)

(isolated impaired fasting glucose)

ཬ෈Ꭴε࡝ Ŵ 126 Ÿ 140 & Ŵ 200(ADA&WHO)

(impaired glucose tolerance)

Isolated IGT Ŵ 100 Ÿ 140 & Ŵ 200(ADA)

(isolated impaired glucose tolerance)

ᎤԌঽ Ÿ 126 Ÿ 200(ADA&WHO&IDF)

(diabetes mellitus)

ၡᐂҋ ref

གྷ࣒࿹

઼ᅫᎤԌঽᓑ༖ ( IDF, International Diabetes Federation ) ၆׎ٙ˭۞౵າ෧ᕝᇾ໤ரѣमளĄ

ֶ໰઼࡚ᎤԌঽጯົ ( ADA ) ۞෧ᕝᇾ໤Ăϒ૱

̝۩ཛҕልཬ෈Ꭴ ( fasting plasma glucose ) ߏŴ 100 mg/dl Ă҃͵ࠧ኎Ϡ௡ᖐ ( WHO ) ઼̈́ᅫᎤԌ ঽᓑ༖ ( IDF ) ۞෧ᕝᇾ໤ߏŴ 110 mg/dl ćд۩

ཛҕᎤઐ੼ొЊĂੵ˞۩ཛҕልཬ෈Ꭴ۞෧ᕝᇾ

໤̙˘ᇹ̝γĂࡶТॡѣീ˾ڇ 75 ҹཬ෈Ꭴ࡝

צྏរ ( OGTT, oral glucose tolerance test ) ׌̈ॡ ޢ۞ҕልཬ෈Ꭴ۞෧ᕝᇾ໤Ϻѣֱ̙Т ( ֶፂ࡚

઼ᎤԌঽጯົ ( A D A ) ۞෧ᕝᇾ໤ߏŴ 2 0 0 mg/dl Ă҃͵ࠧ኎Ϡ௡ᖐ ( WHO ) ઼̈́ᅫᎤԌঽ ᓑ༖ ( IDF ) ۞෧ᕝᇾ໤ߏŴ 140 mg/dl

ğĄТॡ

ֶ໰઼࡚ᎤԌঽጯົ ( ADA ) 2007 ѐ۞౵າ෧ᕝ ᇾ໤Ă༊۩ཛҕልཬ෈ᎤŸ 100 mg/dl ׶Ŵ 126 mg/dl Ă҃˾ڇ 75 ҹཬ෈Ꭴ࡝צྏរ׌̈ॡޢ۞

ҕልཬ෈ᎤŴ 140 mg/dl ॡĂჍࠎ isolated IFG ( isolated impaired fasting glucose )ćдཬ෈Ꭴε࡝

ొЊĂ༊۩ཛҕልཬ෈ᎤŴ 100 mg/dl ҃˾ڇ 75 ҹཬ෈Ꭴ࡝צྏរ׌̈ॡޢ۞ҕልཬ෈ᎤŸ 140 mg/dl ׶Ŵ 200 mg/dl ॡĂჍࠎ isolated IGT ( iso- lated impaired glucose tolerance )

Ą

ଂҕᎤள૱࠻͕ҕგ়ঽ

൴ϠҕᎤள૱̝፟ົົᐌ඾ѐ᛬҃ᆧΐĂְ

၁˯ᎤԌঽ׶ཬ෈Ꭴε࡝۞஽ҖதϺߏᐌ඾ѐ᛬

ᆧΐ҃ᆧΐ

Ą DECODE study дለ߷۞ࡁտ޽΍

ཬ෈Ꭴε࡝дّ̃ͧշّரкĂѩγ˵ົᐌ඾ѐ ࡔᆧΐ҃ᆧΐ

Ăдֲ߷˵ӔனТᇹଐԛ

Ą࠹

ྵٺҕᎤϒ૱۞ˠĂཬ෈Ꭴ࡝צّள૱۰׎Ѫ˸

தົព඾ᆧΐĂ Saydah SH ඈˠ۞ࡁտ൴னཬ෈

Ꭴε࡝ଈ۰׎Ѫ˸த̂ࡗົᆧΐ 40% Ă҃ᎤԌঽ ଈ۰׎Ѫ˸த̂ࡗົᆧΐ 80%

Ą࠹ྵٺᐠޢҕ Ꭴள૱Ă۩ཛҕᎤдᎮଈ͕ҕგ়ঽ׶ЯᎮଈ͕

ҕგ়ঽѪ˸͞ࢬ՟ѣ࿰ീ۞ΑਕĂ DECODE s t u d y ࠹ᙯࡁտ൴னੵ˞۩ཛҕልཬ෈ᎤŸ 126mg/dl ̝γĂᅮТॡЪ׀ѣᐠޢҕᎤ۞̿੼Ă

͕ҕგ়ঽă݄ېજਔ͕᝙়ঽ׶׎ιࣧЯ͔੓

۞Ѫ˸த̖ົᆧΐĂ҃Ѫ˸த۞ᆧΐ˵ᄃཬ෈Ꭴ ε࡝Ӕனۡቢቢّ࠹ᙯ҃ᄃ۩ཛҕᎤ݋൑ځព࠹

ᙯ

Ą

Ꭾଈ͕ҕგ়ঽ۞ПᐍЯ̄Β߁˞੼ҕᑅ ( hypertension )ă٩ඵăҕ਌ள૱ ( dyslipidemia ) ׶Ꭴ ԌঽĂᎤԌঽଈߏᎮଈ͕ҕგ়ঽ੼Пᐍཏ

Ąॲ ፂ Hu FB ඈˠ۞ࡁտ௚ࢍĂҡᐌҕᎤள૱ଐԛĂ

଀ז͕҉ୟ๫۞ࢲᐍځពᆧΐ

Ąௐ 2 ݭᎤԌঽ ଈᎮଈ͕҉ୟ๫ ( myocardial infarction ) ۞ࢲᐍඈ Тٺ̏ѣ݄ېજਔ়ঽঽΫଈ۰

ĄᎤԌঽଈ൴ Ϡཝҕგ়ঽ۞፟ົ˵ͧܧᎤԌঽଈ੼ĂТॡᎤ Ԍঽ˵ົᆧΐ൴Ϡ̚ࢲ ( stroke ) ۞፟ົ

ĄЯѩ ᎤԌঽΞͽᄲߏඈТٺ͕ҕგ়ঽ

Ą

ѩγĂ DECODE study ׶ Creager MA ඈˠ۞

ࡁտ˵൴னĂᎤԌঽ݈ഇଈ۰׎Ꭾଈ͕ҕგ়ঽ

۞ࢲᐍͧ˘ਠҕᎤϒ૱۞ˠ੼Ă͍׎ߏᐠޢҕᎤ ள૱ᄃᎮଈ͕ҕგ়ঽࢲᐍ۞ᆧΐ׍ѣځព۞࠹

ᙯّ

Ą࠹ྵٺ۩ཛҕᎤઐ੼ĂᐠޢҕᎤ̿੼

ߏᎮଈ͕ҕგ়ঽă݄ېજਔ͕᝙়ঽ׶࠹၆੼

Ѫ˸த̝࿰ീЯ̄Ąཬ෈Ꭴ࡝צّள૱ ( Β߁Ꭴ Ԍঽ׶ཬ෈Ꭴε࡝ ) ۰Ꭾଈ͕ҕგ়ঽă݄ېજ ਔ͕᝙়ঽ׶ٙѣࣧЯ۞Ѫ˸தົځព੼ٺ۩ཛ ҕᎤઐ੼׶۩ཛҕᎤϒ૱۞ˠ

Ą൑૶ཉႷ

۞ĂᐠޢҕᎤ̿੼ົᆧΐ͕ҕგ়ঽְІă͕ҕ გ়ঽѪ˸׶ܧ͕ҕგ়ঽѪ˸۞፟ົ

Ą

ҌٺҕᎤள૱тң͔൴͕ҕგ়ঽ۞൴ϠĂ ಶϫ݈̏ۢ͹ࢋߏྫྷ੼ҕᎤ̈́਍फ৵ԩّ ( in- sulin resistance ) ѣᙯĄฺޢ੼ҕᎤົ၆ҕგ̰ϩ

௟ࡪயϠউ̼ᑅ˧Ăౄјҕგ̰ϩΑਕள૱Ă͔

੓ҕგ൴ۆ̈́ҕ̈ڕ۞߿̼Ăซ˘Վጱ࡭જਔҕ გඓېർ̼҃யϠ͕ҕგ়ঽ

Ą҃਍फ৵ԩّ

ߏԛјᎤԌঽ׶͕ҕგ়ঽ۞В఼ࣧЯ

Ă਍फ

৵ԩّдజ෧ᕝࠎௐ 2 ݭᎤԌঽ̝݈Ă۩ཛҕᎤ ઐ੼ٕཬ෈Ꭴε࡝ॡӈ̏хдĂ਍फ৵ԩّ۞ԛ ј˵ົயϠҕგ̰ϩΑਕள૱׶ҕ਌ள૱Ă͔൴ જਔҕგќᒺ׶ҕგ൴ۆͅᑕጱ࡭જਔҕგඓې ർ̼Ă͔൴͕ҕგ়ঽ۞൴Ϡ

ĄЯѩдҕᎤள

૱ଈ۰གྷϤ਍फ৵ԩّă੼ҕᎤ׶ഫᗓ਌۹ᅕ۞

Ϲ̢үϡĂ͔൴જਔҕგќᒺĂҕგ̰ϩயϠ൴ ۆͅᑕ׶ҕং۞ԛјĂ౵ޢጱ࡭જਔҕგඓېർ

̼Ăซ͔҃൴͕ҕგ়ঽ

Ą

ଂ͕ҕგ়ঽ࠻ҕᎤள૱

̂ݭ۞ࡁտт DECODE study ୻຾۞ពϯ˞

Я͕ҕგ়ঽѪ˸۞ࢲᐍྫྷҕᎤள૱ѣᙯĂ͍׎

ߏྫྷᐠޢҕᎤ̿੼ѣ૜̷࠹ᙯ

Ą Bartnik M ඈˠ۞ࡁտ൴னĂ༊͕ҕგ়ঽଈ۰Ъ׀ѣҕᎤ

΃ᔁள૱ॡĂ౵͹ࢋ۞ҕᎤள૱ߏᐠޢҕᎤ̿

੼Ă҃۩ཛҕᎤݒ఼૱ߏϒ૱۞ېၗ

Ą

Hasdai ඈˠ੫၆ለ߷̈́г̚ঔ 25 ࣎ݱξ۞

ާّ݄͕া(acute coronary syndrome)ঽଈٙઇ۞

݈ᖀّࡁտ̶ژពϯĂࡗα̶̝˘۞ާّ݄͕া

ଈ۰̏གྷᎮଈѣᎤԌঽ

ć҃ Hu DY ඈˠ੫၆̚

઼݄ېજਔ়ঽଈ۰ٙઇ۞࠹ᙯࡁտ˵ពϯѣˬ

̶̝˘۞ঽଈ̏གྷᎮଈѣᎤԌঽĂ҃дග̟˾ڇ ཬ෈Ꭴ࡝צྏរޢ൴ன੼྿ 64.2% ۞ঽଈѣཬ෈

Ꭴ࡝צّள૱۞ଐԛ

Ą

Norhammar A ඈˠ۞ࡁտ˵൴னд̝݈൑Ꭴ ԌঽΫ۞ާّ͕҉ୟ๫ ( acute myocardial infarc- t i o n ) ঽଈдࣣజ෧ᕝॡѣҕᎤள૱۞ͧதࡗ 67% Ăд෧ᕝޢ۞ 3 ࣎͡ॡ൴னѣҕᎤள૱۞ͧ

தࡗ 66%

Ąдާّ݄͕াĦާّ͕҉ୟ๫׶̙

ᘦؠ͕ඔ൭ ( unstable angina pectoris )ħଈ۰Ꭾଈ ᎤԌঽ۞ଐԛ˵ޝ૱֍Ă̂ࡗ 2 0 % ۞ާّ͕҉

ୟ ๫ ଈ ۰ ׎ ၁ ̏ གྷ Ꭾ ଈ Ꭴ Ԍ ঽ ҃ Ϗ జ ෧ ᕝ

΍ֽ

ĄЯѩĂд̝݈൑ᎤԌঽঽΫ̝ާّ͕҉

ୟ๫ଈ۰Ăᑕ҂ᇋͽ˾ڇཬ෈Ꭴ࡝צྏរᑭീ׎

ѣ൑ཬ෈Ꭴ࡝צّள૱۞ଐԛĄ

д̚ࢲଈ۰˵૱֍Ъ׀ѣҕᎤ΃ᔁள૱Ă׎

̚౵૱֍۞ҕᎤ΃ᔁள૱˵ߏᐠޢҕᎤ̿੼Ă Vancheri F ඈˠ۞ࡁտពϯ̚ࢲଈ۰д΍ੰॡ੼

྿ 84% ѣҕᎤ΃ᔁள૱ଐԛĂ҃д΍ੰ 3 ࣎͡ޢ ѣ੼྿ 62% ѣҕᎤ΃ᔁள૱ଐԛĂ׎̚ 39% ࠎ ཬ෈Ꭴε࡝Ă 2 7 % ࠎາ෧ᕝ۞ᎤԌঽĄЯѩĂ д΍ੰॡගٺ˾ڇཬ෈Ꭴ࡝צྏរĂࡶѣᐠޢҕ Ꭴள૱ĂΞ༊үߏ΍ੰ 3 ࣎͡ޢາ෧ᕝࠎᎤԌঽ

඗ָ࿰ീЯ̄

Ą

ϤѩΞۢĂд̂ొ̶۞͕ҕგ়ঽଈ۰Ă

̙ኢߏާّ͕҉ୟ๫ٕ̙ᘦؠ͕ඔ൭۞͕᝙ҕგ

়ঽଈ۰ĂϺٕߏཝҕგ়ঽଈ۰Ăд൴ঽॡ఼

૱ౌ̏ТॡЪ׀ѣҕᎤ΃ᔁள૱ଐԛĄ

ҕᎤள૱Ъ׀͕ҕგ়ঽ۞ڼᒚ

ҕᎤள૱ͽ͕̈́ҕგ়ঽ۞࿰֨׶ڼᒚߏк

͞ࢬ۞Ăд UKPDS ( United Kingdom Prospective

Diabetes Study ) ۞ࡁտ̚·̶ពϯд۲ࡡ۞ௐ 2 ݭᎤԌঽଈࡶֹϡ metformin ఺ᙷᘽۏֽᚑॾ۞

ଠטҕᎤĂព඾۞ΞͽࢫҲᎮଈ͕҉ୟ๫۞ࢲᐍ

׶ഴ͕͌ҕგ়ঽ۞Ѫ˸த

Ą҃Тॡଂᘽۏ׶

ᖣϤϠ߿͞ё۞ԼតĂഴࢦă฼ࢴଠט׶ྻજк

͞ࢬ඾͘ڼᒚྫྷ็௚ڼᒚ͞ё࠹ྵĂдௐ 2 ݭᎤ ԌঽଈΞͽځព۞ഴ͕͌ҕგ়ঽ۞൴Ϡ

Ą

Ϥٺ਍फ৵ԩّߏԛјᎤԌঽ׶͕ҕგ়

ঽ۞ВТࣧЯ̝˘Ă҃ᐠޢҕᎤள૱ᄃ͕ҕგ

়ঽ۞൴Ϡ˫ѣព඾۞࠹ᙯّĂЯѩдᏴፄᘽ ۏॡĂΞͽ҂ᇋᏴፄ͹ࢋࢫҲᐠޢҕᎤ׶Լච

਍फ৵ԩّ۞ᘽۏĄҌٺࢫҲᐠޢҕᎤߏӎΞ ͽഴ͕͌ҕგ়ঽ۞൴Ϡĉ˘࣎к͕̚ăᐌ፟

ّ׶щᇐ጗၆໰۞ࡁտ ( STOP NIDDM Trial, Study TO Prevent Non-Insulin-Dependent Diabetes Mellitus ) ޽΍ĂͽܠႬ൴ཬ෈Ꭴ Ժט጗

( ɗ-glucosidase inhibitor, ACARBOSE ) ڼᒚཬ෈

Ꭴε࡝۞ଈ۰Ξͽᆧΐ਍फ৵۞ୂຏّĂԼච ᐠޢҕᎤĂซ҃࿰͕֨ҕგ়ঽ۞൴Ϡ׶ࢫҲ Ϥཬ෈Ꭴε࡝ᖼតјௐ 2 ݭᎤԌঽ۞፟தĂТॡ Ξ ࢫ Ҳ Ї ˘ ͕ ҕ გ ְ І ׶ ͕ ҉ ୟ ๫ ۞ ൴ Ϡ ፟ தĂࡁտ˵ពϯ၆ٺࢫҲќᒺᑅăഴ͌າயϠ

੼ҕᑅଈ۰۞ͧத

Ăͽ̈́Լචҕგ̰ϩΑਕ

׶ഴቤᐚજਔ̰ቯז̚ቯᆧݓ۞ిޘ

Ă׍ѣ௚

ࢍ˯ព඾۞ຍཌྷĄҌٺܠႬ൴ཬ෈Ꭴ Ժט

጗Ξͽഴ͕͌ҕგ়ঽ۞ྎ௟፟ᖼϫ݈̪̙୻

຾ĂΞਕొЊ໚ٺࢫҲҕᎤ۞ड़ڍĂপҾߏࢫ ҲᐠޢҕᎤĂࢫҲ਍फ৵ԩّ׶Լචҕ਌۹۞

ड़ڍĄѩγĂͽ˛࣎੫၆ௐ 2 ݭᎤԌঽڼᒚ۞ܜ ഇࡁտٙઇ۞ᓁ׶̶ژ ( meta-analysis ) ྏរ˵

൴னĂͽܠႬ൴ཬ෈Ꭴ Ժט጗ڼᒚҕᎤள

૱Ă׎ඕڍྫྷ STOP NIDDM Trial ࠹ҬĂΞͽࢫ ҲҕᎤ׶ˬᅕϟڵ⟯۞፧ޘ̈́࿰͕֨҉ୟ๫׶

̚ࢲඈ͕ҕგ়ঽ۞൴ϠĂព඾۞ࢫҲ͕ҕგ

়ঽ۞Ѫ˸த

ĄЯѩĂԼචᐠޢҕᎤΞͽࢫҲ Ꭾଈ͕ҕგ়ঽ۞ࢲᐍ׶Ѫ˸தĄ Wascher TC

׶ Meneilly GS

ඈˠ۞ࡁտ˵ពϯĂܠႬ൴ཬ෈

Ꭴ Ժט጗Ξͽځព۞ࢫҲᐠޢҕᎤ׶Լච ௐ 2 ݭᎤԌঽଈ਍फ৵ԩّĄ

౵ܕĂѣᝥٺ͕ҕგ়ঽ׶ҕᎤ΃ᔁள૱

( ᎤԌঽ׶ᎤԌঽ݈ഇ ) ۞ࢦࢋĂለ߷͕᝙ጯົ

( ESC, European Society of Cardiology ) ׶ለ߷Ꭴ Ԍঽࡁտጯົ ( EASD, European Association for the Study of Diabetes ) ۞ᎤԌঽᄃ͕ҕგ়ঽ̍ү̈

௡̳Ҷ˞౵າ۞ڼᒚ໤݋׶ޙᛉĂࢦϦᐠޢҕᎤ ၆ٺ൴Ϡ͕ҕგ়ঽ۞ࢦࢋّ੼ٺ۩ཛҕᎤĄѩ γĂѣᝥٺᎤԌঽᄃ݄ېજਔ়ঽ̝ࢦࢋᙯాĂ ޙᛉᎤԌঽٕ݄ېજਔ়ঽଈ۰࠰ืซ˘Վᑭߤ ߏӎѣᎮଈ݄ېજਔ়ঽٕᎤԌঽ۞Ξਕ( ဦ˘)Ą

ٙѣ۞ᎤԌঽଈ۰Ăౌޙᛉщଵ݄ېજਔ়ঽѣ ᙯ̝ᑭߤĂּт͕࿪ဦă͕᝙෹ࢰگ׶ྻજ͕࿪

ဦ۞ᑭߤĂࡶᑭߤౌϒ૱Ăޙᛉఢ݋۞੠ᖸćࡶ

ᑭߤѣள૱Ăޙᛉᖼ̬ග͕᝙૞ࡊᗁरତצซ˘

ՎڼᒚĄ̝ͅ၆ٙѣ۞݄ېજਔ়ঽଈ۰Ăౌޙ ᛉщଵѣᙯᎤԌঽ̝ᑭߤĂּт˾ڇཬ෈Ꭴ࡝צ

ྏរ׶ᑭរ׎ҕ਌ăҕᎤ׶Ꭴ̼ҕҒ৵Ăࡶᑭߤ

ౌϒ૱Ăޙᛉఢ݋۞੠ᖸćࡶᑭߤඕڍࠎາ෧ᕝ

۞ᎤԌঽٕཬ෈Ꭴε࡝׶Ъ׀׎ι΃ᔁள૱Ăޙ ᛉᖼ̬ගᎤԌঽ૞ࡊᗁरତצซ˘ՎڼᒚĄ̏ѣ ᎤԌঽঽΫ۞݄ېજਔ়ঽଈ۰ĂࡶҕᎤଠט̙

рĂޙᛉซ˘Վщଵѣᙯඪঽត۞ᎡᑭĂ֭ᖼ̬

ගᎤԌঽ૞ࡊᗁर

Ą

ඕኢ

ҕᎤள૱ᄃ͕᝙ҕგ়ঽ͍׎ߏ݄ېજਔ͕

᝙ঽѣ૜̷̝ᙯܼĂᑕ̈́ѝ੫၆ѣ͕᝙ҕგયᗟ

̝ঽଈᑭߤҕᎤ̈́΃ᔁЯ৵֭ΐͽڼᒚĄ၆ٺѣ ҕᎤள૱̝ঽଈੵ˞ڼᒚ׎ҕᎤள૱γĂᑕؠഇ ᑭߤ͕᝙ҕგΑਕĂࡶѣள૱ᑕ̈́ѝڼᒚĄᐠޢ

੼ҕᎤྵ۩ཛҕᎤՀਕ࿰ീᎮଈ͕ҕგ়ঽ׶͕

ҕგ়ঽѪ˸۞ࢲᐍĄЯѩĂд࿰֨׶ڼᒚ͞ࢬ Ξ҂ᇋଂࢫҲᐠޢҕᎤ׶Լච਍फ৵ԩّ඾͘Ą ϫ݈д઼γ̏ѣ఺ᙷͽᘽۏࢫҲᐠޢҕᎤͽ྿ז Լච਍फ৵ԩّ۞̂ݭᓜԖྏរϒдซҖĂҌٺ ߏӎਕѣड़۞࿰֨ᎤԌঽă੼ҕᑅă͕ҕგ়ঽ

۞൴Ϡ׶ࢫҲ͕ҕგ়ঽ۞Ѫ˸தĂ̪ѣޞ˯ࢗ

ᓜԖྏរ۞౵ޢඕڍֽྋඍĄ

ણ҂͛ᚥ

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.. .. .. ..

.. .. .. ..

..

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`

Dysglycemia and Cardiovascular Disease

Yi-Yu Tu

, and Wayne Huey-Herng Sheu

Dysglycemia usually increases with age. In fact, the prevailing rate of diabetes and impaired glucose tolerance shows an increase with age. Epidemiological data revealed that the risk and mortality rate for cardiovas- cular diseases in individuals with glucose intolerance is higher than in individuals with normal blood glucose, and there is an obvious relationship with postprandial hyperglycemia. In addition, more than half of the patients with cardiovascular diseases, whether they have acute myocardial infarction, unstable angina pectoris or cere- brovascular disease, already have metabolic disorder of blood glucose and part of them have postprandial hy- perglycemia. Those who are at high risks for type 2 diabetes and/or cardiovascular diseases need lifestyle in- tervention, exercise, and diet modification or medication which reduce postprandial glucose and improve insulin sensitivity. According to the latest guidelines from the European Society of Cardiology (ESC) and the European Association for the Study of Diabetes (EASD), subjects with postprandial hyperglycemia should be treated ag- gressively to reduce the mortality rate and the recurrence of cardiovascular risk. ( J Intern Med Taiwan 2008; 19:

289-296 )

1

Division of Endocrinology and Metabolism,

Department of Internal Medicine,Taichung Veterans General Hospital,Taiwan, R.O.C.

2

Department of Internal Medicine,Taichung Armed Forces General Hospital, Taiwan, R.O.C.