颈动脉内膜中层厚度(CIMT)与糖尿病心血管 并发症的关系及中医药调控研究

Relationship between Carotid Intima-Media Thickness (CIMT) and Diabetic Cardiovascular Complications and the Regulatory Research of Traditional Chinese Medicine

摘要: 颈动脉内膜中层厚度(CIMT)是无创评估亚临床动脉粥样硬化的有效指标，与糖尿病心血管并发症的发生发展密切相关。本文系统梳理CIMT的生理病理基础及其与糖尿病冠心病、脑卒中、外周动脉疾病及微血管病变的相关性，指出高血糖、胰岛素抵抗、炎症反应、氧化应激及miRNA调控异常是CIMT增厚的主要机制。中医药以“气虚血瘀、脉络瘀阻”为核心病机，采用益气活血、化瘀通络治则，通过复方、单味中药及其有效成分等多种方式多靶点调控CIMT异常，延缓动脉粥样硬化进展。中西医结合干预融合西医快速控险与中医整体调节优势，是当前优化模式。然而，现有研究仍存在CIMT风险预测增量价值存疑、中医药研究质量参差不齐、机制探索不深、长期随访缺乏及检测标准不统一等问题。未来需深化机制研究、推进中医药标准化、开展高质量临床试验，以提升CIMT在糖尿病心血管并发症防治中的应用价值。

Abstract: Carotid intima-media thickness (CIMT) is a non-invasive and effective indicator for assessing subclinical atherosclerosis and is closely associated with the development and progression of diabetic cardiovascular complications. This review systematically summarizes the pathophysiological basis of CIMT and its correlations with diabetic coronary heart disease, stroke, peripheral arterial disease, and microvascular complications. It highlights that hyperglycemia, insulin resistance, inflammatory responses, oxidative stress, and dysregulated miRNA expression are the main mechanisms underlying CIMT thickening. Traditional Chinese medicine (TCM), based on the core pathogenesis of “qi deficiency and blood stasis with collateral obstruction”, adopts the therapeutic principles of replenishing qi, activating blood, and removing stasis to unblock collaterals. Through various approaches including herbal formulas, active components, TCM regulates CIMT abnormalities via multiple targets and pathways, thereby delaying the progression of atherosclerosis. The integrated approach of TCM and Western medicine, which combines the rapid risk factor control of Western medicine with the holistic regulatory advantages of TCM, represents the current optimal model. However, existing studies still have limitations, including questionable incremental value of CIMT in risk prediction, variable quality of TCM research, insufficient mechanistic exploration, lack of long-term follow-up, and inconsistent measurement standards. Future efforts should focus on deepening mechanistic studies, promoting standardization of TCM research, and conducting high-quality clinical trials to enhance the value of CIMT in the prevention and treatment of diabetic cardiovascular complications.