糖尿病相关冠状动脉侧枝形成障碍：免疫代谢机制与潜在干预
Immunometabolic Mechanisms and Potential Interventions for Diabetes-Related Impairment of Coronary Collateral Formation
DOI: 10.12677/acm.2026.1672744, PDF,   
作者: 刘 峰*, 曾照红：赣南医科大学第一临床医学院，江西 赣州；赣南医科大学第一附属医院心胸外科，江西 赣州
关键词: 糖尿病；冠状动脉侧枝循环；动脉生成；免疫代谢；内皮功能障碍；慢性完全闭塞；Diabetes Mellitus； Coronary Collateral Circulation； Arteriogenesis； Immunometabolism； Endothelial Dysfunction； Chronic Total Occlusion
摘要: 冠状动脉侧枝循环是慢性冠状动脉闭塞后维持缺血心肌灌注的重要代偿途径，2型糖尿病患者常存在侧枝形成不良。功能性侧枝主要依赖预存小动脉在血流刺激下完成启动、扩张重塑和成熟，其核心过程属于动脉生成。糖尿病相关弥漫性冠脉病变可削弱侧枝两端压力差和剪切应力；线粒体功能障碍、氧化还原失衡、炎症放大、内皮代谢异常及血管壁成熟障碍等因素可进一步影响不同阶段的侧枝形成。临床研究和组学分析提示，不良侧枝循环与炎症代谢状态及免疫代谢表型有关，但人体冠脉侧枝组织的直接证据仍不足。现有降糖、抗炎抗氧化、代谢调节及新型递送策略在缺血组织修复中显示一定潜力，其冠脉转化价值仍需验证。本文综述糖尿病相关冠脉侧枝形成障碍的免疫代谢机制及潜在干预，并讨论表型分层和多机制联合治疗的研究方向。
Abstract: Coronary collateral circulation is an important compensatory pathway for maintaining myocardial perfusion after chronic coronary occlusion, whereas collateral formation is frequently impaired in patients with type 2 diabetes mellitus. Functional collaterals mainly depend on the initiation, enlargement, remodeling, and maturation of pre-existing arterioles in response to flow-related stimuli, a process dominated by arteriogenesis. Diabetes-related diffuse coronary artery disease may attenuate the pressure gradient and shear stress across collateral vessels. Mitochondrial dysfunction, redox imbalance, inflammatory amplification, altered endothelial metabolism, and impaired vascular-wall maturation may further affect different stages of collateral development. Clinical and omics studies suggest that poor collateralization is associated with inflammatory-metabolic status and immunometabolic phenotypes, although direct evidence from human coronary collateral tissues remains insufficient. Glucose-lowering, anti-inflammatory, antioxidant, metabolic, and novel delivery strategies have shown potential in ischemic tissue repair, but their translational value in coronary collateral formation requires further validation. This review summarizes the immunometabolic mechanisms and potential interventions involved in diabetes-related impairment of coronary collateral formation, and discusses future directions for phenotype-based stratification and multi-mechanism combination therapy.
文章引用：刘峰, 曾照红. 糖尿病相关冠状动脉侧枝形成障碍：免疫代谢机制与潜在干预[J]. 临床医学进展, 2026, 16(7): 2155-2164. https://doi.org/10.12677/acm.2026.1672744

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