Abendroth D, Landgraf R, Pfeiffer M, Reininger J, Seidel D, Land W
University of Ulm, Division of Thoracic and Vascular Surgery, Germany.
Transpl Int. 1994;7 Suppl 1:S417-9. doi: 10.1111/j.1432-2277.1994.tb01408.x.
The long-term effect of pancreatic and kidney transplantation (spkt) on blood viscosity, lipid metabolism and skin microcirculation in insulin-dependent diabetes mellitus (IDDM) was studied because impaired rheological properties of blood may play a role in the development of diabetic micro- and macroangiopathy. 46 IDDM-patients (16 f/30 m; 23 +/- 34 y mean duration of diabetes; 60 +/- 14 mos mean follow up period) underwent spkt (Gr.I: n = 28) or solitary kidney (Gr.II: n = 18) transplantation, and were compared with healthy controls (C). Rheological measurements were performed with Mooney-Ewart rotation-viscosimeter determining whole blood viscosity (WBV), at shear rates 1, 5, 10, 20, 50, 100, 200 sec(-1). Triglycerides, total and HDL-, LDL- and VLDL cholesterol and fibrinogen were measured. Microcirculation was estimated by transcutaneous oxygen tension measurement (tcpO2) and laser speckle method, in the forefoot area. Hemoglobin A1 was normalized only in group I (I: 7.2 +/- 0.2%; II: 8.3 +/- 0.3%; C: < 8%). WBV at low shear (1, 5, 10) was increased in both groups, when compared to healthy controls (I: 12.4 +/- 2; 12.5 +/- 1; 6.8 +/- 0.5 mpas; II: 18.7 +/- 2; 13.4 +/- 15; 9.4 +/- 1 mpas; C: 7.5 +/- 0.5; 6.7 +/- 0.3; 5.4 +/- 0.2 mpas; P < 0.05). Plasma fibrinogen was elevated in both groups compared to normals: (I: 384 +/- 19; II: 448 +/- 20; C: 250 +/- 50 mg/dl; P < 0.05). There was a positive influence of spkt on skin microcirculation: tcpO2/prior tx: I: 44 +/- 3; II: 49 +/- 6 mmHg; post tx: I: 59 +/- 4; II: 42 +/- 3 mmHg. Laser speckle prior tx I: 3.3 +/- 0.3; II: 4.7 +/- 0.2 rel. U.; post tx: 3.8 +/- 0.2; II: 4.3 +/- 0.2 rel. U. Patients with progression of angiopathy showed still higher fibrinogen and shear rates (P < 0.05). There was no significant difference for total HDL-, LDL- and VLDL cholesterol. Despite normalization of glucose metabolism and significant improvement of microcirculation in spkt patients, fibrinogen and the shear rates are increased indicating a persisting "individual" vascular risk. It is suggested that an additional hemorheological approach in the treatment posttrransplant might prevent the progression of vascular complications.
研究了胰肾联合移植（SPKT）对胰岛素依赖型糖尿病（IDDM）患者血液粘度、脂质代谢和皮肤微循环的长期影响，因为血液流变学特性受损可能在糖尿病微血管和大血管病变的发展中起作用。46例IDDM患者（16例女性/30例男性；糖尿病平均病程23±34年；平均随访期60±14个月）接受了SPKT（第一组：n = 28）或单独肾移植（第二组：n = 18），并与健康对照组（C）进行比较。使用穆尼 - 尤尔特旋转粘度计在剪切速率1、5、10、20、50、100、200秒⁻¹下测定全血粘度（WBV）进行流变学测量。测量甘油三酯、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、极低密度脂蛋白胆固醇和纤维蛋白原。通过经皮氧分压测量（tcpO2）和激光散斑法在前足区域估计微循环。仅在第一组中糖化血红蛋白A1恢复正常（第一组：7.2±0.2%；第二组：8.3±0.3%；对照组：<8%）。与健康对照组相比，两组在低剪切力（1、5、10）下的WBV均升高（第一组：12.4±2；12.5±1；6.8±0.5毫帕秒；第二组：18.7±2；13.4±15；9.4±1毫帕秒；对照组：7.5±0.5；6.7±0.3；5.4±0.2毫帕秒；P<0.05）。与正常组相比，两组血浆纤维蛋白原均升高：（第一组：384±19；第二组：448±20；对照组：250±50毫克/分升；P<0.05）。SPKT对皮肤微循环有积极影响：tcpO2/移植前：第一组：44±3；第二组：49±6毫米汞柱；移植后：第一组：59±4；第二组：42±3毫米汞柱。激光散斑移植前第一组：3.3±0.3；第二组：4.7±0.2相对单位；移植后：3.8±0.2；第二组：4.3±0.2相对单位。血管病变进展的患者纤维蛋白原和剪切速率仍然更高（P<0.05）。总高密度脂蛋白胆固醇、低密度脂蛋白胆固醇和极低密度脂蛋白胆固醇无显著差异。尽管SPKT患者的糖代谢恢复正常且微循环有显著改善，但纤维蛋白原和剪切速率升高，表明存在持续的“个体”血管风险。建议在移植后治疗中采用额外的血液流变学方法可能预防血管并发症的进展。
