Brun Jean-Frédéric
Service Central de Physiologie Clinique, Centre d'Exploration et de Réadaptation de Anomalies du Métabolisme Musculaire, CHU Lapeyronie, Montipellier, France.
Clin Hemorheol Microcirc. 2002;26(3):155-74.
Hemorheological effects of exercise are a triphasic phenomenon including: (a) short-term effects (hyperviscosity mostly due to fluid shifts and alterations of erythrocyte rigidity and aggregability); (b) middle-term effects (i.e., the reversal of acute effects due to plasma volume expansion (autohemodilution) that lowers both plasma viscosity and hematocrit; (c) long-term effects that further improve blood fluidity, parallel with the classical training-induced hormonal and metabolic alterations. Red cell rheology during these 3 stages is affected by white cells and oxidant stress. On the other hand, most metabolic and hormonal alterations play a role in exercise-induced hemorheological changes: among them, blood lactate appears to have opposite effects according to the training status, since it generally impairs erythrocyte fluidity while it improves it in some subgroups of highly trained athletes, a difference that could be related to membrane monocarboxylate transporter status. Body composition (mostly hydration status and the amount of fat mass) as well as its major hormonal regulating system (the growth-hormone-IGF-I axis) are both markedly modified by training and these modifications are correlated with hemorheology. Nutritional disturbances affecting caloric and proteic intake, lipids, iron, zinc, etc. also modulate the hemorheologic effects of exercise. The overtraining syndrome represents a situation of unbalance between body's possibilities, nutrition, and work load, and is associated with metabolic, hormonal, immunologic and hemorheologic disturbances. The clinical relevance of these data is underlined by studies showing that exercise training in patients suffering from metabolic and/or cardiovascular disorders (such as the insulin resistance syndrome) results in a parallel improvement of metabolism, risk factors, blood rheology and fitness. Hemorheological measurements require to be studied, at least as sensitive markers of training, and possibly as "true" risk factors highly sensitive to exercise intensification.
运动的血液流变学效应是一种三相现象，包括：(a) 短期效应（高粘度，主要由于液体转移以及红细胞刚性和聚集性的改变）；(b) 中期效应（即急性效应的逆转，这是由于血浆容量扩张（自身血液稀释）降低了血浆粘度和血细胞比容）；(c) 长期效应，可进一步改善血液流动性，同时伴有经典的训练诱导的激素和代谢改变。在这三个阶段中，红细胞流变学受到白细胞和氧化应激的影响。另一方面，大多数代谢和激素改变在运动诱导的血液流变学变化中起作用：其中，血乳酸根据训练状态似乎有相反的作用，因为它通常会损害红细胞流动性，而在一些训练有素的运动员亚组中却能改善红细胞流动性，这种差异可能与膜单羧酸转运体状态有关。身体成分（主要是水合状态和脂肪量）及其主要激素调节系统（生长激素 - IGF - I 轴）都受到训练的显著改变，并且这些改变与血液流变学相关。影响热量和蛋白质摄入、脂质、铁、锌等的营养紊乱也会调节运动的血液流变学效应。过度训练综合征代表了身体能力、营养和工作量之间失衡的一种情况，并与代谢、激素、免疫和血液流变学紊乱相关。这些数据的临床相关性通过研究得到强调，这些研究表明患有代谢和/或心血管疾病（如胰岛素抵抗综合征）的患者进行运动训练会导致代谢、危险因素、血液流变学和健康状况的平行改善。血液流变学测量至少需要作为训练的敏感标志物进行研究，并且可能作为对运动强度高度敏感的“真正”危险因素进行研究。
