Cicco G, Cicco S
CEMOT, Centro Interdipartimentale di Ricerca in Emoreologia, Microcircolazione, Trasporto di Ossigeno e Tecnologie ottiche non invasive, Università degli Studi di Bari, Bari.
Minerva Med. 2007 Dec;98(6):625-31.
It is very interesting in physiopathology to evaluate the blood flow in the microvasculature of patients affected by diabetes, arterial hypertension, lipoproteinosis, peripheral occlusive arterial disease (POAD) and liver failure.
We studied 4 groups. Group 1: controls formed by 25 healthy subjects (15 males and 10 females aged 36+/-3 years); group 2: diabetes, including 32 patients (group 2A, 20 subjects with diabetes type 1: 12 males and 8 females aged 43+/-4 years and group 2B, 12 subjects with diabetes type 2: 6 males and 6 females aged 45+/-3 years); group 3: liver failure, formed by 6 subjects (3 males and 3 females aged 44+/-5 years); group 4: hypertensives, 50 subjects (group 4A, 28 smokers 12 males and 16 females aged 40+/-4 years and group 4B, 22 non-smokers: 12 males and 10 females aged 38+/-3 years). We evaluated the capillary morphology using computerized videocapillaroscopy, the hemorheology (red blood cell RBC deformability and aggregability) using LORCA (Laser assisted Optical Rotational Red Cell Analyzer) and tissue oxygenation using transcutaneous oxymeter (Periflux 5000 Perimed). Statistical analysis were performed using the Student t-test.
The capillary loops in patients with diabetic microangiopathy had in 50% of the patients studied an image such as ''deer horns'', as ''elephant nose'' in 72% and as ''cork screw'' in 44%. In diabetics we found also a capillary rarefaction in 28% of them. An improvement in perfusion was observed in patients with liver failure one week after liver transplantation from cadaver in 83% of them. Morphological alterations were present in hypertensives (27% in non-smokers, 46% in smokers). The RBC deformability evaluated as elongation index (EI) and RBC aggregability (t1/2 expressed in seconds) were detected using LORCA. Group 1: EI 0.59+/-0.02, t1/2 3+/-1 s; group 2A: EI 0.55+/-0.01; t1/2 2+/-0.5 s p<0.05 vs controls; group 2B: EI 0.56+/-0.01; t1/2 2+/-0.2 s p<0.04 vs controls; group 3: EI 0.56+/-0.02, t1/2 2+/-0.4 s p<0.04; group 4A: EI 0.56+/-0.02, t1/2 2+/-0.6 s p<0.03; group 4B: 0.57+/-0.02, t1/2 2+/-0.6 s p<0.04. We evaluated also the TcpO2 at the dorsum of the right foot expressed in mmHg: group 1, 96+/-11 mmHg; group 2A, 74+/-9 p<0.05 vs controls; group 2B, 76+/-8 mmHg p<0.05; group 3, 69+/-6 mmHg p<0.05; group 4A, 70+/-5 mmHg p<0.05; group 4B, 77+/-9 mmHg p<0.05.
This study indicates an interesting and complete methodology in order to evaluate the microcirculation condition in different pathologies inducing microvasculature alterations.
评估糖尿病、动脉高血压、脂蛋白沉积症、外周动脉闭塞性疾病（POAD）及肝衰竭患者的微血管血流情况在病理生理学上具有重要意义。
我们研究了4组人群。第1组：25名健康受试者组成的对照组（15名男性和10名女性，年龄36±3岁）；第2组：糖尿病患者，包括32例（2A组，20例1型糖尿病患者：12名男性和8名女性，年龄43±4岁；2B组，12例2型糖尿病患者：6名男性和6名女性，年龄45±3岁）；第3组：肝衰竭患者，由6名受试者组成（3名男性和3名女性，年龄44±5岁）；第4组：高血压患者，50名受试者（4A组，28名吸烟者，12名男性和16名女性，年龄40±4岁；4B组，22名非吸烟者：12名男性和10名女性，年龄38±3岁）。我们使用计算机视频毛细血管镜评估毛细血管形态，使用LORCA（激光辅助光学旋转红细胞分析仪）评估血液流变学（红细胞RBC变形性和聚集性），并使用经皮血氧仪（Periflux 5000 Perimed）评估组织氧合情况。采用学生t检验进行统计分析。
在研究的糖尿病微血管病变患者中，50%的患者毛细血管袢呈现“鹿角”样图像，72%呈现“象鼻”样，44%呈现“螺旋状”。在糖尿病患者中，28%还存在毛细血管稀疏。83%的肝衰竭患者在尸体肝移植一周后灌注得到改善。高血压患者存在形态学改变（非吸烟者中27%，吸烟者中46%）。使用LORCA检测以伸长指数（EI）评估的RBC变形性和RBC聚集性（以秒表示的t1/2）。第1组：EI 0.59±0.02，t1/2 3±1秒；2A组：EI 0.55±0.01；t1/2 2±0.5秒，与对照组相比p<0.05；2B组：EI 0.56±0.01；t1/2 2±0.2秒，与对照组相比p<0.04；第3组：EI 0.56±0.02，t1/2 2±0.4秒，p<0.04；4A组：EI 0.56±0.02，t1/2 2±0.6秒，p<0.03；4B组：0.57±0.02，t1/2 2±0.6秒, p<0.04。我们还评估了右脚背部的经皮氧分压（TcpO2），以mmHg为单位表示：第1组，96±11 mmHg；2A组，74±9，与对照组相比p<0.05；2B组，76±8 mmHg，p<0.05；第3组，69±6 mmHg，p<0.05；4A组，70±5 mmHg，p<0.05；4B组，77±9 mmHg，p<0.05。
本研究表明了一种有趣且完整的方法，用于评估导致微血管改变的不同病理状态下的微循环状况。
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