Hedreville Mona, Connes Philippe, Romana Marc, Magnaval Guillaume, David Thierry, Hardy-Dessources Marie-Dominique, Belloy Marie-Sylvaine, Etienne-Julan Maryse, Hue Olivier
Laboratory ACTES UPRES-EA 3596, Department of Physiology, University of the French West Indies, Campus of Fouillole, Pointe-a-Pitre, Guadeloupe, France.
Med Sci Sports Exerc. 2009 Jan;41(1):14-8. doi: 10.1249/MSS.0b013e31818313d0.
A 26-yr-old man with sickle cell trait (SCT) suddenly lost visual acuity in the left eye after a cycling race in hot tropical environment. The cause was massive central retinal vein occlusion (CRVO) with hemorrhaging that rapidly worsened to neovascular glaucoma. Although medically treated, the eye is now marked by total retinal detachment. Cardiovascular function assessment shows no electrocardiographic abnormalities, no anomaly in the supra-aortic tree, and no evidence of structural heart disease. Although normal coagulation markers values (i.e., activated partial thromboplastin time, prothrombin time, fibrinogen concentration, antithrombin III, factor V, proteins C and S) were observed 2.5 months after the clinical event, a transesophageal echocardiogram performed few hours after the incident revealed the presence of four thrombi in the left atrium suggesting a postexercise hypercoagulable state at that time. Hemorheological measurements at distance of the events demonstrated high red blood cell rigidity at baseline. Therefore, marked blood rheological impairment and activation of the coagulation pathway in response to the heavy and prolonged cycling race could have promoted CRVO in this cyclist carrying SCT. These data suggest that SCT could be considered as a risk factor for significant ocular complications when severe exercise is performed and support the idea that SCT is a contributing factor in blood rheology and vascular dysfunctions.
一名26岁患有镰状细胞性状（SCT）的男性在炎热的热带环境中参加自行车比赛后，突然左眼视力丧失。病因是大量视网膜中央静脉阻塞（CRVO）并伴有出血，迅速恶化为新生血管性青光眼。尽管进行了药物治疗，但该眼目前已出现完全视网膜脱离。心血管功能评估显示无心电图异常，主动脉弓上无异常，也无结构性心脏病证据。尽管在临床事件发生2.5个月后观察到凝血标志物值正常（即活化部分凝血活酶时间、凝血酶原时间、纤维蛋白原浓度、抗凝血酶III、因子V、蛋白C和S），但事件发生后数小时进行的经食管超声心动图显示左心房存在四个血栓，提示当时运动后处于高凝状态。在事件发生一段时间后的血液流变学测量显示基线时红细胞刚性较高。因此，对于这名携带SCT的自行车运动员，高强度和长时间的自行车比赛导致明显的血液流变学损害和凝血途径激活，可能促使了CRVO的发生。这些数据表明，当进行剧烈运动时，SCT可被视为发生严重眼部并发症的危险因素，并支持SCT是血液流变学和血管功能障碍的一个促成因素这一观点。
