Wiernsperger N, Rapin J R
CarMeN Laboratory, INSA Lyon, Villeurbanne, France.
Cardiovasc Hematol Agents Med Chem. 2012 Jun;10(2):167-83. doi: 10.2174/187152512800388885.
The microvascular bed is an anatomical entity which comprises myriads of small arterioles, capillaries and venules. Microvessels and surrounding tissue metabolism are tightly coupled; consequently they are equipped with many, very specific and fine-tuned mechanisms allowing permanent, precise regulation of nutrient delivery. The review thoroughly describes the structure and physiology of arterioles and capillaries as well as the specialized means to investigate them. Microcirculation has been largely neglected for decades, mainly because of lack of technical possibilities for visualization and quantitation. However the past years have completely renewed the scientific interest, due to the combination of the availability of new techniques in human research and the recognition that the microcirculation is autonomically and causally involved in diseases previously thought to be essentially a question of macrocirculation. Today we start to see that microangiopathy is not only a consequence of large vessel diseases but can be the source of many pathologies in both cardiovascular and metabolic disorders, the best example -developed here- being the cardiometabolic syndrome or prediabetes. With very few exceptions, pentoxifylline and the antidiabetic metformin, no specific treatments have been developed for treating disorders at the microcirculatory level. Metformin has unique, intrinsic actions specifically at the level of terminal arterioles, which are completely independent of its antidiabetic effect. Other drugs are shortly described which have revealed a potential interest in this field. Our review aims at showing that microcirculation is entering a new era, starting with rapidly increasing knowledge of its intimate functioning and worth specific pharmacological developments.
微血管床是一个解剖学实体，由无数小动脉、毛细血管和小静脉组成。微血管与周围组织的代谢紧密相连；因此，它们具备许多非常特殊且经过精细调节的机制，能够对营养物质的输送进行持续、精确的调节。这篇综述全面描述了小动脉和毛细血管的结构与生理功能，以及研究它们的专门方法。几十年来，微循环在很大程度上被忽视了，主要是因为缺乏可视化和定量分析的技术手段。然而，由于人体研究中新技术的出现，以及人们认识到微循环在自主和因果关系上参与了以前被认为主要是大循环问题的疾病，过去几年对微循环的科学兴趣完全被重新激发。如今我们开始认识到，微血管病变不仅是大血管疾病的后果，还可能是心血管和代谢紊乱中许多病理状况的根源，这里所阐述的最佳例子就是心脏代谢综合征或糖尿病前期。除了己酮可可碱和抗糖尿病药物二甲双胍外，几乎没有针对微循环水平疾病的特异性治疗方法。二甲双胍在终末小动脉水平具有独特的内在作用，这完全独立于其抗糖尿病作用。文中还简要介绍了其他一些在该领域显示出潜在价值的药物。我们的综述旨在表明，微循环正进入一个新时代，这始于对其精细功能的快速增长的认识，以及值得进行特异性药理学开发。
