Allegra C, Bartolo M, Carioti B, Cassiani D
Department of Angiology, San Giovanni Hospital, Rome, Italy.
Int J Microcirc Clin Exp. 1995;15 Suppl 1:50-4. doi: 10.1159/000179096.
In the more advanced stages of chronic venous insufficiency, stasis in the skin microcirculation is associated with a decreased red blood cell velocity and an increase in packed cell volume related to the red blood cell piling phenomenon. Although the main factor determining blood viscosity is packed cell volume, the direct relationship between this variable, viscosity and velocity is no longer valid at the microcirculatory level (sigma effect). Viscosity is influenced by blood composition and red blood cell deformability. The aim of this open pilot study was to verify the variations in capillary packed cell volume in comparison with the velocity in 24 patients with third-stage chronic venous insufficiency before (day 1) and after (day 28) a 28-day treatment with Daflon 500 mg, a micronized purified flavonoid fraction consisting of diosmin, 450 mg, and hesperidin, 50 mg, per tablet, 1 g/day, and then 14 days (day 42) after cessation of treatment. Ankle skin microcirculation was evaluated by dynamic capillaroscopy. Values of relative capillary packed cell volume were calculated by a densitometric method, and red blood cell velocity was calculated using the cross-correlation simplified method. Relative capillary packed cell volume (mean +/- SD) significantly (p = 0.001) increased from day 1 (64.10 +/- 9.34%) to day 28 (72.89 +/- 5.74%) and then decreased until day 42 (66.84 +/- 7.48%). In the same patients, red blood cell velocity (mean +/- SD) significantly (p = 0.041) increased from day 1 (0.26 +/- 0.14 mm/sec) to day 28 (0.35 +/- 0.11 mm/sec) and then remained stable until day 42 (0.33 +/- 0.16 mm/sec). Two possible explanations can account for this apparent discrepancy: first, dissociation between viscosity and velocity due to the Fahraeus-Lindqvist effect (sigma effect); and secondly, increased deformability of red blood cells leading to an increased red blood cell velocity despite an increased packed cell volume. It can be concluded that Daflon 500 mg seems to have a beneficial haemorheological effect, resolving the stasis with an increase in red blood cell velocity. A concomitant increase in relative packed cell volume and red blood cell velocity after therapy suggests an improvement of the flexibility of red blood cells.
在慢性静脉功能不全的更晚期阶段，皮肤微循环中的血液瘀滞与红细胞速度降低以及与红细胞堆积现象相关的红细胞压积增加有关。尽管决定血液粘度的主要因素是红细胞压积，但在微循环水平上，该变量、粘度和速度之间的直接关系不再成立（西格玛效应）。粘度受血液成分和红细胞变形能力的影响。这项开放性试点研究的目的是，在24例患有第三阶段慢性静脉功能不全的患者中，比较在接受为期28天的达弗隆500毫克治疗前（第1天）、治疗后（第28天）以及治疗停止后14天（第42天），毛细血管红细胞压积与速度的变化。达弗隆500毫克为微粉化纯化类黄酮成分，每片含地奥司明450毫克和橙皮苷50毫克，每日1克。通过动态毛细血管显微镜检查评估踝部皮肤微循环。通过密度测定法计算相对毛细血管红细胞压积值，并使用互相关简化方法计算红细胞速度。相对毛细血管红细胞压积（平均值±标准差）从第1天（64.10±9.34%）到第28天（72.89±5.74%）显著（p = 0.001）增加，然后在第42天降至（66.84±7.48%）。在同一组患者中，红细胞速度（平均值±标准差）从第1天（0.26±0.14毫米/秒）到第28天（0.35±0.11毫米/秒）显著（p = 0.041）增加，然后在第42天保持稳定（0.33±0.16毫米/秒）。对于这种明显差异有两种可能的解释：第一，由于法-林效应（西格玛效应）导致粘度和速度解离；第二，红细胞变形能力增加，尽管红细胞压积增加，但红细胞速度仍提高。可以得出结论，达弗隆500毫克似乎具有有益的血液流变学效应，通过增加红细胞速度来解决血液瘀滞问题。治疗后相对红细胞压积和红细胞速度同时增加表明红细胞柔韧性得到改善。
