Dupuy-Fons C, Brun J F, Quere I, Bardet L, Janbon C
Service de Médecine Interne B, Hôpital Saint-Eloi, Montpellier.
J Mal Vasc. 1996;21(3):165-70.
Peripheral occlusive arterial disease (P.O.A.D.) is one of the situations in which hemorheological abnormalities are usually described. However the clinical relevance of hemorheological measurements in angiologic practice remains to be defined. The aim of the study was to investigate whether hemorheological disturbances are associated with alterations in oxygen diffusion and prognosis of the arterial disease. Three groups of patients were included in this work. First, a study was realized on 160 nondiabetic P.O.A.D patients (suffering from intermittent claudication to critical limb ischemia) in order to evaluate the possible influence of hemorheological disturbances on oxygen diffusion in distal tissue. A control group of 30 subjects matched for age and sex was also studied. A second study was performed on 80 diabetic P.O.A.D. patients (stage III and IV of Leriche and Fontaine classification) to determinate if hemorheological parameters could be considered as prognostic factors in the P.O.A.D. course. Hemorheological parameters were determined on different devices: red blood cell (RBC) aggregation by Myrenne aggregometer, blood and plasma viscosities by MT 90 falling ball viscometer. Transcutaneous oxygen pressure was measured by Radiometer TCM2 oxygen monitor. Several rheological parameters of non diabetic patients suffering from P.O.A.D. were significantly higher than those of control group subjects : blood viscosity (p < 0.05), plasma viscosity (p < 0.001), erythrocyte rigidity index (p < 0.01) and fibrinogen level (p < 0.0001). In the nondiabetic patients TcPO2 was negatively correlated with RBC aggregation, erythrocyte rigidity index and hematocrit /viscosity ratio. The diabetic patients who needed major amputation (above or below knee) presented significantly increased hemorheological parameters (blood viscosity, RBC aggregation, RBC rigidity index, hematocrit/viscosity ratio, fibrinogen level) compared to diabetic who had not been major amputated (no amputation or only toes' amputation). Our finding suggests that hemorheological factors (1) may influence oxygen transfer to distal tissues by maldistribution of blood flow and (2) may have prognostic significance in chronic peripheral occlusive arterial disease.
外周闭塞性动脉疾病（P.O.A.D.）是通常会描述血液流变学异常情况的病症之一。然而，血液流变学测量在血管病学实践中的临床相关性仍有待确定。本研究的目的是调查血液流变学紊乱是否与动脉疾病的氧扩散改变及预后相关。本研究纳入了三组患者。首先，对160例非糖尿病P.O.A.D.患者（患有间歇性跛行至严重肢体缺血）进行研究，以评估血液流变学紊乱对远端组织氧扩散的可能影响。还对30名年龄和性别匹配的受试者组成的对照组进行了研究。对80例糖尿病P.O.A.D.患者（Leriche和Fontaine分类的III期和IV期）进行了第二项研究，以确定血液流变学参数是否可被视为P.O.A.D.病程中的预后因素。使用不同设备测定血液流变学参数：用Myrenne血液凝集仪测定红细胞（RBC）聚集，用MT 90落球粘度计测定血液和血浆粘度。用Radiometer TCM2氧监测仪测量经皮氧分压。患有P.O.A.D.的非糖尿病患者的几个流变学参数显著高于对照组受试者：血液粘度（p < 0.05）、血浆粘度（p < 0.001）、红细胞刚性指数（p < 0.01）和纤维蛋白原水平（p < 0.0001）。在非糖尿病患者中，经皮氧分压（TcPO2）与红细胞聚集、红细胞刚性指数和血细胞比容/粘度比呈负相关。与未进行大截肢（未截肢或仅脚趾截肢）的糖尿病患者相比，需要进行大截肢（膝盖以上或以下）的糖尿病患者的血液流变学参数（血液粘度、红细胞聚集、红细胞刚性指数、血细胞比容/粘度比、纤维蛋白原水平）显著升高。我们的研究结果表明，血液流变学因素（1）可能通过血流分布不均影响氧向远端组织的转移，（2）可能在慢性外周闭塞性动脉疾病中具有预后意义。
