Valensi P, Mesangeau D, Paries J, Zkhiri F, Garnier M
Laboratoire de Nutrition - Maladies métaboliques, Hôpital Jean Verdier, Université Paris-Nord, Bondy.
J Mal Vasc. 1996;21(3):185-7.
Reduced red cell filtration and increased aggregation have been reported in diabetic patients. Heart enlargement is a classical complication of high blood pressure but is also frequently encountered in diabetics. The aim of this work was to explore the relationship between rheological disorders and heart enlargement in diabetics and in an animal model of genetically diabetic rats. 1. Among a series of 92 patients with insulin-dependent or non-insulin-dependent diabetes mellitus, silent myocardial ischemia was evidenced in 28. Coronarography in 24 of these patients was strictly normal in 15. In the patients with angiographically normal coronary arteries, the coronary reserve was perturbed by intracoronary injection of papaverine. The left ventricular mass was normal in 79 patients. In patients with silent myocardial ischemia and angiographically normal coronary arteries, there was a positive correlation between left ventricular mass and red cell filtration index using the Hanss hemorheometer (n = 8, r = 0.954, p = 0.001). 2. Red cell stiffness was studied sequentially from 3 to 18 months in diabetic rats Goto Kakisaki (GK). In these rats, cardiac index (heart weight/body weight) was significantly higher than that in Wistors control rats (0.27 +/- 0.02% vs. 0.17 +/- 0.01%, p < 0.001) and was significantly correlated with erythrocyte magnesium (r = 0.920, p 0.026). Overall, the cardiac index in the rats was significantly correlated with red cell filtration (r = 0.370, p = 0.044). In GK rats, heart rate was significantly slower and systolic blood pressure was slightly higher than in control rats (telemetric measures). These findings show that in diabetes mellitus, heart enlargement may be determined by factors other than hypertension or sensitivity to sympathetic stimulation and might be favored by rheological changes and/or excessive intracellular magnesium. In patients with diabetes, the reduced coronary reserve could result in left ventricular hypertrophy but also rheological changes.
据报道，糖尿病患者的红细胞滤过率降低且聚集性增加。心脏扩大是高血压的经典并发症，但在糖尿病患者中也很常见。这项研究的目的是探讨糖尿病患者以及遗传性糖尿病大鼠动物模型中血液流变学紊乱与心脏扩大之间的关系。1. 在92例胰岛素依赖型或非胰岛素依赖型糖尿病患者中，28例存在无症状性心肌缺血。其中24例患者进行了冠状动脉造影，15例结果完全正常。在冠状动脉造影正常的患者中，通过冠状动脉内注射罂粟碱可发现冠状动脉储备受到干扰。79例患者的左心室质量正常。在无症状性心肌缺血且冠状动脉造影正常的患者中，使用汉斯血液流变仪测量，左心室质量与红细胞滤过指数之间存在正相关（n = 8，r = 0.954，p = 0.001）。2. 对Goto Kakisaki（GK）糖尿病大鼠在3至18个月期间连续进行红细胞刚性研究。这些大鼠的心脏指数（心脏重量/体重）显著高于Wistar对照大鼠（0.27 +/- 0.02% 对 0.17 +/- 0.01%，p < 0.001），并且与红细胞镁含量显著相关（r = 0.920，p 0.026）。总体而言，大鼠的心脏指数与红细胞滤过显著相关（r = 0.370，p = 0.044）。在GK大鼠中，心率显著较慢，收缩压略高于对照大鼠（遥测测量）。这些发现表明，在糖尿病中，心脏扩大可能由高血压或对交感神经刺激的敏感性以外的因素决定，并且可能受血液流变学变化和/或细胞内镁过多的影响。在糖尿病患者中，冠状动脉储备降低可能导致左心室肥厚，也会引起血液流变学变化。
