Le Dévéhat C, Khodabandehlou T, Zhao H, Vimeux M
Service Diabétologie-Endocrinologie-Nutrition, Centre Hospitalier, Nevers, France.
Clin Hemorheol Microcirc. 1997 Sep-Oct;17(5):363-70.
The relationship between either an acute or a chronic hyperglycemia and functional microcirculatory disturbances was studied in insulin-dependent diabetic (IDD) patients in comparison to healthy volunteers. Acute hyperglycemia, provoked in 10 IDD patients, was accompanied by an increase in laser doppler skin blood flux while transcutaneous oxygen pressure (TcPO2) decreased. These changes, accompanied by that in the concentration of moving blood cells indicate that acute hyperglycemia results in a vasodilation in favour of non-nutritive microvascular shunts. The effect of chronic hyperglycemia was studied in 36 IDD patients who had a duration of diabetes of less than 5 years and had no clinical signs of micro- and macroangiopathy. In these patients, erythrocyte aggregation, plasma viscosity and fibrinogen concentration were increased and transcutaneous oxygen pressure reduced, compared with the levels seen in healthy subjects. More marked impairments were observed in patients with poor glycemic control. This suggests that chronic hyperglycemia involves functional disturbances which will contribute to the development of the vascular complications of diabetes. In 34 patients with poorly controlled diabetes who received intensive insulin therapy for 36 months, these changes were reversed in patients in whom good glycemic control was achieved within 2 months, but not in those in whom glycemic control remained poor. It is concluded that disturbances in blood flow and TcPO2 occur early in diabetes, and are consequences of poor glycemic control. These disturbances can be reversed or normalized if glycemic control is improved by intensive treatment.
为了与健康志愿者进行对比，我们对胰岛素依赖型糖尿病（IDD）患者急性或慢性高血糖与功能性微循环障碍之间的关系进行了研究。在10例IDD患者中诱发急性高血糖，结果发现激光多普勒皮肤血流增加，而经皮氧分压（TcPO2）降低。这些变化以及流动血细胞浓度的变化表明，急性高血糖会导致血管舒张，有利于非营养性微血管分流。我们对36例糖尿病病程小于5年且无微血管和大血管病变临床体征的IDD患者研究了慢性高血糖的影响。与健康受试者相比，这些患者的红细胞聚集、血浆黏度和纤维蛋白原浓度增加，经皮氧分压降低。血糖控制不佳的患者出现了更明显的损伤。这表明慢性高血糖涉及功能性障碍，这将促使糖尿病血管并发症的发生。在34例血糖控制不佳且接受了36个月强化胰岛素治疗的糖尿病患者中，在2个月内实现良好血糖控制的患者上述变化得到逆转，而血糖控制仍然不佳的患者则没有。研究得出结论，糖尿病早期会出现血流和TcPO2的紊乱，这是血糖控制不佳的结果。如果通过强化治疗改善血糖控制，这些紊乱可以得到逆转或恢复正常。
