The problem of tissue oxygenation in diabetes mellitus. I. Its relation to the early functional changes in the microcirculation of diabetic subjects.
The problem of tissue oxygenation in diabetes mellitus. I. Its relation to the early functional changes in the microcirculation of diabetic subjects.
复制标题
糖尿病中的组织氧合问题。
DOI：
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发表时间：
2009
期刊：
影响因子：
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通讯作者：
E. Standl
中科院分区：
文献类型：
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作者：
J. Ditzel;E. Standl
导致可逆的功能性变化的胰岛素依赖型糖尿病受试者的微循环在疾病的早期视网膜病变和肾病（功能性微血管病）的任何临床体征之前的根本原因进行了讨论。有人建议，在糖尿病患者中观察到的初始微血管扩张是由于相对组织缺氧的自动调节反应，提供了增加的组织灌注，以改善组织氧输送。支持这一建议的证据来自以下发现：糖尿病患者可能同时表现出组织耗氧量增加和循环血液向组织释放氧气的能力降低。后一种缺陷可能是由两个相互关联的因素造成的：1。具有高氧亲和力的血红蛋白A1 c的比例增加，以及2.维持足够高的血浆无机磷酸盐浓度以在红细胞中提供最佳的2，3-二磷酸甘油酸（2，3-DPG）含量的困难。糖尿病患者的基础需氧量可能在几个小时内波动，这取决于代谢控制的状态，并且在调节不良时增加。因此，糖尿病患者可能会遭受无数的细胞缺氧损伤，在疾病的最初几年，这些损伤在微循环中被自动调节反应抵消。这些与血浆渗透增加相关的微血管反应多年来可能对糖尿病退行性微血管病的发展至关重要。
The underlying cause leading to the reversible functional changes in the microcirculation of insulin-dependent diabetic subjects early during the disease prior to any clinical signs of retinopathy and nephropathy (functional microangiopathy) is discussed. It is suggested that the initial microvascular dilation observed in diabetics is due to an autoregulatory response to relative tissue hypoxia providing an increased tissue perfusion in order to improve tissue oxygen delivery. Supporting evidence for this suggestion is derived from the findings that diabetics simultaneously may show increased tissue oxygen consumption and decreased ability of the circulating blood to release oxygen to the tissues. The latter defect is likely to be caused by two interrelated factors: 1. an increased proportion of haemoglobin A1c with high oxygen affinity, and 2. difficulties of maintaining a sufficiently high concentration of plasma inorganic phosphate in order to provide an optimal 2,3-diphosphoglycerate (2,3-DPG) content in the erythrocytes. The basal oxygen demand of diabetics may fluctuate even within a few hours dependent upon the state of metabolic control and is increased at times of poor regulation. Hence, diabetics may suffer from innumerable cellular hypoxic injuries, which during the first years of the disease are counteracted in the microcirculation by an autoregulatory response. These microvascular reactions associated with increased plasma permeation may over the years be of major importance for the development of the degenerative microangiopathy in diabetes.