Carrington A L, Abbott C A, Griffiths J, Jackson N, Johnson S R, Kulkarni J, Van Ross E R, Boulton A J
University Department of Medicine, Manchester Royal Infirmary, Oxford Road, Manchester, U.K.
Clin Sci (Lond). 2001 Sep;101(3):261-6.
Multiple factors, including peripheral vascular disease and neuropathy, contribute to the development and perpetuation of complications of the lower extremities in diabetes. The main aim of the present study was to assess the peripheral vascular and nerve status of diabetic and non-diabetic subjects that had undergone lower limb amputation. Various non-invasive tests of peripheral vascular and nerve function were carried out on subjects who had undergone unilateral lower limb amputation and were now attending a Rehabilitation Centre. The control group (n=23), the diabetic amputee group (n=64) and the non-diabetic amputee group (n=32) were age-matched. Only the diabetic amputee group had evidence of medial arterial calcification. Transcutaneous oxygen levels were significantly lower in the diabetic amputee group (median 43 mmHg; interquartile range 33-49 mmHg) than in the control (59; 56-74 mmHg) and non-diabetic amputee (57; 43-65 mmHg) groups (control compared with diabetic amputee group, P<0.001; diabetic amputee compared with non-diabetic amputee group, P<0.01). The same trend was found for carbon dioxide levels in the skin [mmHg: diabetic amputees, 25 (21-37); controls, 38 (32-42); non-diabetic amputee, 34 (31-39)] (control compared with diabetic amputee, P<0.01; diabetic amputee compared with non-diabetic amputee, P<0.05). Vibration and pressure perception measurements (which assess Abeta nerve fibre function) showed that both the diabetic amputee and non-diabetic amputee subjects had significantly greater impairment than the controls. However, measures of Aalpha and C nerve fibre function were abnormal only in the diabetic amputee group. Thus the peripheral vascular and nerve functions of age-matched diabetic and non-diabetic subjects having undergone lower limb amputation show specific differences, with non-diabetic amputees exhibiting signs of neuropathy. This indicates that factors characteristic of diabetes (such as hyperglycaemia and non-enzymic glycation) are associated with calcification, lower oxygen and carbon dioxide levels in the skin, and abnormal Aalpha and C nerve fibre function.
多种因素，包括外周血管疾病和神经病变，都促使糖尿病患者下肢并发症的发生和持续发展。本研究的主要目的是评估接受下肢截肢手术的糖尿病和非糖尿病患者的外周血管和神经状况。对接受单侧下肢截肢手术且正在康复中心接受治疗的患者进行了多种外周血管和神经功能的非侵入性检测。对照组（n = 23）、糖尿病截肢组（n = 64）和非糖尿病截肢组（n = 32）年龄匹配。只有糖尿病截肢组有内侧动脉钙化的证据。糖尿病截肢组的经皮氧水平（中位数43 mmHg；四分位间距33 - 49 mmHg）显著低于对照组（59；56 - 74 mmHg）和非糖尿病截肢组（57；43 - 65 mmHg）（对照组与糖尿病截肢组比较，P<0.001；糖尿病截肢组与非糖尿病截肢组比较，P<0.01）。皮肤二氧化碳水平也呈现相同趋势[mmHg：糖尿病截肢者，25（21 - 37）；对照组，38（32 - 42）；非糖尿病截肢者，34（31 - 39）]（对照组与糖尿病截肢者比较，P<0.01；糖尿病截肢者与非糖尿病截肢者比较，P<0.05）。振动和压力觉测量（评估Aβ神经纤维功能）显示，糖尿病截肢组和非糖尿病截肢组患者的功能损害均显著大于对照组。然而，Aα和C神经纤维功能检测仅在糖尿病截肢组出现异常。因此，年龄匹配的接受下肢截肢手术的糖尿病和非糖尿病患者的外周血管和神经功能存在特定差异，非糖尿病截肢者也表现出神经病变迹象。这表明糖尿病的特征性因素（如高血糖和非酶糖基化）与钙化、皮肤中较低的氧和二氧化碳水平以及Aα和C神经纤维功能异常有关。
