Nabuurs-Franssen M H, Houben A J H M, Tooke J E, Schaper N C
Department of Internal Medicine, University Hospital Maastricht and Cardiovascular Research Institute Maastricht (CARIM), The Netherlands.
Diabetologia. 2002 Aug;45(8):1164-71. doi: 10.1007/s00125-002-0872-z. Epub 2002 Jul 3.
AIMS/HYPOTHESIS: The aim of this study was to investigate the influence of peripheral polyneuropathy (PNP) on skin microcirculation and foot swelling rate in the feet of patients with Type II (non-insulin-dependent) diabetes mellitus.
38 Type II diabetic patients, 24 with PNP (PNP+), 14 without PNP (PNP-), and 16 healthy control subjects were studied, first supine and subsequently sitting with the foot dependent for 50 mn.
In patients with PNP, foot skin temperature was higher, (p<0.04) and capillary blood cell velocity (CBV, nailfold capillary microscopy), was lower compared to patients without PNP (222 vs 313 micro m/s respectively, p<0.03). Compared to the control subjects, the percentage reduction in skin blood flux, (LDF, laser-Doppler fluxmetry), after 10 min was higher in the PNP- and PNP+ patients (3% vs 18% and 26% respectively, p<0.02). These disturbances were most pronounced in PNP+ patients with a history of a foot ulcer. Foot swelling rate (mercury strain gauge plethysmography) in the first 10 min of dependency, was lower in patients with PNP+ compared to the control subjects (0.00165 vs 0.00286 ml.100 ml(-1)s respectively, p<0.01). In addition, we found a negative correlation (r=-0.41; p<0.01) between Valk-score (severity of PNP) and FSR.
CONCLUSION/INTERPRETATION: Type II diabetes PNP is associated with multiple abnormalities in the (skin) microcirculation of the foot, characterised by reduced capillary blood flow, an enhanced reduction in skin blood flux and impaired fluid filtration after sitting up. The most severe abnormalities were observed in patients with a history of foot ulceration.
目的/假设：本研究旨在调查周围神经病变（PNP）对II型（非胰岛素依赖型）糖尿病患者足部皮肤微循环和足部肿胀率的影响。
对38例II型糖尿病患者进行研究，其中24例患有PNP（PNP+），14例未患PNP（PNP-），并选取16名健康对照者，首先让他们仰卧，随后让他们坐着，足部下垂50分钟。
与未患PNP的患者相比，患PNP的患者足部皮肤温度更高（p<0.04），甲襞毛细血管显微镜检查显示毛细血管血细胞速度（CBV）更低（分别为222与313微米/秒，p<0.03）。与对照者相比，PNP-和PNP+患者在10分钟后皮肤血流量（激光多普勒血流仪测量）的减少百分比更高（分别为3%、18%和26%，p<0.02）。这些紊乱在有足部溃疡病史的PNP+患者中最为明显。与对照者相比，PNP+患者在足部下垂的前10分钟内足部肿胀率（水银应变片体积描记法）更低（分别为0.00165与0.00286毫升·100毫升-1·秒，p<0.01）。此外，我们发现Valk评分（PNP严重程度）与FSR之间存在负相关（r=-0.41；p<0.01）。
结论/解读：II型糖尿病PNP与足部（皮肤）微循环的多种异常有关，其特征是毛细血管血流减少、皮肤血流量减少加剧以及坐起后液体滤过受损。在有足部溃疡病史的患者中观察到最严重的异常。
