Rendell M, Bamisedun O
Creighton Diabetes Center, Omaha, Nebraska 68131.
Am J Med. 1992 Dec;93(6):611-8. doi: 10.1016/0002-9343(92)90193-f.
To determine a potential relationship between skin blood flow changes and the duration of diabetes and the presence of other microvascular complications.
Skin blood flow was measured by laser Doppler techniques at the finger and toe pulps, areas of predominant arteriovenous anastomotic (AVA) flow, and on the finger and toe dorsums, which have a greater nutritive microvascular contribution, in 83 diabetic patients and 39 nondiabetic control subjects. The average duration of diabetes was 14 +/- 1 years. Thirty-four patients had retinopathy. Eighteen patients had proteinuria. Forty patients had definite signs and symptoms of neuropathy, whereas 11 had no detectable neuropathy.
There was little difference between diabetic and nondiabetic skin blood flow at normal body temperatures. However, at an elevated skin temperature of 44 degrees C, significant reductions in skin blood flow versus control were demonstrated in the diabetic group. Skin blood flow at finger and toe dorsums showed a decrease as a function of the duration of diabetes. In contrast, there was little, if any, relationship between the duration of diabetes and skin blood flow at the finger and toe pulps. Diabetic patients with retinopathy had significantly lower blood flow at both finger and toe dorsums than those without retinopathy. Even excluding patients with recent onset of diabetes from the analysis, flows at finger (18.6 +/- 2.0 mL/min/100 g) and toe dorsums (11.2 +/- 1.4 mL/min/100 g) in the patients with retinopathy were significantly lower than in diabetic patients without retinopathy [finger: 28.6 +/- 2.7 mL/min/100 g (p < 0.01) and toe: 15.1 +/- 1.5 mL/min/100 g (p < 0.05)]. The presence of proteinuria was also associated with lower blood flow at the toe dorsum. There were no differences between patients with or without clinical diabetic neuropathy. At finger and toe pulps, there were no significant differences between diabetic patients with or without retinopathy, proteinuria, or neuropathy.
There appears to be a diabetic cutaneous microangiopathy that coexists with diabetic retinal and renal microvascular disease. This process is expressed primarily at sites of nutritive microvasculature. The ability to use the skin as a model for diabetic microangiopathy would have great practical importance, both experimentally and in clinical practice.
确定皮肤血流变化与糖尿病病程以及其他微血管并发症之间的潜在关系。
采用激光多普勒技术，对83例糖尿病患者和39例非糖尿病对照者的手指和脚趾指腹（主要为动静脉吻合支血流的部位）以及手指和脚趾背侧（营养性微血管贡献更大的部位）的皮肤血流进行测量。糖尿病的平均病程为14±1年。34例患者患有视网膜病变。18例患者有蛋白尿。40例患者有明确的神经病变体征和症状，而11例未检测到神经病变。
在正常体温下，糖尿病患者与非糖尿病患者的皮肤血流差异不大。然而，在皮肤温度升高至44℃时，糖尿病组的皮肤血流与对照组相比显著降低。手指和脚趾背侧的皮肤血流随糖尿病病程的延长而降低。相比之下，糖尿病病程与手指和脚趾指腹的皮肤血流之间几乎没有关系。患有视网膜病变的糖尿病患者手指和脚趾背侧的血流均显著低于无视网膜病变的患者。即使在分析中排除近期发病的糖尿病患者，患有视网膜病变的患者手指（18.6±2.0毫升/分钟/100克）和脚趾背侧（11.2±1.4毫升/分钟/100克）的血流仍显著低于无视网膜病变的糖尿病患者[手指：28.6±2.7毫升/分钟/100克（p<0.01），脚趾：15.1±（此处原文似乎有误，推测为1.5）毫升/分钟/100克（p<0.05）]。蛋白尿的存在也与脚趾背侧血流降低有关。有或无临床糖尿病神经病变的患者之间没有差异。在手指和脚趾指腹，有或无视网膜病变、蛋白尿或神经病变的糖尿病患者之间没有显著差异。
似乎存在一种与糖尿病视网膜和肾脏微血管疾病共存的糖尿病皮肤微血管病变。这一过程主要表现在营养性微血管部位。将皮肤用作糖尿病微血管病变模型的能力在实验和临床实践中都具有重要的实际意义。
