Urbancic-Rovan V, Stefanovska A, Bernjak A, Azman-Juvan K, Kocijancic A
Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre, Zaloska 7, SI-1525 Ljubljana, Slovenia.
J Vasc Res. 2004 Nov-Dec;41(6):535-45. doi: 10.1159/000081810. Epub 2004 Oct 28.
Microvascular blood flow in the human skin is subject to rhythmic variations reflecting the influence of heartbeat, respiration, intrinsic myogenic activity, neurogenic factors and endothelial activity. The aim of our study was to test the hypothesis that basal skin blood flow (BSBF) and its dynamic components differ (1) among diabetic patients without autonomic neuropathy and with it and healthy control subjects, and (2) among the upper and lower extremities.
BSBF at four recording sites with predominantly nutritive capillary circulation (right and left caput ulnae, right and left medial malleolus) was measured by laser Doppler flowmetry in 25 diabetic patients without cardiovascular autonomic neuropathy (D), 18 neuropathic diabetic patients (DAN) and 36 healthy controls (C). Wavelet transform was applied to the laser Doppler signal.
In absolute terms, mean flow, mean amplitude of the total spectrum and mean amplitudes at all frequency intervals were highest in C, followed by DAN and lowest in D. However, these differences were statistically significant only in the left arm. Within all three groups, mean flow and spectral amplitudes were significantly higher in the arms than in the legs, besides there was a significant difference between the two arms in D.
We have confirmed the differences in BSBF among D, DAN and C, and demonstrated differences among the four recording sites which have not been previously described. The latter indicates an uneven progression of autonomic neuropathy and allows for speculation that the left arm is the latest to be affected.
人体皮肤中的微血管血流会出现节律性变化，这反映了心跳、呼吸、内在肌源性活动、神经源性因素和内皮活动的影响。我们研究的目的是检验以下假设：（1）在无自主神经病变和有自主神经病变的糖尿病患者以及健康对照者之间，基础皮肤血流量（BSBF）及其动态成分存在差异；（2）在上肢和下肢之间存在差异。
通过激光多普勒血流仪测量了25例无心血管自主神经病变的糖尿病患者（D组）、18例神经病变性糖尿病患者（DAN组）和36例健康对照者（C组）四个主要具有营养性毛细血管循环的记录部位（左右尺骨小头、左右内踝）的BSBF。对激光多普勒信号应用小波变换。
从绝对值来看，平均血流量、总频谱的平均幅度以及所有频率区间的平均幅度在C组中最高，其次是DAN组，在D组中最低。然而，这些差异仅在左臂具有统计学意义。在所有三组中，除了D组双臂之间存在显著差异外，手臂的平均血流量和频谱幅度均显著高于腿部。
我们证实了D组、DAN组和C组之间BSBF存在差异，并证明了四个记录部位之间存在差异，这是此前未曾描述过的。后者表明自主神经病变进展不均衡，并使人推测左臂是最后受到影响的部位。
