Kitaoka H, Majima M, Kitazawa A, Sakane S, Takeda K, Takamatsu J, Ohsawa N
First Department of Internal Medicine, Osaka Medical College, Japan.
Bull Osaka Med Coll. 1989 Nov;35(1-2):99-105.
This study aimed at evaluating vasomotor response of the hand in patients with diabetes mellitus. A skin temperature of the hand was measured before and after exposure to ice water, and the recovery rates of the skin temperature were determined at 3, 5, and 10 min after the cold exposure. Ninety-two diabetics ranging in age from 25 to 59 years and 43 normal subjects ranging from 23 to 69 years old participated in this study. Since the recovery rate was delayed in normal subjects over the age of 60, comparison was made between the diabetics and the normals under 60 years old. The skin temperature was significantly lower in 26 diabetics with severe peripheral neuropathy (PN) than 40 diabetics without PN. The recovery rate were markedly delayed in the patients with PN, and also delayed in diabetics with severe retinopathy. The recovery rate was not different between the patients with and without ischemic changes in electrocardiogram. The delayed recovery rate was most prominent in the diabetics who had both abnormal heart rate variation (HRV) and orthostatic hypotension, followed by those with abnormal HRV but without orthostatic hypotension. Recovery rates in the diabetics with abnormal HRV alone were within the normal range. Our data suggest that the dysfunction of the regulation of skin temperature in the patients with diabetes mellitus was due to peripheral sympathetic nerve abnormality. The cold exposure test would be useful in the estimation of the sympathetic nerve activity of the diabetics.
本研究旨在评估糖尿病患者手部的血管舒缩反应。在手部暴露于冰水前后测量皮肤温度，并在冷暴露后3分钟、5分钟和10分钟测定皮肤温度的恢复率。92名年龄在25至59岁之间的糖尿病患者和43名年龄在23至69岁之间的正常受试者参与了本研究。由于60岁以上正常受试者的恢复率延迟，因此对60岁以下的糖尿病患者和正常受试者进行了比较。26名患有严重周围神经病变（PN）的糖尿病患者的皮肤温度明显低于40名无PN的糖尿病患者。PN患者的恢复率明显延迟，严重视网膜病变的糖尿病患者的恢复率也延迟。心电图有缺血性改变和无缺血性改变的患者之间恢复率无差异。恢复率延迟在心率变异性（HRV）异常且伴有体位性低血压的糖尿病患者中最为明显，其次是HRV异常但无体位性低血压的患者。仅HRV异常的糖尿病患者的恢复率在正常范围内。我们的数据表明，糖尿病患者皮肤温度调节功能障碍是由于外周交感神经异常所致。冷暴露试验有助于评估糖尿病患者的交感神经活动。
