Winocour P H, Mitchell W S, Gush R J, Taylor L J, Baker R D
University of Manchester, Department of Medicine, UK.
Diabet Med. 1988 Dec;5(9):861-6. doi: 10.1111/j.1464-5491.1988.tb01125.x.
Disturbed upper limb skin blood flow has been described in insulin-dependent (Type 1) diabetes mellitus, but the pathophysiological mechanism remains unclear. Hand skin blood flow was therefore measured at room temperature and following immersion of hands in cold and warm water in 13 healthy control subjects, in 10 patients with Type 1 diabetes mellitus and cardiovascular autonomic neuropathy, and a further 10 Type 1 diabetic patients with normal cardiovascular autonomic tone. Following cold challenge there was failure of digital artery clampdown in all diabetic patients in comparison with healthy control subjects (p less than 0.005), and the index finger temperature fell less (p less than 0.05). Laser Doppler flow was reduced at the palms at room temperature or following the warm challenge (p less than 0.008), as well as on the dorsum at room temperature (p less than 0.05), in all diabetic patients. In addition laser Doppler flow in the diabetic patients was reduced at the palms and dorsum immediately following cold water challenge (p less than 0.004) and this reduction persisted 15 min (p less than 0.05) and 30 min (p less than 0.01) into the recovery phase. In comparison to those diabetic patients with normal cardiovascular tone, those with cardiovascular autonomic neuropathy had reduced laser Doppler flow at the pulp 15 min after cold water immersion (p less than 0.05), at the nailbed immediately after cold water immersion (p less than 0.01), and at the palms immediately after warm water challenge (p less than 0.01).
胰岛素依赖型（1型）糖尿病患者存在上肢皮肤血流紊乱的情况，但病理生理机制尚不清楚。因此，对13名健康对照者、10名患有1型糖尿病且伴有心血管自主神经病变的患者以及另外10名心血管自主神经功能正常的1型糖尿病患者，在室温下以及将手浸入冷水和温水中后测量手部皮肤血流。与健康对照者相比，所有糖尿病患者在冷刺激后指动脉均无法收缩（p<0.005），且食指温度下降幅度较小（p<0.05）。所有糖尿病患者在室温下或温刺激后手掌的激光多普勒血流减少（p<0.008），在室温下手背的激光多普勒血流也减少（p<0.05）。此外，糖尿病患者在冷水刺激后手掌和手背的激光多普勒血流立即减少（p<0.004），且这种减少在恢复阶段持续15分钟（p<0.05）和30分钟（p<0.01）。与心血管自主神经功能正常的糖尿病患者相比，伴有心血管自主神经病变的患者在冷水浸泡15分钟后指腹的激光多普勒血流减少（p<0.05），在冷水浸泡后立即在甲床的激光多普勒血流减少（p<0.01），在温水刺激后立即在手掌的激光多普勒血流减少（p<0.01）。
