Siperstein M D, Unger R H, Madison L L
J Clin Invest. 1968 Sep;47(9):1973-99. doi: 10.1172/JCI105886.
A technique is described for the measurement of muscle capillary basement membranes by electron microscopic examination of needle biopsies of the quadriceps muscle. With this procedure it has been possible to obtain an objective evaluation of the significance of capillary basement membrane hypertrophy in diabetic microangiopathy. The results of such studies of muscle capillary basement membrane thickness in 50 normal, 51 diabetic, and 30 prediabetic patients have demonstrated the following. First, that the average capillary basement membrane width of diabetic patients is over twice that of normal subjects; moreover, such basement membrane thickening is a very constant finding among overtly diabetic patients, in that approximately 98% of individual diabetic subjects demonstrated this lesion. The degree of basement membrane thickening in diabetic patients is, however, unrelated to age, weight, severity, or duration of diabetes. Second, capillary basement membrane hypertrophy has been found in approximately 50% of patients who are genetically prediabetic but who have not yet demonstrated evidence of the manifest carbohydrate disturbances of diabetes mellitus. Third, in contrast to the results obtained in genetically diabetic patients, subjects with severe hyperglycemia due to causes other than genetic diabetes only infrequently show basement membrane hypertrophy. These results indicate that thickening of the muscle capillary basement membranes is a characteristic of genetic diabetes mellitus, and further, that the hyperglycemia of diabetes is probably not the factor responsible for the microangiopathy characteristic of diabetes mellitus. Finally, the discovery of thickened capillary basement membranes in prediabetic patients suggests that basement membrane hypertrophy is a relatively early lesion of the diabetic syndrome and provides further support for the conclusion that this vascular defect is independent of carbohydrate derangements of diabetes mellitus.
本文描述了一种通过对股四头肌进行针吸活检的电子显微镜检查来测量肌肉毛细血管基底膜的技术。通过该程序，可以对糖尿病微血管病变中毛细血管基底膜肥大的意义进行客观评估。对50名正常患者、51名糖尿病患者和30名糖尿病前期患者的肌肉毛细血管基底膜厚度进行的此类研究结果如下。首先，糖尿病患者的平均毛细血管基底膜宽度是正常受试者的两倍多；此外，这种基底膜增厚在显性糖尿病患者中是一个非常常见的发现，因为大约98%的个体糖尿病患者都有这种病变。然而，糖尿病患者基底膜增厚的程度与年龄、体重、严重程度或糖尿病病程无关。其次，在大约50%的遗传易患糖尿病但尚未表现出糖尿病明显碳水化合物紊乱证据的患者中发现了毛细血管基底膜肥大。第三，与遗传性糖尿病患者的结果相反，非遗传性糖尿病导致的严重高血糖患者很少出现基底膜肥大。这些结果表明，肌肉毛细血管基底膜增厚是遗传性糖尿病的一个特征，而且，糖尿病的高血糖可能不是导致糖尿病微血管病变特征的因素。最后，在糖尿病前期患者中发现毛细血管基底膜增厚表明基底膜肥大是糖尿病综合征相对早期的病变，并进一步支持了这一血管缺陷独立于糖尿病碳水化合物紊乱的结论。
