Mayrovitz H N, Larsen P B
Miami Heart Research Institute, Vascular Laboratory and Wound Healing Center, Florida 33140.
Microvasc Res. 1994 Nov;48(3):338-48. doi: 10.1006/mvre.1994.1060.
Appropriate assessment of microvascular function is now recognized as an important adjunct to the diagnostic workup and medical follow-up for a variety of conditions. Laser Doppler fluxmetry (LDF)-derived rbc perfusion (Q) and the volume (V) and velocity (U) components are useful in this regard but the fact that the sampled volume includes both nutritional and nonnutritional components may limit its specificity and range of usefulness. It was reasoned that if the depth of penetration could be reduced without significantly altering essential optical transmission features, then the detected signal would better represent the nutritional component. A 0.68-mm-thick Delrin spacer was fabricated and used to compare LDF values with (WITH) and without (WITHOUT) its use on the foot dorsum of 71 limbs of 44 diabetic (DM) and nondiabetic (NO-DM) subjects with lower extremity arterial disease (LEAD, n = 39) and without disease (NORM, n = 32). Overall LDF values WITH as compared to WITHOUT had a slightly greater U (1.01 vs 0.89 mm/sec, P < 0.01) and much lower V (0.06 vs 0.63%, P < 0.001) and Q (0.25 vs 1.88 ml/min/100 g, P < 0.001). In NO-DM subjects, WITH detected a lower Q in limbs with LEAD (0.14 vs 0.27, P < 0.05) but WITHOUT did not (1.48 vs 1.47, ns). In DM subjects, WITH measured a significantly lower U in LEAD limbs (1.05 vs 1.22 mm/sec, P < 0.05), which was not detected WITHOUT. Without the spacer, NORM limb LDF values were all greater in DM vs NO-DM subjects. With spacer use, only the DM velocity component was significantly greater. Use of a modified LDF procedure has shown both utility and promise as a method for evaluation of skin microcirculation and appears to offer some potential benefits as compared with the currently used standard method. Previously undocumented differences between LEAD and NORM limbs in DM and NO-DM patients as herein reported represent initial findings using a 0.68-mm spacer.
如今，微血管功能的恰当评估被视为对多种病症进行诊断检查和医学随访的一项重要辅助手段。激光多普勒血流仪（LDF）得出的红细胞灌注量（Q）以及血容量（V）和血流速度（U）分量在这方面很有用，但所采集的体积既包含营养成分又包含非营养成分这一事实可能会限制其特异性和有用范围。据推断，如果能在不显著改变基本光学传输特性的情况下减小穿透深度，那么检测到的信号将能更好地代表营养成分。制作了一个0.68毫米厚的聚甲醛垫片，并将其用于比较44名患有下肢动脉疾病（LEAD，n = 39）和未患疾病（NORM，n = 32）的糖尿病（DM）和非糖尿病（NO - DM）受试者的71条肢体足背在使用（WITH）和不使用（WITHOUT）该垫片时的LDF值。总体而言，与不使用垫片相比，使用垫片时LDF值的血流速度U略高（1.01对0.89毫米/秒，P < 0.01），血容量V低得多（0.06对0.63%，P < 0.001），红细胞灌注量Q也低得多（0.25对1.88毫升/分钟/100克，P < 0.001）。在非糖尿病受试者中，使用垫片时检测到患有LEAD的肢体中红细胞灌注量Q较低（0.14对0.27，P < 0.05），但不使用垫片时未检测到差异（1.48对1.47，无显著差异）。在糖尿病受试者中，使用垫片时测得患有LEAD的肢体中血流速度U显著较低（1.05对1.22毫米/秒，P < 0.05），不使用垫片时未检测到该差异。不使用垫片时，糖尿病受试者的正常肢体LDF值均高于非糖尿病受试者。使用垫片时，只有糖尿病受试者的血流速度分量显著更高。使用改良的LDF程序已显示出作为评估皮肤微循环方法的实用性和前景，并且与目前使用的标准方法相比似乎具有一些潜在益处。本文所报告的糖尿病和非糖尿病患者中LEAD和正常肢体之间此前未记录的差异代表了使用0.68毫米垫片的初步研究结果。
