Shore A C, Price K J, Sandeman D D, Tripp J H, Tooke J E
Diabetes Research Laboratory, Postgraduate Medical School, University of Exeter.
Arch Dis Child. 1994 Jan;70(1):22-6. doi: 10.1136/adc.70.1.22.
In healthy subjects, standing elicits a reduction in blood flow to the skin of the foot. In adults with insulin dependent diabetes this posturally induced response is deficient, resulting in capillary hypertension when the foot is in the dependent position (that is, below heart level). Such functional abnormalities of the microcirculation in diabetes may precede any evidence of clinically detectable microangiopathy. This study investigates the posturally induced change in blood flow to the skin of the foot in prepubertal and postpubertal patients with insulin dependent diabetes. Laser Doppler fluximetry was used to assess the postural change in blood flow at the pulp of the great toe. Postural vasoconstriction (dependent flux value/supine flux value x 100) was greater after puberty in normal subjects (median (range) 60.4 (7.0-164.9)% prepubertal v 20.5 (5.9-101.0)% postpubertal). Prepubertal children with diabetes did not differ from their healthy peers (69.8 (7.2-192.7)% with diabetes v 60.4 (7.0-164.9)% controls); however postpubertal children with diabetes had a significantly impaired postural vasoconstriction (40.6 (7.9-140.2)% with diabetes v 20.5 (5.9-101.7)% controls). Abnormalities in the normal reduction of blood flow on standing occurred in young postpubertal children with diabetes, most of whom were free of complications.
在健康受试者中，站立会引起足部皮肤血流量减少。在胰岛素依赖型糖尿病成人患者中，这种体位性诱导反应不足，导致足部处于下垂位置（即低于心脏水平）时出现毛细血管高血压。糖尿病患者微循环的这种功能异常可能在临床可检测到的微血管病变迹象出现之前就已存在。本研究调查了青春期前和青春期后胰岛素依赖型糖尿病患者足部皮肤血流量的体位性诱导变化。使用激光多普勒血流仪评估拇趾趾腹处血流量的体位变化。正常受试者青春期后体位性血管收缩（下垂血流量值/仰卧位血流量值×100）更大（中位数（范围）青春期前为60.4（7.0 - 164.9）%，青春期后为20.5（5.9 - 101.0）%）。青春期前糖尿病儿童与健康同龄人无差异（糖尿病患儿为69.8（7.2 - 192.7）%，对照组为60.4（7.0 - 164.9）%）；然而，青春期后糖尿病儿童的体位性血管收缩明显受损（糖尿病患儿为40.6（7.9 - 140.2）%，对照组为20.5（5.9 - 101.7）%）。青春期后糖尿病患儿在站立时正常的血流量减少出现异常，其中大多数患儿无并发症。
