Abbot N C, Beck J S, Wilson S B, Khan F
Department of Pathology, Ninewells Hospital and Medical School, University of Dundee, UK.
Clin Auton Res. 1993 Jun;3(3):189-93. doi: 10.1007/BF01826232.
Fingertip skin blood flow was measured by laser Doppler flowmetry (as LDflux) under environmental conditions promoting vasodilation in Scottish patients with diabetes mellitus and Indian patients with leprosy. The reflex control of fingertip blood flow was assessed by measuring the reduction in LDflux induced by deep inspiratory gasp (IG) and cold challenge (CC) of immersing the contralateral hand in cold water. The uncomplicated diabetic patients showed normal vasomotor reflexes and an increased, though non significant, LDflux level (p < 0.06). The patients with diabetic neuropathy had resting LDflux levels significantly less than the uncomplicated group and also had substantial impairment of both IG and CC reflexes. Those with retinopathy (but no clinically apparent neuropathy) had LDflux within the normal range, but they showed minor evidence of impairment of the vasomotor reflexes. The uncomplicated newly registered leprosy patients had reduced LDflux and substantial impairment of CC reflexes. These changes were more marked in newly registered leprosy patients with clinical evidence of neuropathy. Leprosy patients with long-standing neuropathy requiring orthopaedic treatment had LDfluxes so greatly reduced that measurement of vasomotor reflexes was not practicable. The CC reflex was more severely affected than the IG reflex and more frequently absent in leprosy patients, possibly because of associated sensory neuropathy affecting the afferent limb of this response. Thus laser Doppler flowmetry can detect impairment of reflex control of fingertip blood flow in both diabetes mellitus and leprosy, but there are functional differences in the pattern of autonomic impairment between the diseases, suggesting differences in the pathogenesis of nerve damage.
在促进血管舒张的环境条件下，采用激光多普勒血流仪（LDflux）测量了苏格兰糖尿病患者和印度麻风病患者的指尖皮肤血流。通过测量深吸气屏气（IG）以及将对侧手浸入冷水中进行冷刺激（CC）所诱导的LDflux降低情况，评估指尖血流的反射控制。无并发症的糖尿病患者表现出正常的血管运动反射，且LDflux水平有所升高，尽管差异不显著（p < 0.06）。糖尿病神经病变患者的静息LDflux水平显著低于无并发症组，并且IG和CC反射均有明显受损。患有视网膜病变（但无临床明显神经病变）的患者LDflux在正常范围内，但他们显示出血管运动反射受损的轻微迹象。新登记的无并发症麻风病患者LDflux降低，CC反射明显受损。这些变化在有神经病变临床证据的新登记麻风病患者中更为明显。患有需要骨科治疗的长期神经病变的麻风病患者LDflux大幅降低，以至于无法进行血管运动反射的测量。CC反射比IG反射受影响更严重，在麻风病患者中更常缺失，这可能是由于相关的感觉神经病变影响了该反应的传入支。因此，激光多普勒血流仪可以检测糖尿病和麻风病中指尖血流反射控制的受损情况，但两种疾病自主神经损伤模式存在功能差异，提示神经损伤发病机制存在差异。
