Yosipovitch G, Schneiderman J, Erman A, Chetrit A, Milo G, Boner G, van Dijk D J
Department of Dermatology, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel.
Diabet Med. 1997 Mar;14(3):235-41. doi: 10.1002/(SICI)1096-9136(199703)14:3<235::AID-DIA331>3.0.CO;2-S.
Patients with longstanding insulin-dependent (Type 1) diabetes mellitus (IDDM) are reported to have microvascular complications in most capillary beds. The microvascular hyperaemia of the skin in normoalbuminuric and microalbuminuric IDDM patients and healthy volunteers was measured with laser Doppler flowmetry. The effect of 3 and 9 months of treatment with captopril, an angiotensin converting enzyme inhibitor, on hyperaemia in the microalbuminuric patients was studied. Mean (+/- SD) pretreatment duration of skin postocclusive reactive hyperaemia was longer in microalbuminuric than in both normoalbuminuric patients and healthy volunteers (118.2 +/- 34.4 vs 57.8 +/- 16.0 vs 63.3 +/- 18.3 sec, respectively, p < 0.00001). After 3 and 9 months of captopril treatment the prolonged hyperaemia was shortened to 78.6 +/- 45.6 s (p < 0.01) and 62.3 +/- 55.6 s (p < 0.03), respectively. Urinary albumin excretion decreased from 63.9 +/- 43.5 to 33.4 +/- 28.1 mg 24 h-1 at 3 months treatment (p < 0.002) and 43.1 +/- 38.5 mg 24 h-1 at the end of the study period (p < 0.02). A positive correlation between changes in urinary albumin excretion and the shortening of the skin postocculsive reactive hyperaemia was found. Blood pressure remained in the same range throughout. These results show that captopril affects skin blood flow, independent of its hypotensive effect. This action may reflect the influence of angiotensin converting enzyme inhibitor on vascular beds other than those of the kidneys.
据报道，长期胰岛素依赖型（1型）糖尿病（IDDM）患者在大多数毛细血管床会出现微血管并发症。采用激光多普勒血流仪测量了正常白蛋白尿和微量白蛋白尿的IDDM患者以及健康志愿者皮肤的微血管充血情况。研究了血管紧张素转换酶抑制剂卡托普利治疗3个月和9个月对微量白蛋白尿患者充血情况的影响。微量白蛋白尿患者皮肤闭塞后反应性充血的平均（±标准差）预处理持续时间长于正常白蛋白尿患者和健康志愿者（分别为118.2±34.4秒、57.8±16.0秒和63.3±18.3秒，p<0.00001）。卡托普利治疗3个月和9个月后，延长的充血时间分别缩短至78.6±45.6秒（p<0.01）和62.3±55.6秒（p<0.03）。治疗3个月时尿白蛋白排泄量从63.9±43.5降至33.4±28.1mg 24 h-1（p<0.002），研究期末降至43.1±38.5mg 24 h-1（p<0.02）。发现尿白蛋白排泄量变化与皮肤闭塞后反应性充血缩短之间存在正相关。血压在整个过程中保持在相同范围内。这些结果表明，卡托普利影响皮肤血流，与其降压作用无关。这种作用可能反映了血管紧张素转换酶抑制剂对肾脏以外血管床的影响。
