MICROANGIOPATHY IN HUMAN DIABETIC NEUROPATHY - RELATIONSHIP BETWEEN CAPILLARY ABNORMALITIES AND THE SEVERITY OF NEUROPATHY
MICROANGIOPATHY IN HUMAN DIABETIC NEUROPATHY - RELATIONSHIP BETWEEN CAPILLARY ABNORMALITIES AND THE SEVERITY OF NEUROPATHY
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DOI：
10.1007/bf00505180
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发表时间：
1989-02-01
期刊：
影响因子：
8.2
通讯作者：
WARD, JD
中科院分区：
文献类型：
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作者：
MALIK, RA;NEWRICK, PG;WARD, JD
对 5 例非神经病变糖尿病患者、5 例伴有轻度神经病变的糖尿病患者和 11 例伴有重度神经病变的糖尿病患者进行了临床、电生理和超微结构形态测量观察。通过同步神经、肌肉和皮肤活检评估毛细血管异常，并与 6 名年龄匹配的非糖尿病对照受试者的结果进行比较。神经毛细血管表现出比皮肤和肌肉毛细血管明显更严重的病理学。与对照组相比，严重神经性糖尿病患者的神经内毛细血管密度显着降低（p < 0.01）。与对照组相比，严重糖尿病神经病变患者的神经毛细血管基底膜（p < 0.002）、内皮细胞（p < 0.003）和总扩散屏障（内皮细胞、周细胞、基底膜）（p < 0.001）厚度显着增加，氧扩散能力显着降低（p < 0.001）。无症状（p < 0.01）、（p < 0.05）和严重神经病变（p < 0.001）、（p < 0.05）糖尿病患者的内皮细胞轮廓数量和管腔周长分别显着增加。然而，与对照组相比，糖尿病患者的内皮细胞外周长（毛细血管尺寸的测量指标）没有显着增加。观察到神经病理学严重程度的神经生理学和神经病理学测量之间存在关联。糖尿病病程和 HbA1 水平与毛细血管病理或神经病变严重程度之间没有显着相关性。很少有肌肉和皮肤异常与神经病变严重程度相关。然而，神经毛细血管病理学的所有测量均与神经病理学严重程度的神经生理学和神经病理学测量显着相关。
Clinical, electrophysiological and ultrastructural morphometric observations were made in 5 diabetic non-neuropathic patients, 5 diabetic patients with mild neuropathy and 11 diabetic patients with severe neuropathy. Capillary abnormalities were assessed in simultaneous nerve, muscle and skin biopsies and compared with results from 6 age-matched, non-diabetic control subjects. Nerve capillaries demonstrated markedly greater pathology than skin and muscle capillaries. Endoneurial capillary density was significantly reduced in severely neuropathic diabetic patients (p < 0.01) when compared with control subjects. Capillary basement membrane (p < 0.002), endothelial cell (p < 0.003) and total diffusion barrier (endothelial cell, pericyte, basement membrane) (p < 0.001) thickness were significantly increased, and oxygen diffusing capacity was significantly reduced (p < 0.001) in the nerves of patients with severe diabetic neuropathy when compared to control subjects. Endothelial cell profile number and luminal perimeter were significantly increased in asymptomatic (p < 0.01), (p < 0.05) and severely neuropathic (p < 0.001), (p < 0.05) diabetic patients respectively. However, endothelial cell outer perimeter, a measure of capillary size, showed no significant increase in diabetic patients when compated with control subjects. An association was observed between neurophysiological and neuropathological measures of neuropathic severity. There was no significant correlation between the duration of diabetes and HbA1 levels with capillary pathology or with neuropathic severity. Very few abnormalities of muscle and skin correlated with neuropathic severity. However, all measures of nerve capillary pathology correlated significantly with neurophysiological and neuropathological measures of neuropathic severity.