Differences in foot and forearm skin microcirculation in diabetic patients with and without neuropathy
Differences in foot and forearm skin microcirculation in diabetic patients with and without neuropathy
复制标题
DOI：
10.2337/diacare.21.8.1339
复制
发表时间：
1998-08-01
期刊：
影响因子：
16.2
通讯作者：
Veves, A
中科院分区：
文献类型：
--
作者：
Arora, S;Smakowski, P;Veves, A
目的-我们已经比较了充血反应愈合和内皮依赖性和内皮非依赖性血管舒张之间的足背和前臂的糖尿病神经病变和非神经病变患者和健康controlsubjects.Research设计和方法-我们研究了皮肤微循环在前臂和足部在15糖尿病患者神经病变，在14糖尿病患者无神经病变，15名年龄、性别、BMI相匹配的对照受试者，以及糖尿病患者的糖尿病持续时间。排除外周血管疾病和/或肾损害患者。所有受试者的足背和前臂屈肌方面的皮肤微循环进行了测试。采用单点激光多普勒测量皮肤加热至44 ℃时的最大充血反应，采用激光多普勒成像扫描仪评价1%氯化乙酰胆碱（Ach）离子导入的反应（内皮依赖性反应）和1%硝普钠（NaNP）结果-神经病组在足和前臂水平的经皮氧分压较低，而对热的最大充血反应在所有三组的足和前臂水平相似。内皮依赖性血管舒张在神经病组中，与前臂相比，（23 +/- 4 vs. 55 +/- 10 [平均值+/- SEM]; P < 0.01）]，非神经病组（33 +/- 6 vs. 88 +/- 14; P < 0.01），对照组（43 +/- 6 vs. 93 +/- 13; P < 0.001）。NaNP离子导入组与对照组比较，差异有统计学意义（P < 0.05）。当计算前臂：足部反应的比率时，三组之间没有发现差异，（神经病组，2.25 ± 0.24;非神经病组，2.55 ± 0.35;对照组，2.11 ± 0.26; P = NS）和内皮非依赖性血管舒张（神经病组，1.54 ± 0.27;非神经病组，2.08 ± 0.33;对照组，2.77 ± 1.03; P = NS）。血管舒张反应，这是有关的C伤害性纤维的行动，减少在足部水平在离子电渗的乙酰胆碱在神经病组。相比之下，没有发现任何差异，在离子电渗的NaNP在脚和前臂的水平和乙酰胆碱在前臂的水平之间所有三个groups.Conclusions -在健康受试者，内皮依赖性和内皮非依赖性血管舒张是较低的脚的水平相比，前臂，和一个普遍的损害微循环的糖尿病患者神经病变保留这个前臂-脚梯度。与前臂相比，这些变化可能是足部神经病变早期受累的一个促成因素。
OBJECTIVE - We have compared the hyperemic response to heal and the endothelium-dependent and endothelium-independent vasodilatation between the dorsum of the foot and the forearm in diabetic neuropathic and non-neuropathic patients and healthy control subjects.RESEARCH DESIGN AND METHODS - We studied the cutaneous microcirculation in the forearm and foot in 15 diabetic patients with neuropathy, in 14 diabetic patients without neuropathy, and in 15 control subjects matched for age, sex, BMI, and in the case of diabetic patients, for the duration of diabetes. Patients with peripheral vascular disease and/or renal impairment were excluded. The cutaneous microcirculation of the dorsum of the foot and the flexor aspect of the forearm was tested in all subjects. Single-point laser Doppler was employed to measure the maximal hyperemic response to heating of the skin to 44 degrees C and laser Doppler imaging scanner was used to evaluate the response to iontophoresis of 1% acetylcholine chloride (Ach) (endothelium-dependent response) and 1% sodium nitroprusside (NaNP) (endothelium-independent response).RESULTS - The transcutaneous oxygen tension was lower in the neuropathic group at both foot and forearm level, while the maximal hyperemic response to heat was similar at the foot and forearm level in all three groups. The endothelium-dependent vasodilatation (percent increase over baseline) was lower in the foot compared to the forearm in the neuropathic group (23 +/- 4 vs. 55 +/- 10 [mean +/- SEM]; P < 0.01)], the non-neuropathic group (33 +/- 6 vs. 88 +/- 14; P < 0.01), and the control subjects (43 +/- 6 vs. 93 +/- 13; P < 0.001). Similar results were observed during the iontophoresis of NaNP (P < 0.05). No differences were found among the three groups when the ratio of the forearm:foot response was calculated for both the endothelium-dependent (neuropathic group, 2.25 +/- 0.24; non-neuropathic group, 2.55 +/- 0.35; and control subjects, 2.11 +/- 0.26; P = NS) and endothelium-independent vasodilatation (neuropathic group, 1.54 +/- 0.27; non-neuropathic group, 2.08 +/- 0.33; and control subjects, 2.77 +/- 1.03; P = NS). The vasodilatory response, which is related to the C nociceptive fiber action, was reduced at the foot level during iontophoresis of Ach in the neuropathic group. In contrast, no difference was found during the iontophoresis of NaNP at the foot and forearm level and of Ach at the forearm level among all three groups.CONCLUSIONS - In healthy subjects, the endothelial-dependent and endothelial-independent vasodilatation is lower at the foot level when compared to the forearm, and a generalized impairment of the microcirculation in diabetic patients with neuropathy preserves this forearm-foot gradient. These changes may be a contributing factor for the early involvement of the foot with neuropathy when compared to the forearm.