Skin blood flow response to locally applied mechanical and thermal stresses in the diabetic foot
Skin blood flow response to locally applied mechanical and thermal stresses in the diabetic foot
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DOI：
10.1016/j.mvr.2013.05.004
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发表时间：
2013-09-01
影响因子：
3.1
通讯作者：
Ennis, William J.
中科院分区：
文献类型：
--
作者：
Jan, Yih-Kuen;Shen, Sa;Ennis, William J.
糖尿病足溃疡是糖尿病患者最常见的并发症之一，会导致严重的残疾和生活质量下降。微血管反应性受损会导致糖尿病足部溃疡的发生。然而，足部溃疡对机械和热应激等外在致病因素的反应导致微血管反应性受损的潜在生理机制尚未得到很好的研究。本研究共纳入26名受试者，其中2型糖尿病伴周围神经病变患者18例，健康对照组8例。用激光多普勒血流计测量在300 mm Hg的机械应力和42℃的快速热应力下，第一跖头的皮肤血流量。皮肤血流振荡的小波分析用于评估代谢、神经源性和肌源性的控制。我们的结果表明，糖尿病患者对热应激的代谢、神经源性和肌源性反应显著降低，尤其是在第一次血管扩张反应期间的神经源性和肌源性对照，以及在第二次血管扩张反应期间的代谢对照。糖尿病患者在反应性充血时对机械应激的肌源性反应显著降低。我们的研究结果表明，局部施加的机械和热应力可以用来评估微血管的反应性和糖尿病足溃疡的风险。(C)2013 Elsevier Inc.保留所有权利。
Diabetic foot ulcers are one of the most common complications in diabetics, causing significant disabilities and decreasing the quality of life. Impaired microvascular reactivity contributes to the development of diabetic foot ulcers. However, underlying physiological mechanisms responsible for the impaired microvascular reactivity in response to extrinsic causative factors of foot ulcers such as mechanical and thermal stresses have not been well investigated. A total of 26 participants were recruited into this study, including 18 type 2 diabetics with peripheral neuropathy and 8 healthy controls. Laser Doppler flowmetry was used to measure skin blood flow at the first metatarsal head in response to a mechanical stress at 300 mm Hg and a fast thermal stress at 42 degrees C. Wavelet analysis of skin blood flow oscillations was used to assess metabolic, neurogenic and myogenic controls. Our results indicated that diabetics have significantly decreased metabolic, neurogenic and myogenic responses to thermal stress, especially in the neurogenic and myogenic controls during the first vasodilatory response and in the metabolic control during the second vasodilatory response. Diabetics have a significantly decreased myogenic response to mechanical stress during reactive hyperemia. Our findings demonstrate that locally applied mechanical and thermal stresses can be used to assess microvascular reactivity and risk of diabetic foot ulcers. (C) 2013 Elsevier Inc. All rights reserved.