BLOOD-FLOW IN THE DIABETIC NEUROPATHIC FOOT
BLOOD-FLOW IN THE DIABETIC NEUROPATHIC FOOT
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DOI：
10.1007/bf00253862
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发表时间：
1982-01-01
期刊：
影响因子：
8.2
通讯作者：
WATKINS, PJ
中科院分区：
文献类型：
--
作者：
EDMONDS, ME;ROBERTS, VC;WATKINS, PJ
沙科关节和足部溃疡发展的机制尚不清楚。目前使用无创多普勒技术的研究表明，在神经性腿部，动脉硬化，外周血流量增加，并与动静脉分流有关。研究对象为伴有严重神经病变的糖尿病患者10例（其中伴有Charcot改变的糖尿病患者5例）、无神经病变的糖尿病患者16例及对照组10例。明显异常的血流速度谱（超声图）仅在那些严重神经病变的患者中表现出来。他们的舒张血流增加（脉搏指数降低2.88±-）。0.8(平均+-。SD值为9.53。无神经病变的糖尿病患者为4.0 (P < 0.001)，无神经病变的糖尿病患者为10.8。3.7例（对照组P < 0.001）提示动静脉分流。通过减少传递次数-57 .+-表示刚性增加。6.3毫秒(平均+-。伴有神经病变的糖尿病患者的SD值与66。无神经病变的糖尿病患者为7.6 ms (P < 0.01)；对照组为9.1 ms （P < 0.05）。同时伴有踝关节收缩压升高-199 +-。22mmhg(平均+-。伴有神经病变的糖尿病患者的SD值与151。无神经病变的糖尿病患者为15 mm Hg (P < 0.001)，无神经病变的糖尿病患者为146。18 mm Hg （P < 0.001）。内侧壁钙化几乎只发生在神经病患者身上。这些血流的改变，包括动静脉分流，可能在神经性腿部并发症的发病机制中很重要。
The mechanisms which underlie the development of Charcot joints and foot ulceration are poorly understood. The present study using non-invasive Doppler techniques demonstrates that in the neuropathic leg, the arteries are rigid, peripheral blood flow is increased and associated with arteriovenous shunting. Ten diabetics with severe neuropathy (including 5 with Charcot changes), 16 diabetics without neuropathy and 10 control subjects were studied. Markedly abnormal blood velocity profiles (sonograms) were demonstrated only in those patients with severe neuropathy. They showed increased diastolic flow (indicated by a reduced Pulsatility Index of 2.88 .+-. 0.8 (mean .+-. SD) compared with 9.53 .+-. 4.0 (P < 0.001) in the diabetics without neuropathy and 10.8 .+-. 3.7 (P < 0.001) in the control subjects) suggesting arteriovenous shunting. Increased rigidity was indicated by decreased transit times -57 .+-. 6.3 ms (mean .+-. SD) in the diabetics with neuropathy compared with 66 .+-. 7.6 ms (P < 0.01) in the diabetics without neuropathy and 67 .+-. 9.1 ms (P < 0.05) in the control subjects. This was accompanied by raised ankle systolic pressures -199 .+-. 22 mm Hg (mean .+-. SD) in the diabetics with neuropathy compared with 151 .+-. 15 mm Hg (P < 0.001) in the diabetics without neuropathy and 146 .+-. 18 mm Hg (P < 0.001) in the control subjects. Medial wall calcification occurred almost exclusively in the neuropathic subjects. These alterations in blood flow which include arteriovenous shunting may be important in the pathogenesis of complications of the neuropathic leg.