Neural and endothelial control of the microcirculation in diabetic peripheral neuropathy
Neural and endothelial control of the microcirculation in diabetic peripheral neuropathy
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DOI：
10.1212/wnl.54.6.1246
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发表时间：
2000-03-28
期刊：
影响因子：
9.9
通讯作者：
Freeman, R
中科院分区：
文献类型：
--
作者：
Kilo, S;Berghof, M;Freeman, R
目的：研究1型和2型糖尿病患者皮肤微循环内皮依赖性和非内皮依赖性血管舒张的作用及其与神经微循环控制的关系。方法：采用电离子导入乙酰胆碱和硝普钠的剂量反应技术。用激光多普勒装置测量内皮依赖性、内皮非依赖性和C纤维介导的血管舒张。结果：糖尿病患者前臂皮肤微循环内皮依赖性血管舒张功能减弱。2型糖尿病患者的反应低于对照组（p < 0.005）。相比之下，1型糖尿病受试者和对照组之间没有显著差异。两组糖尿病患者内皮非依赖性血管舒张功能均无明显异常。1型和2型糖尿病患者前臂C纤维介导的轴突反射受损，这与小纤维神经病变一致（p < 0.005）。2型糖尿病患者的糖尿病病程是最大内皮介导血管舒张的重要预测因素。结论：在糖尿病周围神经病变过程中，皮肤血流的变化相对较早，其特征是内皮和神经功能障碍，而不是平滑肌功能障碍。在2型糖尿病患者中，两组患者均存在显著的C纤维损伤，同时2型糖尿病患者的内皮依赖性血管舒张功能显著更差，这表明内皮功能和一氧化氮可能在2型糖尿病患者的糖尿病周围神经病变的发病机制中发挥更大的作用。
Objective: To examine the role played by endothelium-dependent and endothelium-independent vasodilation of the cutaneous microcirculation and their relationship to neural microcirculatory control in type 1 and type 2 diabetic patients. Methods: Acetylcholine and sodium nitroprusside were iontophoresed using a dose-response technique. Endothelium-dependent, endothelium-independent, and C-fiber-mediated vasodilation were measured with a laser Doppler device. Results: Endothelium-dependent vasodilation of the forearm cutaneous microcirculation was attenuated in diabetic subjects. The response was less in type 2 diabetic subjects than in controls (p < 0.005). In contrast, there was no significant difference between type 1 diabetic subjects and controls. There was no significant abnormality in endothelium-independent vasodilation in either diabetic group. The C-fiber-mediated axon reflex in the forearm was impaired in both type 1 and type 2 diabetics, which is consistent with a small-fiber neuropathy (p < 0.005). The duration of diabetes in type 2 diabetics was a significant predictor of the maximum endothelium-mediated vasodilation. Conclusion: Changes in cutaneous blood flow are seen relatively early in the course of diabetic peripheral neuropathy and are characterized by endothelial and neural but not smooth muscle dysfunction. The presence of significant C-fiber impairment in both diabetic groups, together with significantly greater dysfunction in endothelium-dependent vasodilation in type 2 diabetics, suggests that the endothelial function and nitric oxide may play a greater role in the pathogenesis of diabetic peripheral neuropathy in type 2 diabetic patients.