Detection of microvascular impairment in type I diabetics by laser Doppler flowmetry.
Detection of microvascular impairment in type I diabetics by laser Doppler flowmetry.
复制标题
通过激光多普勒血流计检测 I 型糖尿病患者的微血管损伤。
DOI：
10.1111/j.1475-097x.1992.tb00306.x
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发表时间：
1992
期刊：
影响因子：
--
通讯作者：
J. Belch
中科院分区：
文献类型：
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作者：
S. B. Wilson;P. Jennings;J. Belch
使用激光多普勒流量计检测微循环障碍和交感神经控制血流的手和脚的异常进行了评价。对15例胰岛素依赖型糖尿病视网膜病变患者、14例无并发症糖尿病患者和15例正常人进行了测定。评估了三项试验：（1）皮肤微循环对44 ℃局部加热的充血反应;（2）皮肤微循环对2分钟动脉闭塞的反应性充血反应;和（3）外周血管收缩剂对冷刺激和吸气性喘息的反射。试验（1）和（2）施用于手和足的背，试验（3）施用于指尖和脚趾的髓。所有测试均在受试者通过间接加热进行外周血管扩张的情况下进行。在这方面，没有发现任何措施组之间的差异。足背局部加热的充血反应显示，并发症糖尿病患者的最大血流量明显低于无并发症患者（P <0.01）和正常人（P <0.002）。一项新的测量，流量增加到3倍基础流量的时间，在复杂组中比无并发症组（P <0.02）和正常组（P <0.001）更长。无并发症组的反应比正常组慢（P <0.01）。闭塞后充血反应在组间无差异。血管收缩反射测定结果显示，并发症组对大脚趾冷刺激的反应比无并发症组差（P <0.02），并发症组一般比其他两组差。总之，我们已经发现，局部加热的充血反应可以检测微血管损伤糖尿病其他并发症变得明显之前，血管收缩试验可能能够识别周围交感神经病变的个人。
The use of a laser Doppler flowmeter to detect microcirculatory impairment and abnormalities in sympathetic neural control of blood flow in the hands and feet was evaluated. Measurements were carried out in 15 insulin dependent diabetic patients with retinopathy, 14 uncomplicated diabetics and 15 normal subjects. Three tests were assessed (1) the hyperaemic response of the skin microcirculation to local heating at 44 degrees C; (2) the reactive hyperaemic response of the skin microcirculation to 2 min arterial occlusion; and (3) the peripheral vasoconstrictor reflexes to cold challenge and inspiratory gasp. Tests (1) and (2) were applied to the dorsum of the hand and foot and test (3) to the pulp of the fingertip and toe. All tests were carried out with the subjects peripherally vasodilated by indirect heating. At the hand no differences were found between the groups for any of the measures. The hyperaemic response to local heating at the dorsum of the foot showed that the maximum flow in complicated diabetics was significantly lower than that in uncomplicated patients (P less than 0.01) and in normal subjects (P less than 0.002). A new measure, the time for flow to increase to 3 times basal flow, was longer in the complicated group compared with the uncomplicated (P less than 0.02) and the normal groups (P less than 0.001). This test also showed that the response in the uncomplicated group was slower than in the normal group (P less than 0.01). The post-occlusive hyperaemic response did not differ between groups. Measurement of vasoconstrictor reflexes showed that the complicated group had a poorer response to cold challenge at the big toe than the uncomplicated group (P less than 0.02) and the complicated group generally tended to have poorer responses than the other two groups. In conclusion, we have found that the hyperaemic response to local heating can detect microvascular impairment in diabetes before other complications become apparent and that the vasoconstriction test may be able to identify individuals with peripheral sympathetic neuropathy.