糖尿病足部溃疡患者对不同刺激的神经血管反应研究

Study on neurovascular responses to different stimulations in diabetic patients with foot ulcer

目的探讨糖尿病足部溃疡患者对不同刺激的神经血管反应情况。方法选取2016年5月至2019年1月我院就诊的2型糖尿病患者200例。将其分为糖尿病足组(DFU,n=46),非糖尿病足组(non-DFU,n=154),及我院体检的健康者为健康对照组(NC,n=50)。对上述3组分别进行热刺激、乙酰胆碱(Ach)刺激和局部压力刺激,采用激光多普勒血流仪持续检测不同刺激下患者足部皮肤血流量(SKBF)和血管舒张功能变化。结果DFU组和non-DFU组的NSS、NDS和DN4Q评分比较,DFU组明显高于non-DFU组(P<0.05);利多卡因处理前后,DFU组的压觉感知阈值(CPTT)显著高于non-DFU组(P<0.05);且DFU组患者的足部皮肤温度、温觉感知阈值显著高于non-DFU组。3组受试者基础皮肤血流量(SKBF)比较,DFU组显著低于NC组(P<0.05);3组受试者热刺激时最大初始峰值差异无统计学意义(P>0.05),但热刺激时最大后高原期,DFU组显著低于NC组(P<0.05);足部Ach刺激时,DFU组的最大初始峰值显著低于NC组(P<0.05),但最大后高原期差异无统计学意义(P>0.05);压力刺激时,3组受试者的SKBF差异存在统计学差异(P<0.05),予以利多卡因后再次进行压力刺激,DFU组和non-DFU组的SKBP均比利多卡因前明显下降(P<0.05),但组间差异不存在统计学意义(P>0.05)。结论与健康受试者相比,糖尿病患者对压力的血管舒张功能明显受损。与non-DFU患者相比,DFU患者的血管舒张能力明显降低,DFU患者对不同刺激的神经血管反应的明显改变可以作为皮肤脆弱的敏感指标,可以用来更好地预测个体病变的风险。

Objective To investigate the neurovascular responses to different stimulations in patients with diabetic foot ulcer.Methods A total of 200 diabetic patents in The Fifth People's Hospital of Zhuhai from May,2016 to January,2019 were involved in this study.Patients with diabetic foot ulcer were assigned into DFU group(n=46)and the other 154 patients without foot ulcer were included into non-DFU group(n=154).Meanwhile,fifty healthy people were included into the healthy control group.Heat stimulation,acetylcholine(Ach)stimulation and local applied pressure stimulation were applied in the three groups,respectively.The changes of skin blood flow(SKBF)and Vasodilation capacities were measured in response to different stimulations detected by a laser doppler flowmeter.Results Compared with the NSS,NDS and DN4Q scores between DFU and non-DFU groups,these indexes in the DFU group were higher than those in the non-DFU group.Before and after administrating lidocaine,the cutaneous pressure perception threshold was higher in DFU group than that in non-DFU group and so did the foot skin temperature and warm perception threshold.There was no difference in the initial peak in response to heating among three groups,but the late plateau phase in the DFU group was much lower than that in the healthy groups.When stimulated by ACh,the initial peak in the DFU group was lower than that in the healthy group,but the difference was not observed in the late plateau phase.There was significant difference of SKBF among three groups in response to local applied pressure.After giving lidocaine,SKBP in DFU and non-DFU groups was decreased,but there was no significant difference between these two groups.Conclusion Vasodilatation in response to pressure is impaired in both diabetic groups compared to healthy subjects,the vasodilator capacity to pressure is lower in patients with DFU compared to those without DFU.This pronounced alteration of neurovascular response to pressure in patients with DFU could be a good marker of skin vulnerability and used to better predict individuals at risk.