糖尿病足溃疡患者皮肤微循环结构改变研究

目的：通过糖尿病足与非糖尿病患者足部皮肤微循环结构的比较，了解糖尿病足患者足部皮肤微循环的特征。方法选取2011年6月至2012年4月在中山大学孙逸仙纪念医院住院的足病患者48例为研究对象，其中糖尿病足患者29例（ DFU组），非糖尿病患者19例（ NDM组），取足部皮肤制作石蜡切片，行血管性血友病因子（ vWF ）、血管内皮生长因子（ VEGF ）及抗体的免疫组化，对比两组患者足部皮肤真皮乳头层微循环结构的各项指标。两两比较采用 t 检验，多因素采用logistic回归分析。结果与非糖尿病患者组比较，糖尿病足患者组足背部皮肤真皮乳头层面积增大[（1.6±0.5）×105比（1.1±0.4）×105μm2，t＝3.5，P＜0.05]，但单位面积下真皮乳头个数减少[（63±18）比（90±30）个/mm2，t ＝4.05， P＜0.05]；真皮乳头内微血管密度降低[（109±34）比（161±40）条/mm2， t＝4.81， P＜0.05]，但微血管外径增大[（23.9±2.8）比（21.9±3.2）μm， t＝2.28， P＜0.05]；微血管内皮细胞密度[（320±150）比（563±212）个/mm2， t＝4.65， P＜0.05]和内皮细胞数量[（8.2±1.5）比（10.3±2.1）个， t＝4.06， P＜0.05]减少，但内皮细胞厚度增加[（4.0±0.4）比（3.2±0.3）μm， t＝6.47，P＜0.05]；同时，血管VEGF表达减少（0.34±0.04比0.41±0.05， t＝4.87， P＜0.05）。结论足部皮肤真皮乳头层内微循环结构的改变可能与糖尿病足的发生和发展有着密切的联系。

Skin microcirculation structural changes diabetic foot ulcer patients

Objective To investigate the structure changes of foot skin microcirculation features of diabetic foot ulcer through comparing the foot skin microcirculation structure between diabetic and non diabetic foot.Methods 29 diabetes with foot ulcer and 19 non-diabetes with orthopedics foot malformation or trauma surgery in-patients were recruited in Sun Yat-sen Memorial Hospital from June 2011 to April 2012.Foot skin was collected to make paraffin section.The von Willebrand factor （vWF） and vascular endothelial growth factor （ VEGF） and its antibody in vascular endothelial cells were showed by immunohistochemistry and the photographs were analysis by Image Pro 6.0 to compare the data of foot skin papillary layer of dermis between two groups.The t test compares the differences between two groups.Association between variables is examined by multiple logistic regression analysis.Results Compared with non-diabetic patients , the papillary dermal area （（1.6 ±0.5） ×105 vs （1.1 ±0.4） ×105 μm2,t =3.5, P 〈0.05） of diabetic patients was increased,but the papillary dermal density （63 ±18 vs 90 ±30,t =4.05, P 〈0.05） was decreased significantly;In diabetes, the microvascular density （109 ±34 vs 161 ±40, t=4.81, P〈0.05） was lower, but the out diameter of microvascular （（23.9 ±2.8）vs（21.9 ±3.2） μm, t=2.28, P〈0.05） in dermal papilla was bigger.The endothelial cells number （8.2 ±1.5 vs 10.3 ±2.1, t=4.06, P〈0.05） and the vascular endothelial cells number per unit area （320 ±150 vs 563 ±212, t=4.65, P〈0.05） were reduced, on the contrary, the vascular endothelial cells thickness （（4.0 ±0.4）vs（3.2 ±0.3）μm, t =6.47, P〈0.05）was increased.At the same time, the expression of VEGF （0.34 ±0.04 vs 0.41 ±0.05, t=4.87, P〈0.05） was decreased significantly.Conclusion The incidence and development of diabetes foot is involved with the change of foot skin microcirculation structure in papillary layer of dermis .