糖尿病大鼠皮肤组织糖代谢紊乱与皮肤神经病变相关性研究

Objective To analyze the relationship between cutaneous glycometabolic disorders and cutaneous neuropathy in diabetic rats, and to look for the mechanism of neuropathy and impaired wound healing. Methods Eighty male SD rats were randomly divided into the normal control group (NC, n =20 ), diabetic group (D, n = 20 ), aminoguanidine-interfered group (AⅠ, n = 20 ), and insulin-interfered group ( Ⅱ, n = 20) by drawing lots. Diabetes was reproduced in rats of D, AⅠ, and Ⅱ groups with intraperoguanidine, while rats in Ⅱ group were subcutaneously injected with insulin for satisfactory control of blood glucose. Changes in mechanical and heat pain thresholds of pad of hind limb were measured at post injection week ( PIW ) 2, 4, 8. Skin specimens were collected during PIW 2-8 from pads for determination of contents of glucose, advanced glycation end product ( AGE), substance P ( SP), calcitonin gene-related peptide ( CGRP), and observation of distribution and ultrastructure of skin nerve fibers. Data were processed with t test. Results The mechanical and heat pain thresholds in D group at PIW 2 [(6.3 ± 1.5) g, (6.0 ±0.9) s, respectively] were obviously lower than those in NC group [(13.0 ±3.2) g, (10.3 ± 1.2) s,with t value respectively 2.71, 3.42, P values all below 0.05]. Contents of glucose and AGE in skin tissue in D group were significantly increased when compared with those in NC group, especially at PIW 8 [(2.85 ±0.33) mg/g, (31.7±3.2) U/mg of hydroxyproline vs. (0.82 ±0.22) mg/g, (22.2 ±1.9) U/mg of hydroxyproline, with t value respectively 1.65, 6.47, P values all below 0.01]. The myelinated nerve fibers were edematous and degenerated, with axons compressed, while the unmyelinated nerve fibers were vacuolated, with microfilament and microtubule disorderly arranged. Content of SP in skin tissue in D group was lower as compared with that in NC group, especially at PIW 2 [(16.8 ±3.4) pg/g vs. (28.5 ±5.0) pg/g,t = 2.42, P ＜ 0.01]. There was no obvious difference in content of CGRP between NC and D groups, and also in content of glucose in skin between D and AⅠ groups. Compared with those in D group, content of AGE in AⅠ group at PIW 8 was decreased markedly [(27.2 ± 1.4) U/mg of hydroxyproline, t = 3.38, P ＜0.05]; contents of glucose and AGE in Ⅱ group at PIW 8 were significantly decreased [( 1.42 ± 0.38 ) mg/g,(23.6 ± 1.3 ) U/mg of hydroxyproline, with t value respectively 1.74, 8.17, P ＜ 0.05 or P ＜ 0. 01].Compared with that in D group, contents of SP in AⅠ and Ⅱ groups were increased, with a delay in time of trough value. Content of CGRP showed no obvious difference among D, AⅠ, and Ⅱ groups. Conclusions High glucose and accumulation of AGE are key mediators of cutaneous neuropathy and impaired wound healing in diabetes mellitus, which confirms that diabetic wound takes an atypical footing during wound repairing. Aminoguanidine and insulin can reduce contents of glucose and AGE in diabetic skin tissue, and ameliorate diabetic cutaneous neuropathy.     

创面修复门诊患者创面病原微生物分布及耐药性分析

目的 分析创面修复门诊患者创面病原微生物的分布特点及耐药性,为创面专科规范化建设提供依据.方法 采用回顾性病例对照研究分析2017年12月至2019年10月上海交通大学医学院附属瑞金医院收治的365例门诊创面患者临床资料,其中男220例,女145例;年龄18～98岁[(58.8 ±18.9)岁].首诊患者92例,复诊患...     

预防糖尿病足部溃疡专用袜研究

糖尿病足的发生与多种因素有关[1],目前的研究多集中于糖尿病足的发病机制及治疗方法,实际上糖尿病足最根本的治疗应该是预防.对于治愈的患者是预防复发,对高危人群是诊断并教育患者如何自查和预防足部损伤.有效预防可明显降低糖尿病足的发生率和截肢率,明显提高患者的生活质量.在各种糖尿病健康教育中,都会有关于如何选购袜子的建议,如提倡穿棉线袜,要柔软合脚,袜端不要过紧,不穿松紧口袜子,不穿有洞或者修补不平的袜子等.种种建议虽然详细但定义模糊、可操作性差,如"不要过紧",怎样才是适度?"不穿松紧口袜子",有什么措施能让袜子不下滑呢?如果袜子滑落势必导致袜底不平整,成为足底损伤的诱因.虽然袜子的材质均为棉线,但纤维粗细各异、吸水性各有不同,很难掌握合适度.     

糖尿病大鼠皮肤组织糖代谢紊乱与皮肤神经病变相关性研究

Objective To analyze the relationship between cutaneous glycometabolic disorders and cutaneous neuropathy in diabetic rats, and to look for the mechanism of neuropathy and impaired wound healing. Methods Eighty male SD rats were randomly divided into the normal control group (NC, n =20 ), diabetic group (D, n = 20 ), aminoguanidine-interfered group (AⅠ, n = 20 ), and insulin-interfered group ( Ⅱ, n = 20) by drawing lots. Diabetes was reproduced in rats of D, AⅠ, and Ⅱ groups with intraperoguanidine, while rats in Ⅱ group were subcutaneously injected with insulin for satisfactory control of blood glucose. Changes in mechanical and heat pain thresholds of pad of hind limb were measured at post injection week ( PIW ) 2, 4, 8. Skin specimens were collected during PIW 2-8 from pads for determination of contents of glucose, advanced glycation end product ( AGE), substance P ( SP), calcitonin gene-related peptide ( CGRP), and observation of distribution and ultrastructure of skin nerve fibers. Data were processed with t test. Results The mechanical and heat pain thresholds in D group at PIW 2 [(6.3 ± 1.5) g, (6.0 ±0.9) s, respectively] were obviously lower than those in NC group [(13.0 ±3.2) g, (10.3 ± 1.2) s,with t value respectively 2.71, 3.42, P values all below 0.05]. Contents of glucose and AGE in skin tissue in D group were significantly increased when compared with those in NC group, especially at PIW 8 [(2.85 ±0.33) mg/g, (31.7±3.2) U/mg of hydroxyproline vs. (0.82 ±0.22) mg/g, (22.2 ±1.9) U/mg of hydroxyproline, with t value respectively 1.65, 6.47, P values all below 0.01]. The myelinated nerve fibers were edematous and degenerated, with axons compressed, while the unmyelinated nerve fibers were vacuolated, with microfilament and microtubule disorderly arranged. Content of SP in skin tissue in D group was lower as compared with that in NC group, especially at PIW 2 [(16.8 ±3.4) pg/g vs. (28.5 ±5.0) pg/g,t = 2.42, P ＜ 0.01]. There was no obvious difference in content of CGRP between NC and D groups, and also in content of glucose in skin between D and AⅠ groups. Compared with those in D group, content of AGE in AⅠ group at PIW 8 was decreased markedly [(27.2 ± 1.4) U/mg of hydroxyproline, t = 3.38, P ＜0.05]; contents of glucose and AGE in Ⅱ group at PIW 8 were significantly decreased [( 1.42 ± 0.38 ) mg/g,(23.6 ± 1.3 ) U/mg of hydroxyproline, with t value respectively 1.74, 8.17, P ＜ 0.05 or P ＜ 0. 01].Compared with that in D group, contents of SP in AⅠ and Ⅱ groups were increased, with a delay in time of trough value. Content of CGRP showed no obvious difference among D, AⅠ, and Ⅱ groups. Conclusions High glucose and accumulation of AGE are key mediators of cutaneous neuropathy and impaired wound healing in diabetes mellitus, which confirms that diabetic wound takes an atypical footing during wound repairing. Aminoguanidine and insulin can reduce contents of glucose and AGE in diabetic skin tissue, and ameliorate diabetic cutaneous neuropathy.