CAJ | 학술논문

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。
목적：통과당뇨병족여비당뇨병환자족부피부미순배결구적비교，료해당뇨병족환자족부피부미순배적특정。방법선취2011년6월지2012년4월재중산대학손일선기념의원주원적족병환자48례위연구대상，기중당뇨병족환자29례（ DFU조），비당뇨병환자19례（ NDM조），취족부피부제작석사절편，행혈관성혈우병인자（ vWF ）、혈관내피생장인자（ VEGF ）급항체적면역조화，대비량조환자족부피부진피유두층미순배결구적각항지표。량량비교채용 t 검험，다인소채용logistic회귀분석。결과여비당뇨병환자조비교，당뇨병족환자조족배부피부진피유두층면적증대[（1.6±0.5）×105비（1.1±0.4）×105μm2，t＝3.5，P＜0.05]，단단위면적하진피유두개수감소[（63±18）비（90±30）개/mm2，t ＝4.05， P＜0.05]；진피유두내미혈관밀도강저[（109±34）비（161±40）조/mm2， t＝4.81， P＜0.05]，단미혈관외경증대[（23.9±2.8）비（21.9±3.2）μm， t＝2.28， P＜0.05]；미혈관내피세포밀도[（320±150）비（563±212）개/mm2， t＝4.65， P＜0.05]화내피세포수량[（8.2±1.5）비（10.3±2.1）개， t＝4.06， P＜0.05]감소，단내피세포후도증가[（4.0±0.4）비（3.2±0.3）μm， t＝6.47，P＜0.05]；동시，혈관VEGF표체감소（0.34±0.04비0.41±0.05， t＝4.87， P＜0.05）。결론족부피부진피유두층내미순배결구적개변가능여당뇨병족적발생화발전유착밀절적련계。
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 .