The purpose of this study is to establish a new, non - invasive diagnostic technique for peripheral circulation in patients with diabetes mellitus in the early stage of arteriosclerosis obliterans (ASO) as one of the complications of diabetes mellitus. We observed peripheral circulation quantitatively by thermography and Laser- Doppler blood flowmetry. The body surface peripheral circulation in 27 patients with diabetes mellitus, including 14 males and 13 females with a mean age of 67.4 years (range from 51-82 years), and with a mean hemoglobin A1C (HbA1C) 019.5% (range from 6.8%-13.0%), and who were suffering coldness, numbness or pain in their feet, was examined using thermography and Laser- Doppler blood flowmetry. Thermographic results were analyzed quantitatively by calculating a recovery ratio as : Recovery ratio= [Total counts of thermography (Pixels) over temperature (T) after cold -loading] + [Initial counts over T after hot-loading] Xl00 (%). Results of recovery ratios for 27 cases were 0% - 93.5%, and the average was 34.0%. At the same time, the blood flow after cold -loading was 0.91 - 5. 36ml/min/lOOg tissue and the average was 2.04ml/min/l00g tissue. We found that the recovery ratio and the blood flow were correlated (r=O. 634, p<O. 0001). The recovery ratio for males was 28.4% and that of females was 39.9%, and there was a tendency for the recovery ratio of females to be higher than males, however, this was not statistically significant. There was a correlation between the recovery ratio and age (r=O.187, p < 0.0001), although, the correlation was low. There was also a slight correlation between the recovery ratio and HbA1C (r=0.041, p<O.OOl). On the other hand, the blood flow of males was 2. 03ml/min/lOOg tissue and that of females was 2.05. There was a tendency for the recovery ratio of females to be higher than males. however. the correlation was not significant. There was a correlation between blood flow and age (r=O. 110, p<0 . 0001) , however, the correlation was low. There was also a slight negative correlation between blood flow and HbA1C (r=-0.179, p<O.OOOl). The ratio of the blood flow after cold -loading at 20t divided by the blood flow after hot -loading at 36 C was 38.1 %-122%, and the average was 80.6%. There was correlation between this ratio and the recovery ratio (r=0.502, p<O.OOOl). The case of the peripheral blood flow recovered immediately to the amount of the hot-loading or access amount of hot-loading after cold-loading, and had a high recovery ratio of thermography. This might mean that the cooled body surface was warmed by overcirculation of blood flow to keep body temperature at 30C in the mean of homeostasis. We showed that thermography and Laser- Doppler blood flowmetry were useful for non - invasive study to separate patients with poor peripheral circulation. We recommend that these methods for evaluation of further treatment, such as with Prostaglandin E1, on peripheral circulation in patients with diabetes mellitus and ASO.

糖尿病患者における閉塞性動脈硬化症の合併を早期に診断,予知,予防する目的で末梢循環障害の程度を非侵襲的にかつ客観的に測定することを試みた｡非侵襲的測定方法としてサーモグラフィーとレ-ザードップラー血流計を同時に用い,得られた結果を数量化した｡症例は,下肢に冷え症,しびれ感,下肢痛を有した51歳から82歳までの 27症例(平均年齢67.4歳)であった｡性別は,男性14例,女性13例,HbA1Cは6.8%-13.0%,辛均9.5%であった｡サーモグラフィーで得られた結果は回復率として数量化して表示された｡回復率の算出方法は回復率-【20℃冷水負荷後の27℃以上の体表面温度のサーモグラフィーの画素(pixel)の総数】÷【36℃の温水負荷後の27℃以上の体表面温度のサーモグラフィーのPixelの総数】×100%で求めた｡ サ-モグラフィーにより測定された回復率は0%-93.5%の範囲にあった｡平均は34.0%であった｡レーザードップラー血流計により20℃冷水負荷後に測定された血流量は0.91-5.36ml/min/100g tissueの範囲にあった｡平均は2.04mi/min/100g tissueであった｡得られたサーモグラフィーの回復率とレ-ザードップラ-血流計の血流量との間には正の相関関係を認めた(p<0.0001,r=0.634)0 36℃の温水負荷後に測定された血流量とサーモグラフィーの回復率との間には20℃冷水負 荷後同様に相関関係(p-0.0002,r=0.483)を認めたが,相関係数は20℃冷水負荷後に比較して低値であった｡性別と回復率との間には男性28%,女性40%で女性の方が回復率が高い傾向にあったが,2群間に有意差を認めなっかた｡年齢と回復率の間には正の相関関係(p<0.0001,r=0.187)を認めたが相関係数は低値であった｡HbA1Cと回復率との間には正の相関関係(p<0.001,r=0.041)を認めたが相関係数は低値であった｡一方,性別と血流量との間には男性2.03,女性2.05ml/min/100g tissueで女性の方が血流量が多い傾向にあったが,2群間に有意差を認めなかった｡年齢と血流量との間には正の相関関係(p<0.0001,r=0.110)を認めたが相関係数は低値であった｡HbA1Cと血涜量との間には負の相関関係(p<0.0001,r=-0.179)を認めたが相関係数は低値であった｡36℃温水負荷時の血流量を100%とした時の20℃冷水負荷時の血流量の割合を求めたところ38.1%～122%の範囲にあった｡ 平均は80.6%であった｡冷水負荷後の血流量の温水負荷時との比と回復率との間には正の相関関係を認めた(p<0.0001,r=0.502)｡このことは,末梢血流量が冷水負荷後,速やかに冷水負荷前値に回復するか,あるいはさらに前値よりも上回って増加する症例においては末梢皮膚温度の回復率が高いことが示された｡ 糖尿病患者における末梢循環障害の程度をサーモグラフィーとレーザ-ドップラー血流計を同時に用い非侵襲的にかつ客観的に測定することが可能であった｡今後,両者の併用は糖尿病患者における閉塞性動脈硬化症の合併の早期診断,予知,予防に役立つことのみならず,末梢循環障害の程度に応じた治療とその効果について定量的な評価に有用な方法と考えられた｡