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目的了解血管病变及微循环障碍，研究导致糖尿病足坏疽的病因、病理及发病机理。方法通过临床观察，截肢标本解剖及糖尿病病故患者尸检后，进行电镜检查。结果５２７例住院糖尿病肢端坏疽病人，其中足背动脉搏动减弱和消失者占６８．３％，下肢有缺血症状者占７７．２％，因糖尿病足坏疽被截肢３例，其标本作病理解剖检查。发现粥样硬化斑块堵塞股动脉下段管腔约８０％，动脉、胫前后动脉及足背动脉管腔完全堵塞，其管壁均有明显的胶原纤维和弹力纤维增生增厚。另外，对２０例糖尿病病故患者作了尸检，电镜检查后发现，微血管超微结构变化，主要是基底膜局部增厚和全层增厚两种表现。内皮细胞下组织细胞增生，呈驼样或乳头状或搭桥样横过血管腔，使微血管内膜粗糙不光滑，管腔狭窄或堵塞，检出率为６０％．并见内皮细胞损伤处血小板粘附和红细胞聚集及微血管栓塞。加重微循环障碍，严重影响血液与组织细胞物质交换，代谢产物不能排除，肢端缺血缺氧，细菌易于感染而导致足坏疽发生，创面不易愈合。结论糖尿病患者除大血管病变，微血管病变及微循环障碍是导致糖尿病足坏疽发生、发展的重要病因病理基础。
Objective To understand the pathological changes of blood vessels and microcirculation and to study the etiology, pathogenesis and pathogenesis of diabetic foot gangrene. Methods After clinical observation, autopsy and autopsy of diabetic patients, the patients were examined by electron microscopy. Results 527 hospitalized gangrene patients with diabetic acral ganglion, in which the dorsiflexive artery pulse weakened and disappeared accounted for 68.3%, lower limb ischemic symptoms accounted for 77.2%, diabetic foot gangrene was amputated in 3 cases, the specimens for pathology Anatomical examination. Atherosclerotic plaque was found to block the lower lumen of the femoral artery about 80% of the arteries, anterior tibial artery and dorsalis pedis artery lumen completely blocked, and its walls were significantly collagen fibers and elastic fibers hyperplasia. In addition, 20 cases of diabetic patients had autopsy, electron microscopy showed that changes in microvascular ultrastructure, mainly in the basilar membrane thickening and full thickness of two kinds of performance. Endothelial cells under the proliferation of cells, was a camel-like or papillary or bypass-like cross-vessel cavity, so that the rough endothelium of the microvascular smooth, lumen stenosis or blocked, the detection rate was 60%. See endothelial cell injury at platelet adhesion and erythrocyte aggregation and microvascular embolism. Increased microcirculation, seriously affecting the exchange of blood and tissue cells, metabolites can not be ruled out, hypoxic ischemic limbs, bacterial infections easily lead to foot gangrene, the wound is not easy to heal. Conclusion In addition to macrovascular disease, microangiopathy and microcirculation in patients with diabetes mellitus is the pathological basis of the important etiology and development of diabetic foot gangrene.