中西医结合治疗方案干预重度糖尿病足病炎性指标临床研究

Clinical Observation on Inflammatory Indexes of Severe Diabetic Foot Intervened by Integrated Traditional Chinese and Western Medicine Treatment Scheme

目的观察中西医结合方案治疗重度糖尿病足溃疡的临床疗效及创面细菌学结果。方法采用随机数字表法将符合纳入标准患者共60例患者随机分为中西医结合治疗组(ZXY)30例和基础治疗组(JC)30例,两组患者分别给予基础治疗基础上,ZXY组予一效膏外用结合自拟中药汤剂(清热通络汤)口服;JC组予常规换药治疗;两组均连续治疗14 d。观察两组患者治疗前后血清肿瘤坏死因子-α(血清TNF-α)、白细胞介素6(IL-6)、C反应蛋白(CRP)表达,创面细菌学结果,中医症候评分、临床疗效及安全性。结果(1)ZXY组血清TNF-α(7.20±2.41)、IL-6(76.33±18.47)、CRP(13.63±8.08)明显优于JC组,P<0.05,具有统计学意义;(2)创面分泌物培养细菌学结果比较,ZXY组(16.67%)明显优于JC组(43.33%),P<0.05,有统计学意义;(3)ZXY组中医证候评分(10.57±5.92)明显优于JC组(13.47±4.71),P<0.05,有统计学意义;(4)ZXY组临床有效率(93.33%)明显优于JC组(70.00%);(5)经14 d治疗后,两组患者均未发生明显不良反应。结论中西医结合治疗方案可降低糖尿病足溃疡患者血清TNF-α、IL-6、CRP表达,降低局部细菌培养阳性率,改善中医症候评分,临床疗效确切,效果显著,安全性高。

Objective To observe the clinical efficacy and wound bacteriological results of integrated traditional Chinese and Western medicine in the treatment of severe diabetic foot ulcer.Methods 60 patients who met the inclusion criteria were randomly divided into integrated traditional Chinese and Western medicine treatment group(ZXY)(n=30)and basic treatment group(JC)(n=30)according to the random number table method.On the basis of basic treatment for the patients in the two groups,the ZXY group was given Yixiao Ointment(一效膏)with external use and the oral administration of self-designed traditional Chinese medicine decoction[Qingre Tongluo Decoction(清热通络汤)].JC group received routine dressing change therapy.Both groups were treated continuously for 14 days.The expressions of serum TNF-α,IL-6 and CRP,wound bacteriological results,TCM symptom score,clinical efficacy and safety in the two groups before and after treatment were observed.Results(1)The levels of serum TNF-α(7.20±2.41),IL-6(76.33±18.47),and CRP(13.63±8.08)in the ZXY group were significantly better than those in the JC group,with statistical significance(P<0.05);(2)Bacteriological results of wound secretion culture in ZXY group(16.67%)were significantly better than those in JC group(43.33%),with statistical significance(P<0.05);(3)The TCM syndrome score of ZXY group(10.57±5.92)points was significantly better than that of JC group(13.47±4.71)points,P<0.05,with statistical significance;(4)The clinical effective rate in the ZXY group(93.33%)was significantly better than that in the JC group(70.00%);(5)After treatment for 14 days,no obvious adverse reactions occurred in both groups.Conclusion The integrated traditional Chinese and Western medicine treatment scheme can reduce the expression of serum TNF-α,IL-6 and CRP in patients with diabetic foot ulcer,improve TCM symptom score,reduce the positive rate of local bacterial culture,with definite clinical effect,remarkable effect and high safety.