不同肾脏功能状态对糖尿病足部溃疡疗效及预后的影响

Relationship between different renal functional state with therapeutic effect on diabetic foot ulcers

目的探讨肾脏功能对糖尿病足部溃疡疗效及预后的影响.方法采用前瞻性研究的方法,对126例Ⅰ～Ⅴ期糖尿病足部溃疡患者在治疗前检查肾脏功能后,进行全身综合治疗及溃疡局部彻底清创,外敷黄芪提取液加适量短效胰岛素,观测溃疡部位肉芽组织出现时间(GT)、溃疡愈合时间(HT)及溃疡治愈率、截肢率.结果糖尿病肾病从Ⅰ期逐渐过渡到Ⅴ期,相同程度糖尿病足部溃疡患者的GT和HT逐渐延长,其中糖尿病肾病Ⅰ～Ⅲ期相同程度足部溃疡患者GT和HT均显著短于糖尿病肾病Ⅳ期(临床蛋白尿期)和Ⅴ期(终末期肾病)相同程度足部溃疡患者的GT和HT(P<0.05或P<0.01);糖尿病足部溃疡患者的GT和HT与糖尿病肾病病情程度间呈显著正相关(r1=2.344和r2=2.563,P均<0.05);糖尿病肾病Ⅰ～Ⅲ期糖尿病足部溃疡患者的截肢率显著少于糖尿病肾病Ⅳ期和Ⅴ期相应程度的足部溃疡患者(P<0.05),治愈率也显著高于后者(P<0.05).结论糖尿病肾病病情的轻重在很大程度上影响了糖尿病足部溃疡的治疗效果及预后,提示对糖尿病足部溃疡患者注重和尽可能改善肾功能状态是非常必要的.

Objective To study the relationship between renal functional state and the therapeutic effect and prognosis of foot ulcers in the patients with diabetic mellitus. Methods The renal function was evaluated in term of glomerular filtration rate, microalbuminuria, protein uria, blood urea nitrogen （BUN） and creatinine （Cr） levels in 126 patients with Ⅰ -Ⅴ class diabetic foot ulcers （according to Wagnar classic standard） before the treatment, and then these patients were divided into 1 -5 classes （according to Mogenson standard） and given systemic treatment and local debridement, with astragulus for topical application. The time of growth of granulation tissue （GT）, the time of healing （HT）, the amputation rate and mortality were observed. Results GT and HT of ulcer prolonged with worsening of diabetic nephropathy regardless of the disease phase of foot ulcers, especially the GT and HT of foot ulcers were significantly longer in Ⅳ and Ⅴ phases of diabetic nephropathy than those of Ⅲ phase diabetic nephropathy though the conditions of their foot ulcers were about the same. GT and HT in all the patients with the foot ulcers in the similar condition exhibited significantly positive linear correlation with the severity of diabetic nephropathy （r1 = 2. 344 and r2= 2. 563, respectively, both P〈0. 05）. The mortality of Ⅰ -Ⅲ phase diabetic nephropathy was significantly lower than that of Ⅳ and Ⅴ phase diabetic nephropathy when the foot ulcers of these patients were of the same extent （P〈0. 05）. Conclusion A worsening of renal function would affect the treatment effect and prognosis of foot ulcers in the patients with diabetic foot ulcers, implicating that it is very important to improve the renal function in the treatment of patients with diabetic foot ulcers.