糖尿病足溃疡患者创面局部注射胰岛素对全身血糖及创面的影响

Effect of insulin by local injection on the level of systemic blood glucose and granulation tissue formation of wound in patients with diabetic foot ulcer

目的观察糖尿病足溃疡患者创面局部注射胰岛素对全身血糖和创面肉芽组织形成的影响。方法选择2009年6月-2010年6月在笔者单位住院治疗的糖尿病足患者32例，按随机数字表法分为胰岛索组和对照组，每组16例。所有患者预先清创。（1）胰岛素组：将胰岛素计算剂量的1／2用生理盐水稀释成lmL后，浸润注射于溃疡创面基底部，另1／2计算量按常规行腹部皮下注射，均为2次／d。（2）对照组：将胰岛素计算剂量的全量常规注射于腹部皮下，溃疡创面基底部浸润注射1mL生理盐水，均为2次／d。2组患者均连续注射7d。于患者每次注射前及注射后0．5、1．0、2．0、4．0h，分别检测其空腹血糖值。于首次注射前及注射3、5、7d，评估创面肉芽组织生长程度；取创面组织标本观察CD34表达情况，据此计算创面微血管密度（MVD）。对实验数据行t检验。结果2组患者观察期内空腹血糖值维持在6．6～12．8（10．0±2．2）mmol／L，各时相点组间比较，差异均无统计学意义（t值为0．000～2．209，P值均大于0．05）。注射第5天起，胰岛素组患者局部创面肉芽组织明显增多；第7天达生长高峰[（59．06±1．58）％]，与对照组[（23．61±1．57）％]比较，差异有统计学意义（t=17．420，P=0．000）。CD34表达情况显示，胰岛素组注射3d起有新生血管形成，但此时MVD与对照组接近（t=0．247，P〉0．05）；注射5、7d，胰岛素组创面组织MVD每200倍视野中分别为（8．34±0．48）、（11．22±0．97）个，明显多于对照组的（4．42±0．14）、（5．44±1．13）个，t值分别为16．568、27．664，P值均小于0．01。结论糖尿病足溃疡患者创面局部注射胰岛素对全身血糖有较明显影响，能加速肉芽组织生长，促进创面愈合。

Objective To investigate the effects of local injection of insulin on the level of systemic blood glucose anti granulation tissue formation of wound in patients with diabetic foot ulcer. Methods Thirty-two patients with diabetic foot ulcer hospitalized in our wards from June 2009 to June 2010 were divided into insulin （ I, n = 16） and control （C, n = 16） groups according to the random number table. For patients in I group, after debridement, one half of calculated dose of insulin dilated with equal amount of norreal saline was injected diffusely into the base of the ulcer, and another half dose of insulin was subcutaneously injected into abdominal wall for 7 days, two times a day. For patients in C group, after debridement, primary insulin was subcutaneously injected into abdominal wall, 1 mL saline was subcutaneously injected into basal layer of ulcer for 7 days, two times a day. Before injection and 0.5, 1. 0, 2.0, and 4.0 hours after injection （PIH） , level of fasting blood glucose was determined. Before injection and on post injection day （ PID ） 3, 5, and 7, the growth of granulation tissue was assessed, and wound specimens were harvested for observation of CD34 expression and calculatiun of microvessel density （MVI））. Data were processed with t test. Results The levels of fasting blood glucose in both groups during observational time points ranged from 6.6 mmol/L to 12.8 mmol/L with a mean of （ 10.0 ± 2.2 ） mmol/l., and there was no statistical difference （ with t values from 0. 000 to 2. 209, P values all above 0.05 ）. Growth of ganulatiun tissue in 1 group was more exuberant from PID 5, especially on PID 7 [ （ 59.06 ± 1.58 ） % ] , which was significantly richer than that in C group [（23.61 ±1.57）%,t = 17. 420, P =0.000]. New vessels were observed inl group from PID 3 as indicated by CD34 expression. There was no obvious difference in the number of MVD between I group and C group on PID 3 （ t =0.247, P 〉0.05）. The number of MVD per 200 times visual field in I group was respectively 8.34 ± 0.48, 11.22 ± 0.97 on PID 5 and 7, which was respectively higher than that in C group （4.42 ± 0.14, 5.44±1.13, with t value respectively 16. 568, 27. 664, P values all below 0.01）. Conclusions Local injection of insulin has a significant effect on systemic blood glucose in patients with diabetic foot ulcer, and it can promote the growth of granulation tissue and wound healing.