糖尿病足介入治疗的荟萃分析

Interventional therapies for diabetic foot:a meta-analysis

目的评价介入治疗糖尿病足的临床疗效及改善血管狭窄的有效性。方法联机检索Coehrane图书馆临床对照试验库、Medline、Embase、中国知网、万方数据库1995年1月至2011年12月发表的有关介入治疗糖尿病足的随机对照研究,并进行荟萃分析。结果共纳入11项研究686例患者,近期疗效包括血供明显改善、踝肱指数(ABI)升高、感染愈合、间歇性跛行改善等。7项研究报道可以改善远期疗效,主要包括截肢率的减低(OR=0.19,95%CI:0.14,0.26),溃疡及感染好转(OR=0.19,95%CI:0.12,0.29)等,4项研究报道远期疗效结果不确定,主要包括血管再狭窄率(OR=0.28,95%CI:0.10,0.78)。结论介入治疗能改善下肢血供,具有明显的近期疗效和一定的远期疗效;受纳入文献质量的限制,所得结论论证强度有待加强,期待大样本、多中心、高质量和针对性强的前瞻性随机对照研究进一步证实。

Objective To evaluate the clinical effect and the improvement of angiostenosis of interventional therapy in treating diabetic foot. Methods The authors collected academic papers about randomized controlled trials concerning interventional treatment for diabetic foot, that were published between January 1995 and December 2011, from Medline, EMBASE, CBMdisc, CNKI, the Coehrane Library and other databases, and the data were analyzed by using Meta-analysis with software RevMan 4.2. Results A total of 11 trials with 686 patients were enrolled in the study. The short- term effect parameters of interventional therapy for diabetic foot included： significant increase in blood flow, increase of ankle-braehial index （ABI） value, healing of infection, improvement of intermittent claudication, etc. Seven trails showed that long-term effects could be obtained, including mainly decrease in diabetes-related lower limb amputation rate （OR = 0.19, 95%CI： 0.14, 0.26） and improvement of ulcer and infection （OR = 0.19, 95%CI： 0.12, 0.29）, while other four studies indicated that the long- term effect was uncertain, mainly in respect of vascular restenosis rate （OR = 0.28, 95% CI： 0.10, 0.78）. Conclusion Interventional treatment can improve the blood flow of lower extremities and this therapy carries significant short-term effects as well as some certain long-term effects for diabetic foot. Considering the limitations of the data used in this study, the conclusions presented in this paper need to be further verified through muhi- center, high- quality, prospective randomized controlled trials with large sample size. （J Intervent Radiol, 2013, 22：718-721 ）