血必净对老年重度糖尿病足围手术期甲状腺激素水平影响作用的临床观察

Level of thyroid hormone(TH) and inflammatory factor during amputation surgery for old patients of severe diabetic foot combined with euthyroid sicks syndrome and the effect from Xuebijing

目的:观察糖尿病足坏疽截肢术围手术期并发正常甲状腺功能病态综合征(ESS)老年患者血甲状腺激素水平及炎症因子的变化,探讨血必净对ESS的影响作用及其机制。方法:56例糖尿病足坏疽伴ESS的老年患者在截肢术前随机分为血必净组及对照组,每组28例,2组术后均给予常规治疗。血必净组组在常规治疗基础上加用血必净50 mL,tid治疗,检测2组在术前、术后第1,7,12天IL-6及FT3,TT3,FT4的变化。结果:(1)同时段2组比较:术前2组间甲状腺激素水平无明显差异,术后第1,12天血必净组T3、FT3水平明显高于对照组(P<0.05),FT42组间无显著性差异(P>0.05)。(2)与术前比较:对照组术后第1,7天测得FT3、T3明显低于术前(P<0.05),第12天测FT3、T3与术前无显著差异(P>0.05)。血必净组第1,7天测FT3、T3较术前水平低(P<0.05),第7,12天测得FT3、T3高于术前(P<0.05)。FT4水平2组各时段与术前均无明显差异(P>0.05)。对照组的炎性介质IL-6水平第12天与术前比较无显著性差异(P>0.05),术后第1天明显增高(P<0.05);血必净组除第1天以外,IL-6水平较术前有显著下降(P<0.05);血必净组第7,12天的IL-6水平低于对照组(P<0.05)。(3)糖尿病足截肢术后老年患者IL-6水平与FT3呈负相关(r=-0.772,P<0.05)。结论:重度糖尿病足截肢术围手术期ESS状态短期内很难完全缓解;血必净可能通过其抗炎作用减轻糖尿病足坏疽截肢术后老年患者ESS。

OBJECTIVE To observe the level of thyroid hormone（TH） and inflammatory factor during amputation surgery for old patients of severe diabetic foot combined with euthyroid sicks syndrome（ESS）,and the effect on ESS from Xuebijing.METHODS 56 amputation surgery of severe diabetic foot combined with euthyroid sicks syndrome patients were selected and randomly divided into normal group（n=28）,Xuebijing group（n=28）,both groups treated with conventional therapy,while the group of Xuebijing mainlined with Xuebijing（50 mL,tid）.TH,IL-6 were detected in the preoperative,the first day（1d）,7,12 d after operation.RESULTS（1） The level of TH in the 1d after operation in both groups was similar（P0.05）.In the 7,12 d after operation,the level of serum T3,FT3 in group of Xuebijing was higher than those in the control group（P0.05）.FT4 was similar between them（P0.05）.（2）Compared with preoperative level,the level of FT3,T3 in control was lower than that in 1 d and 7 d（P0.05）,but FT3,T3 wasn＇t different with that before operation in 12 d.Compared with preoperative level,the level of FT3,T3 in group of Xuebijing was lower than that in 1 d（P0.05）.The level of FT3,T3 in group of Xuebijing was higher than that in 7 d and 12 d（P0.05）.The level of serum FT4 was similar among them（P0.05）.The level of IL-6 in control group in 7 d and 12 d was indifference with that before operation（P0.05）.The level of IL-6 in both groups was higher significantly than that before operation in the 1 d.In the 7 d and 12 d after operation,the level of IL-6 in the group of Xuebijing decreased markedly（P0.05）.（3） The level of IL-6 was significantly negative correlated with FT3（r=-0.772,P0.05）.CONCLUSION The ESS during perioperative period of amputation surgery of severe diabetic foot was hardly complete remission,with the control of inflammation not easy.Xuebijing could mitigate it by anti-inflammatory effect.