中医药综合疗法治疗糖尿病足59例临床研究

Clinical Research About Combining Therapy on Traditional Chinese Medicine Treat Diabetic Foot with 59 Cases

目的:探讨中药内服和外治相结合的综合疗法治疗糖尿病足的临床疗效及作用机制。方法:将118例患者随机按数字法分为对照组57例和治疗组59例。对照组采用西医常规疗法,治疗组在西医常规治疗的基础上加用中药内服,中药熏洗、湿敷方等综合措施。两组疗程均为8周。进行治疗前后创面面积、创面深度、肉芽组织形态、脓液情况、创周红肿、疼痛、温度评分;检测治疗前后患肢腓总神经和腓肠神经的运动神经传导速度(MNCV)和感觉神经传导速度(SNCV);检测治疗前后纤维蛋白原(FIB),糖化血红蛋白(Hb A1c),一氧化氮(NO),内皮素(ET),血管内皮生长因子(VEGF)水平;计算创面闭合指数。结果:两组临床疗效经Ridit分析,治疗组优于对照组(P<0.05);治疗后治疗组创面面积、创面深度、肉芽组织形态、脓液情况、创周红肿评分均低于对照组;治疗后治疗组腓总神经和腓肠神经的MNCV和SNCV的速度均快于对照组(P<0.01);治疗后8周治疗组创面愈合率和创面闭合指数均高于对照组(P<0.05);治疗后治疗组FIB,Hb A1c,ET水平均低于对照组(P<0.01),治疗组NO和VEGF水平均高于对照组(P<0.01)。结论:在西医常规治疗的基础上,中药内服和局部给药相结合的疗法促进了创面的愈合,促进了神经的传导速度,提高了临床疗效,其作用机制可能与降低FIB,Hb A1c,调节NO/ET,升高VEGF水平有关。

Objective： To discuss the clinical effect and its mechanism action oncombining treatment in diabetic foot of traditional chinese medicine internal and external combination therapy. Method： One hundred and eighteen patients were randomly divided into control group （57 cases） and treatment group （59 cases） by random number table. Patients in control group received combining therapy of Western medicine, patients in treatment group added traditional Chinese medicine for oral administration, herbal fumigation and hydropathic compress. The treatment lasted 8 weeks. Before and after treatment, scores of area of wound surface, depth of burn, morphology of granulation tissue, pus, red and swollen, pain and temperature were recorded. Motor nerve conduction velocity （MNCV） and sensory nerve conduction velocity （SNCV） of limb of common peroneal nerve and sural nerve were detected. Levels of fibrinogen （FIB） , glycosylated hemoglobin （HbAlc） , nitric oxide （NO） , endothelin （ET） and vascular endothelial growth factor （VEGF） were detected. Wound closing index was calculated. Result： Analyzed by Ridit, the clinical efficient in treatment group was superior to which in control group （P 〈 0.05 ）. After treatment, scores of area of wound surface, depth of burn, morphology of granulation tissue, pus, red and swollen, pain and temperature in treatment group were lower than those in control group. MNCV and SNCV were faster than those in control group （P 〈 0.01 ）. At the eighth week after treatment, healing rate and wound closing index were higher than those in control group （P 〈 0.05 ）. Levels of FIB, HbA1 c and ET were lower than those in control group （P 〈 0.01 ）, and levels of NO and VEGF were higher than those in control group （P 〈 0.01 ）. Conclusion ： Based on the therapy of Western medicine, combining therapy of traditional Chinese medicine for oral administration combined with external treatment can promote wound healing, nerve conduction velocity, and improve clinical efficacy. Its mechanism of action may be associated with declining levels of FIB and HbAlc, regulating NO/ET, and raising level of VEGF.