化瘀通痹汤联合盐酸沙格雷酯片治疗老年2型糖尿病合并下肢动脉硬化闭塞症临床研究

Clinical study of Huayu-Tongbi decoction combined with sarpogrelate in the treatment of senile diabetes mellitus complicated with arteriosclerosis obliterans of lower extremities

目的评价化瘀通痹汤联合盐酸沙格雷酯片治疗老年T2DM合并下肢动脉硬化闭塞症(atheriosclerosis obliterans, ASO)的疗效。方法将符合入选标准的105例ASO患者采用随机数字表法分为对照组52例和观察组53例。对照组口服盐酸沙格雷酯片,观察组在对照组基础上加服化瘀通痹汤。2组均治疗2个月。采用全自动生化分析仪检测FPG、HbA1c、TC、HDL-C、LDL-C水平,计算动脉硬化指数(arteriosclerosis index, AI)、踝肱指数(ankle brachial index, ABI)及动脉内膜中层厚度(intima-media thickness, IMT),采用超声检测仪检测2组治疗前后的胫后和足背动脉血管内径、血管峰值流速及血流量,评价临床疗效。结果观察组总有效率为94.3%(50/53)、对照组为76.9%(40/52),2组比较差异有统计学意义(χ2=6.502,P=0.011)。治疗后,观察组FPG、HbA1c、TC及LDL-C水平均低于对照组(t值分别为5.201、6.716、5.878、10.293,P值均<0.01),胫后动脉与足背动脉血管内径、血管峰值流速及血流量均大于对照组(t值分别为4.295、6.639、8.310、5.045、5.393、9.672,P值均<0.01)。治疗后,观察组AI[(4.23±0.65)比(4.81±0.83),t=3.991]、IMT[(0.95±0.10)mm比(1.11±0.13)mm,t=4.829]均小于对照组(P<0.01),ABI[(1.10±0.19)比(0.93±0.17),t=7.077]大于对照组(P<0.01)。结论化瘀通痹汤联合盐酸沙格雷酯片可有效调节老年T2DM合并ASO患者的糖脂代谢紊乱,改善胫后动脉与足背动脉的血液循环,提高临床疗效。

Objective To evaluate the effect of Huayu-Tongbi decoction combined with sarpogrelate in the treatment of senile diabetes mellitus complicated with arteriosclerosis obliterans (ASO) of lower extremities. Methods A total of 105 ASO patients who met the inclusion criteria were divided into control group (52 cases) and observation group (53 cases) by random number table method. The control group was treated with oral sarpogrelate. The observation group was treated with Huayu-Tongbi decoction on the basis of the control group. Both groups were treated for 2 months. The level of FPG, HbA1c, TC, HDL-C and LDL-C were detected by automatic biochemical analyzer. The arteriosclerosis index (AI), ankle brachial index (ABI) and intima-media thickness (IMT) were calculated. The internal diameter of posterior tibial artery and dorsal pedal artery, peak velocity and blood flow were measured by ultrasound detector before and after treatment in two groups. The clinical effect was evaluated. Results The total effective rate was 94.3%(50/53) in the observation group and 76.9%(40/52) in the control group. There was a significant difference between the two groups (χ2=6.502, P=0.011). After treatment, the level of FPG, HbA1c, TC and LDL-C in the observation group was significantly lower than those in the control group (t were 5.201, 6.716, 5.878 and 10.293, respectively, all Ps<0.01). internal diameter of posterior tibial artery and dorsal pedal artery, peak velocity and blood flow in the observation group were significantly larger than those in the control group (t were 4.295, 6.639, 8.310, 5.045, 5.393 and 9.672, respectively, all Ps<0.01). After treatment, the AI (4.23 ± 0.65 vs. 4.81 ± 0.83, t=3.991), IMT (0.95 ± 0.10 mm vs. 1.11 ± 0.13 mm, t=4.829) in the observation group were significantly lower than those in the control group (P<0.01), while the ABI (1.10 ± 0.19 vs. 0.93 ± 0.17, t=7.077) was significantly higher than those in the control group (P<0.01). Conclusions The Huayu-Tongbi decoction combined with sarpogrelate can regulate the disorder of glucose and lipid metabolism in elderly diabetic patients with ASO, improve the blood circulation of posterior tibial artery and dorsal pedal artery, in order to improve the clinical effect.