芪丹通络汤联合封闭负压引流治疗糖尿病足临床疗效及对溃疡区微炎症状态、血管新生的影响

Efficacy of Qidan Tongluo Decoction Combined with Vacuum Sealing Drainage on Diabetic Foot and Its Effects on Microinflammation and Angiogenesis of Ulcers

目的探讨芪丹通络汤联合封闭负压引流(VSD)治疗糖尿病足(DF)的临床疗效及对溃疡区微炎症状态、血管新生的影响。方法采用随机数字表法将98例患者分为治疗组和对照组各49例。2组均予糖尿病饮食,合理运动,控制血糖、血脂、血压等基础治疗;对照组同时予VSD;治疗组在对照组基础上予芪丹通络汤,每日1剂,每日2次,口服。观察2组溃疡处肉芽组织出现时间、溃疡愈合时间;比较2组治疗前后足背血流指标及血清白细胞介素(IL)-6、IL-18、肿瘤坏死因子(TNF)-α、血管内皮生长因子(VEGF)、碱性成纤维生长因子(bFGF)、内皮抑素(ES)水平;观察创缘新生皮肤和皮下肉芽组织HE染色后新生血管情况;比较2组临床疗效。结果治疗组溃疡面肉芽组织出现时间和溃疡愈合时间少于对照组(P<0.01)。2组治疗后足背动脉血流速度、血管内径和搏动指数均高于对照组(P<0.01)。与本组治疗前比较,2组血清IL-6、IL-18、TNF-α、ES水平明显降低,VEGF、bFGF水平明显升高(P<0.01);2组治疗后比较,治疗组血清IL-6、IL-18、TNF-α、ES水平明显低于对照组(P<0.01),VEGF、bFGF水平明显高于对照组(P<0.01)。组织学检查显示,治疗组治疗后创面新生微血管丰富。治疗组总有效率为93.88%(46/49),对照组为79.59%(39/49),2组比较差异有统计学意义(P<0.05)。结论芪丹通络汤口服联合VSD有利于改善DF溃疡区微炎症状态,增加血液循环,促进新生血管形成,加速溃疡愈合,疗效显著。

Objective To investigate the efficacy of Qidan Tongluo Decoction combined with vacuum sealing drainage(VSD) on diabetic foot(DF) and its effects on microinflammation and angiogenesis of ulcers. Methods Totally 98 patients with DF were divided into treatment group and control group according to random number table method, with 49 cases in each group. Both groups were given basic treatment such as diabetes diet, reasonable exercise, blood sugar control, blood lipid control and blood pressure control. The control group was given VSD treatment at the same time. The treatment group were given Qidan Tongluo Decoction orally on the basis of the treatment of the control group, one dosage per day, twice a day, orally. The occurrence time of granulation tissue and healing time of ulcer were compared between the two groups, and the indexes of dorsum of foot blood flow, serum interleukin(IL)-6, IL-18, tumor necrosis factor(TNF)-α, vascular endothelial growth factor(VEGF), basic fibroblast growth factor(bFGF) and endostatin(ES) were compared before and after treatment. The marginal new skin and subcutaneous granulation tissue were observed under the microscope after HE staining, and the clinical efficacy was compared between the two groups. Results The time of granulation tissue appearance and ulcer healing of the treatment group were less than those of the control group(P<0.01). The blood flow velocity, vessel diameter and pulsation index of dorsum of foot of the treatment group were higher than those of the control group(P<0.01). Compared with before treatment, the serum levels of IL-6, IL-18, TNF-α and ES decreased(P<0.01), and the levels of VEGF and bFGF increased(P<0.01) in both groups;After treatment, the serum levels of IL-6, IL-18, TNF-α and ES of the treatment group were lower than those of the control group(P<0.01), and the levels of VEGF and bFGF were higher than those of the control group(P<0.01). The total effective rate was 93.88%(46/49) in the treatment group and 79.59%(39/49) in the control group, with statistical significance(P<0.05). Conclusion Qidan Tongluo Decoction combined with VSD can improve the microinflammation in ulcer area of DF, increase blood circulation, promote angiogenesis, accelerate ulcer healing, and has significant efficacy.