前列地尔联合硫辛酸对老年2型糖尿病足患者的临床疗效、血流动力学、纤维连接蛋白及血浆D-二聚体的影响

Effects of alprostadil combined with lipoic acid on clinical efficacy, hemodynamics, fibronectin and plasma D-dimer in elderly patients with type 2 diabetic foot

目的:探讨前列地尔联合硫辛酸对老年2型糖尿病足患者的临床疗效、血流动力学、纤维连接蛋白及血浆D-二聚体的影响。方法:选取老年2型糖尿病足患者96例作为研究对象,随机分为对照组48例和病例组48例。对照组给予硫辛酸治疗,病例组在对照组基础上给予注射用前列地尔。观察两组临床疗效、临床症状评分、溃疡愈合情况、足背动脉血流动力学指标、纤维连接蛋白及血浆D-二聚体的变化。结果:病例组总有效率显著高于对照组,差异具有统计学意义(P<0.05)。治疗后两组疼痛、肿胀、跛行、麻木评分、溃疡面积、创面pH值、血浆D-二聚体水平低于治疗前,创面氧分压高、血流流速、血管内径、阻力指数(RI)、搏动指数(PI)、纤维连接蛋白水平高于治疗前,差异具有统计学意义(P<0.05)。病例组临床疗效、溃疡愈合、足背动脉血流动力学指标、纤维连接蛋白及血浆D-二聚体水平改善情况显著优于对照组,差异具有统计学意义(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:前列地尔联合硫辛酸对老年2型糖尿病足患者临床疗效显著,纠正足背动脉血流动力学异常,促进足部溃疡愈合,提高溃疡组织纤维连接蛋白含量,降低血浆D-二聚体水平,改善高凝状态,具有较高的有效率和安全性,值得临床进一步推广。

Objective:To investigate the effects of alprostadil combined with lipoic acid on clinical efficacy,hemodynamics,fibronectin and plasma D-dimer in elderly patients with type 2 diabetic foot.Methods:Ninety-six elderly patients with type 2 diabetic foot hospitalized in Department of Endocrinology,Xining First People's Hospital from January 2017 to June 2019 were selected as the study subjects.They were divided into the control group(48 cases)and the case group(48 cases)by random number table method.The control group was treated with lipoic acid,and the case group was treated with alprostadil for injection on the basis of the control group.The clinical efficacy,clinical symptom score,ulcer healing,hemodynamics of dorsal artery of foot,fibronectin and plasma D-two dimer in two groups were observed.Results:The total effective rate of the case group was 95.83%,which was significantly higher than that of the control group(83.33%).The difference was statistically significant(P<0.05).After treatment,the pain,swelling,claudication,numbness score,ulcer area,wound PH value,plasma D-dimer level of the two groups were lower than those before treatment,and the oxygen partial pressure,blood flow velocity,vascular diameter,Resistance index,pulsation index and fibronectin levels of the two groups were higher than those before treatment,the difference was statistically significant(P<0.05).The improvement of clinical efficacy,ulcer healing,dorsal pedal artery hemodynamics,fibronectin and plasma D-dimer levels in the case group were significantly better than those in the control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion:Alprostadil combined with lipoic acid has significant clinical effect on elderly patients with type 2 diabetic foot.It can correct the abnormal hemodynamics of dorsal pedal artery,promote the healing of foot ulcer,increase the content of fibronectin ulcer tissue,reduce the level of plasma D-dimer and improve the high coagulation state.It has high efficiency and safety.It is worthy of clinical application and further promotion.