糖尿病足合并下肢动脉粥样硬化闭塞症患者腔内介入治疗效果观察

Effect of endovascular interventions on patients with diabetic foot combined with atherosclerotic obliteration of lower extremity

目的观察下肢动脉介入治疗对糖尿病足合并下肢动脉粥样硬化闭塞症患者的效果。方法选取2020年1月至2021年8月在包头医学院第二附属医院内分泌科就诊的糖尿病足合并下肢动脉粥样硬化闭塞症患者56例,根据随机数字表法分为介入组及药物治疗组,各28例。所有受试者均给予抗血小板、他汀类药物稳定斑块及足部溃疡清创治疗,药物治疗组予己酮可可碱静脉滴注,介入组予下肢动脉球囊扩张成形术。3个月后随访,比较2组踝肱指数、动脉狭窄率及溃疡愈合情况。分析影响患者溃疡愈合的危险因素。结果 治疗后,介入组踝肱指数高于治疗前且高于药物治疗组[(0.79±0.17)比(0.50±0.13)],动脉狭窄率低于治疗前且低于药物治疗组[(25±15)%比(84±10)%](均P<0.01)。介入组愈合率、总有效率均高于药物治疗组(均P<0.01)。多因素Logistic回归分析结果显示,药物治疗、高糖化血红蛋白及高低密度脂蛋白胆固醇为糖尿病足合并下肢动脉粥样硬化闭塞症患者溃疡不愈合的危险因素(均P<0.05)。结论对于合并下肢动脉粥样硬化闭塞症的糖尿病足溃疡患者,血管内介入治疗效果明显优于药物保守治疗,且安全性相当,如无禁忌可优先选择。

Objective To observe the effect of endovascular interventions on patients with diabetic foot combined with atherosclerotic obliteration of lower extremity. Methods A total of 56 patients with diabetic foot combined with atherosclerotic obliteration(ASO) of lower extremity were enrolled, who were admitted to Department of Endocrinology, the Second Affiliated Hospital of Baotou Medical College from January 2020 to August 2021. Patients were randomly divided into intervention group and drug treatment group, with 28 cases in each group. All patients were treated with antiplatelet coagulation and statins to stabilize plaques and debridement of foot ulcer. The drug treatment group was treated with pentoxifylline intravenous drip. The intervention group was treated with balloon angioplasty of lower extremity arteries. Patients were followed-up for 3 months after treatment. The ankle brachial index(ABI) arterial stenosis rate and ulcer healing were compared between the two groups, and the risk factors for delaying ulcer healing were analyzed. Results After treatment, ABI in the intervention group was higher than that before treatment and that in the drug treatment group [(0.79±0.17) vs(0.50±0.13)], and the arterial stenosis rate in the intervention group was lower than that before treatment and that in the drug group [(25±15)% vs(84±10)%](all P<0.01). The healing rate and the total effective rate in the intervention group were higher than those in the drug treatment group(both P<0.01). Multivariate Logistic regression analysis showed that drug treatment, high hemoglobin and high lwo-density lipoprotein cholesterol were the risk factors for ulcer non-healing(all P<0.05). Conclusion For patients with diabetic foot ulcers complicated by ASO of lower extremity, endovascular intervention is superior to conservative treatment with good safety and can be preferred when patients have no contraindications.