中医“治未病”干预糖尿病高危足的临床研究

Intervention of High Risk Diabetic Foot by“Preventive Treatment of Disease”of Traditional Chinese Medicine

目的分析中医“治未病”干预糖尿病高危足的效果。方法2020年1月—2022年3月河北省沧州中西医结合医院糖尿病一科收治的糖尿病高危足患者120例,通过随机数字表法分为对照组(60例)与联合组(60例)。对照组在常规降糖治疗的基础上,给予胰激肽原酶肠溶片、甲钴胺片治疗,联合组在对照组基础上给予中医“治未病”(低频脉冲、足浴)治疗,两组均治疗32周。比较两组治疗32周后临床疗效,治疗前、治疗32周后症状评分、足部血流指标、感觉及神经功能、疾病相关血清指标,治疗期间安全性。结果治疗32周后,联合组在两组中总有效率更高[95.00%vs 80.00%,P<0.05]。与治疗前比较,治疗32周后两组中医症状评分(主症、次症、舌象、脉象)、多伦多临床神经病变评分(Toronto Clinical neuropathy score,TCSS)评分,震动感觉阈值,血清C反应蛋白(C-reactive protein,CRP)、肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)水平降低,且联合组更低(P<0.05)。与治疗前比较,治疗32周后,两组踝肱指数(ABI)、足背动脉血流量、足部皮温、腓总神经传导速度、腓肠神经传导速度,血清胰岛素样生长因子-1(insulin-like growth factor-1,IGF-1)水平升高,且联合组更高(P<0.05)。治疗过程中均无血常规、尿常规、肝功能、肾功能及心电图的异常等不良反应发生。结论中医“治未病”干预糖尿病高危足的效果较好,可改善临床症状,改善足部血流指标、感觉及神经功能,调节疾病相关血清指标表达,安全性良好。

Objective To analyze the effect of“preventive treatment of disease”of traditional Chinese medicine intervention on high-risk diabetic foot.Methods From January 2020 to March 2022,120 high-risk diabetic foot patients admitted to the first department of diabetes in Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine were divided into the control group(60 cases)and the combination group(60 cases)by random number table method.On the basis of routine hypoglycemic treatment,the control group was given pancreatic kininogenase enteric-coated tablets and mecobalamine tablets,while the combination group was given“preventive treatment of disease”of traditional Chinese medicine(low-frequency pulse,foot bath)treatment on the basis of the control group.Both groups were treated for 32 weeks.The clinical efficacy,symptom scores,foot blood flow indexes,sensory and neurological functions,disease-related serum indexes and safety during treatment were compared between the two groups after 32 weeks of treatment.Results After 32 weeks of treatment,the total effective rate of the combination group was higher than that of the control group(95.00%vs 80.00%,P<0.05).Compared with those before treatment,after 32 weeks of treatment,the scores of traditional Chinese medical symptoms(main symptoms,secondary symptoms,tongue image,pulse image),Toronto Clinical neuropathy score(TCSS),serum levels of shock sensation threshold,serum C-reactive protein(CRP)and tumor necrosis factor-α(TNF-α)in the two groups decreased,and those in the combination group were lower(P<0.05).Compared with those before treatment,after 32 weeks of treatment,the values of ankle brachial index(ABI),dorsal foot arterial blood flow,foot skin temperature,common peroneal nerve conduction velocity and sural nerve conduction velocity and serum levels of insulin-like growth factor-1(IGF-1)increased in both groups,and those were higher in the combination group(P<0.05).No adverse reactions(abnormal blood,urine routine,liver function,kidney function and electrocardiogram)occurred during the treatment.Conclusion The“preventive treatment of disease”of traditional Chinese medicine had a good effect on the high-risk diabetic feet,which could relieve the clinical symptoms,improve foot blood flow indexes,sensory and neurological functions and regulate the expressions of disease-related serum indexes,with good safety.