自体富血小板凝胶联合负压引流对糖尿病足患者胰岛素抵抗水平及创面愈合状况的影响
|
摘要
目的探讨自体富血小板凝胶(APG)联合负压引流对糖尿病足患者胰岛素抵抗水平及创面愈合状况的影响。方法选取2016年1月至2018年5月山东省立第三医院内分泌科收治的94例糖尿病足溃疡患者为研究对象,采用随机数字表法分为观察组和对照组,每组47例,对照组采用常规治疗,观察组采用APG联合负压引流治疗,治疗4周后,比较两组患者的临床疗效、临床指标变化、创面愈合时间、住院时间、住院费用及不良反应。结果治疗前,两组患者的空腹血糖(FPG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbAlc)、胰岛素抵抗指数(HOMA-IR)、总胆固醇(TC)比较,差异均无统计学意义(P>0.05);治疗后,观察组患者的FPG、2 hPG、HOMA-IR、HbAlc水平分别为(8.53±1.06) mmol/L、(9.31±1.03) mmol/L、(0.51±0.23)、(6.53±0.51)%,明显低于对照组的(11.26±3.13) mmol/L、(14.52±3.12) mmol/L、(1.20±0.25)、(8.87±1.96)%,TC水平为(5.24±1.05) mmol/L,明显高于对照组的(4.79±1.07) mmol/L,差异均有统计学意义(P<0.05);观察组患者的治疗总有效率为95.74%,明显高于对照组的72.34%,差异有统计学意义(P<0.05);观察组患者的创面愈合时间、住院时间、住院费用分别为(36.42±3.41) d、(41.95±3.27) d、(4 593.62±453.73)元,均明显低于对照组的(47.28±3.52) d、(56.37±3.96) d、(5 785.76±547.83)元,差异均有统计学意义(P<0.05);治疗期间,对照组患者不良反应发生率为14.89%;略高于观察组的4.26%,但差异无统计学意义(P>0.05)。结论 APG联合负压引流治疗糖尿病足溃疡患者临床疗效较佳,其能降低胰岛素抵抗水平,改善血糖水平,创面愈合率高,不良反应少。
Objective To investigate the effects of autologous platelet-rich gel(APG) combined with negative pressure drainage on insulin resistance level and wound healing in diabetic foot patients. Methods A total of 94 patients with diabetic foot ulcer from January 2016 to May 2018 in Department of Endocrinology, Shandong Provincial Third Hospital were selected and randomly divided into study group and control group, with 47 cases in each group. Patients in the control group received routine treatment, while those in the study group were treated with APG combined with negative pressure drainage. After 4 weeks of treatment, the clinical efficacy, clinical indexes changes, wound healing time, length of hospital stay, hospitalization expenses, and adverse reactions were compared between the two groups.Results Before treatment, there were no significant differences in fasting blood glucose(FPG), postprandial 2 h blood glucose(2 hPG), glycosylated hemoglobin(HbAlc), insulin resistance index(HOMA-IR), total cholesterol(TC) between the two groups(P>0.05). After treatment, the levels of FPG, 2 h PG, HOMA-IR and HbAlcin the study group were(8.53±1.06) mmol/L,(9.31 ± 1.03) mmol/L,(0.51 ± 0.23),(6.53 ± 0.51)%, respectively, which were significantly lower than(11.26±3.13) mmol/L,(14.52±3.12) mmol/L,(1.20±0.25),(8.87±1.96)% in the control group(P<0.05), and TC level was(5.24±1.05) mmol/L, which was significantly higher than(4.79±1.07) mmol/L in the control group(P<0.05). The total effective rate of treatment in the study group was 95.74%, which was significantly higher than 72.34% in the control group(P<0.05). The wound healing time, length of hospital stay, and hospitalization expenses of the study group were(36.42±3.41) d,(41.95 ± 3.27) d,(4 593.62 ± 453.73) yuan respectively, which were significantly lower than(47.28 ± 3.52) d,(56.37±3.96) d,(5 785.76±547.83) yuan in the control group(P<0.05). During the treatment period, the incidence of adverse reactions in the control group was 14.89%, which was slightly higher than 4.26% in the study group(P>0.05).Conclusion APG combined with negative pressure drainage in the treatment of diabetic foot ulcer patients has better clinical efficacy. It can reduce insulin resistance level, improve blood glucose levels, and has high wound healing rate and fewer adverse reactions.
Objective To investigate the effects of autologous platelet-rich gel(APG) combined with negative pressure drainage on insulin resistance level and wound healing in diabetic foot patients. Methods A total of 94 patients with diabetic foot ulcer from January 2016 to May 2018 in Department of Endocrinology, Shandong Provincial Third Hospital were selected and randomly divided into study group and control group, with 47 cases in each group. Patients in the control group received routine treatment, while those in the study group were treated with APG combined with negative pressure drainage. After 4 weeks of treatment, the clinical efficacy, clinical indexes changes, wound healing time, length of hospital stay, hospitalization expenses, and adverse reactions were compared between the two groups.Results Before treatment, there were no significant differences in fasting blood glucose(FPG), postprandial 2 h blood glucose(2 hPG), glycosylated hemoglobin(HbAlc), insulin resistance index(HOMA-IR), total cholesterol(TC) between the two groups(P>0.05). After treatment, the levels of FPG, 2 h PG, HOMA-IR and HbAlcin the study group were(8.53±1.06) mmol/L,(9.31 ± 1.03) mmol/L,(0.51 ± 0.23),(6.53 ± 0.51)%, respectively, which were significantly lower than(11.26±3.13) mmol/L,(14.52±3.12) mmol/L,(1.20±0.25),(8.87±1.96)% in the control group(P<0.05), and TC level was(5.24±1.05) mmol/L, which was significantly higher than(4.79±1.07) mmol/L in the control group(P<0.05). The total effective rate of treatment in the study group was 95.74%, which was significantly higher than 72.34% in the control group(P<0.05). The wound healing time, length of hospital stay, and hospitalization expenses of the study group were(36.42±3.41) d,(41.95 ± 3.27) d,(4 593.62 ± 453.73) yuan respectively, which were significantly lower than(47.28 ± 3.52) d,(56.37±3.96) d,(5 785.76±547.83) yuan in the control group(P<0.05). During the treatment period, the incidence of adverse reactions in the control group was 14.89%, which was slightly higher than 4.26% in the study group(P>0.05).Conclusion APG combined with negative pressure drainage in the treatment of diabetic foot ulcer patients has better clinical efficacy. It can reduce insulin resistance level, improve blood glucose levels, and has high wound healing rate and fewer adverse reactions.
引文
[1]彭小兵.糖尿病足流行病学及糖尿病足截肢的临床分析[J].糖尿病新世界,2015,35(11):152-153.
[2]晋溶辰,黄政德,张晋如,等.糖尿病足溃疡高危体质的临床特征及对伤口愈合影响的研究[J].湖南中医药大学学报,2016,36(4):56-59.
[3]罗士欢.糖尿病足溃疡全面治疗的研究现状[J].临床医药文献电子杂志,2016,3(40):8074.
[4]YANG L,GAO L,LV Y,et al.Autologous platelet-rich gel for lower-extremity ischemic ulcers in patients with type 2 diabetes[J].International Journal of Clinical&Experimental Medicine,2017,10(9):13796-13801.
[5]张丽,强丹,孙永慧.自体富血小板凝胶治疗糖尿病足溃疡的临床观察[J].宁夏医学杂志,2016,38(9):809-811.
[6]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2013年版)[J].中华内分泌代谢杂志,2014,30(10):893-942.
[7]NICODEME JD,PAULIN EN,ZINGG M,et al.The infected diabetic foot:diagnosis and management[J].Revue Me?dicale Suisse,2015,11(477):1238-1241.
[8]DHAMODHARAN U,VISWANATHAN V,KRISHNAMOORTA-HY E,et al.Genetic association of IL-6,TNF-α,and SDF-I,polymorphisms with serum cytokine levels in diabetic foot ulcer[J].Gene,2015,565(1):62-67.
[9]任芝莉,刘会娟.眼表烧伤治疗中自体富血小板凝胶的临床应用效果观察[J].现代诊断与治疗,2016,27(22):4349-4351.
[10]LI X.The association between MCP-1,VEGF polymorphisms and their serum levels in patients with diabetic foot ulcer[J].Medicine,2018,97(24):e10959-e10963.
[11]BURNOUF T,GOUBRAN HA,CHEN TM,et al.Blood-derived biomaterials and platelet growth factors in regenerative medicine[J].Blood Reviews,2013,27(2):77-89.
[12]陈新婵,王筱菁,林健才,等.自体富血小板凝胶联合持续封闭式负压引流治疗糖尿病足溃疡的疗效观察[J].护理实践与研究,2018,15(11):42-44.
[13]孙正刚.自体富血小板凝胶联合负压引流治疗老年糖尿病足的临床探讨[J].中外医疗,2017,36(7):55-57.
[14]陈德清,左国庆,朱丹平,等.自体富血小板凝胶治疗不同治疗周期中糖尿病足溃疡的临床评价[J].中国糖尿病杂志,2018,26(4):285-289.
[15]AMABLE PR,CARIAS RB,TEIXEIRA MV,et al.Platelet-rich plasma preparation for regenerative medicine:optimization and quantification of cytokines and growth factors[J].Stem Cell Research&Therapy,2013,4(3):67-71.
[16]安静思,赵锦.自体富血小板凝胶治疗糖尿病足溃疡的临床疗效观察及对患者血糖水平的影响[J].国际医药卫生导报,2018,24(9):1340-1342.
[17]MARIANI E,FILARDO G,CANELLA V,et al.Platelet-rich plasma affects bacterial growth in vitro[J].Cytotherapy,2014,16(9):1294-1304.
[18]周丽华,陈清华,陈宗存,等.自体富血小板凝胶联合封闭式负压引流术治疗糖尿病足溃疡的效果观察[J].中国医学前沿杂志(电子版),2017,9(6):131-134.
[2]晋溶辰,黄政德,张晋如,等.糖尿病足溃疡高危体质的临床特征及对伤口愈合影响的研究[J].湖南中医药大学学报,2016,36(4):56-59.
[3]罗士欢.糖尿病足溃疡全面治疗的研究现状[J].临床医药文献电子杂志,2016,3(40):8074.
[4]YANG L,GAO L,LV Y,et al.Autologous platelet-rich gel for lower-extremity ischemic ulcers in patients with type 2 diabetes[J].International Journal of Clinical&Experimental Medicine,2017,10(9):13796-13801.
[5]张丽,强丹,孙永慧.自体富血小板凝胶治疗糖尿病足溃疡的临床观察[J].宁夏医学杂志,2016,38(9):809-811.
[6]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2013年版)[J].中华内分泌代谢杂志,2014,30(10):893-942.
[7]NICODEME JD,PAULIN EN,ZINGG M,et al.The infected diabetic foot:diagnosis and management[J].Revue Me?dicale Suisse,2015,11(477):1238-1241.
[8]DHAMODHARAN U,VISWANATHAN V,KRISHNAMOORTA-HY E,et al.Genetic association of IL-6,TNF-α,and SDF-I,polymorphisms with serum cytokine levels in diabetic foot ulcer[J].Gene,2015,565(1):62-67.
[9]任芝莉,刘会娟.眼表烧伤治疗中自体富血小板凝胶的临床应用效果观察[J].现代诊断与治疗,2016,27(22):4349-4351.
[10]LI X.The association between MCP-1,VEGF polymorphisms and their serum levels in patients with diabetic foot ulcer[J].Medicine,2018,97(24):e10959-e10963.
[11]BURNOUF T,GOUBRAN HA,CHEN TM,et al.Blood-derived biomaterials and platelet growth factors in regenerative medicine[J].Blood Reviews,2013,27(2):77-89.
[12]陈新婵,王筱菁,林健才,等.自体富血小板凝胶联合持续封闭式负压引流治疗糖尿病足溃疡的疗效观察[J].护理实践与研究,2018,15(11):42-44.
[13]孙正刚.自体富血小板凝胶联合负压引流治疗老年糖尿病足的临床探讨[J].中外医疗,2017,36(7):55-57.
[14]陈德清,左国庆,朱丹平,等.自体富血小板凝胶治疗不同治疗周期中糖尿病足溃疡的临床评价[J].中国糖尿病杂志,2018,26(4):285-289.
[15]AMABLE PR,CARIAS RB,TEIXEIRA MV,et al.Platelet-rich plasma preparation for regenerative medicine:optimization and quantification of cytokines and growth factors[J].Stem Cell Research&Therapy,2013,4(3):67-71.
[16]安静思,赵锦.自体富血小板凝胶治疗糖尿病足溃疡的临床疗效观察及对患者血糖水平的影响[J].国际医药卫生导报,2018,24(9):1340-1342.
[17]MARIANI E,FILARDO G,CANELLA V,et al.Platelet-rich plasma affects bacterial growth in vitro[J].Cytotherapy,2014,16(9):1294-1304.
[18]周丽华,陈清华,陈宗存,等.自体富血小板凝胶联合封闭式负压引流术治疗糖尿病足溃疡的效果观察[J].中国医学前沿杂志(电子版),2017,9(6):131-134.