Zhang Zhao-xin, Liu Xiao-long, Lü Lei, Zhang Liang, Ji Dong-liang, Liu Li-hua
Department of Burns, People's Hospital of Xinjiang Uygur Autonomous Region, Urumchi, China.
Zhonghua Shao Shang Za Zhi. 2011 Dec;27(6):451-5.
To investigate the effects of local injection of insulin on the level of systemic blood glucose and granulation tissue formation of wound in patients with diabetic foot ulcer.
Thirty-two patients with diabetic foot ulcer hospitalized in our wards from June 2009 to June 2010 were divided into insulin (I, n = 16) and control (C, n = 16) groups according to the random number table. For patients in I group, after debridement, one half of calculated dose of insulin diluted with equal amount of normal saline was injected diffusely into the base of the ulcer, and another half dose of insulin was subcutaneously injected into abdominal wall for 7 days, two times a day. For patients in C group, after debridement, primary insulin was subcutaneously injected into abdominal wall, 1 mL saline was subcutaneously injected into basal layer of ulcer for 7 days, two times a day. Before injection and 0.5, 1.0, 2.0, and 4.0 hours after injection (PIH), level of fasting blood glucose was determined. Before injection and on post injection day (PID) 3, 5, and 7, the growth of granulation tissue was assessed, and wound specimens were harvested for observation of CD34 expression and calculation of microvessel density (MVD). Data were processed with t test.
The levels of fasting blood glucose in both groups during observational time points ranged from 6.6 mmol/L to 12.8 mmol/L with a mean of (10.0 ± 2.2) mmol/L, and there was no statistical difference (with t values from 0.000 to 2.209, P values all above 0.05). Growth of granulation tissue in I group was more exuberant from PID 5, especially on PID 7 [(59.06 ± 1.58)%], which was significantly richer than that in C group [(23.61 ± 1.57)%, t = 17.420, P = 0.000]. New vessels were observed in I group from PID 3 as indicated by CD34 expression. There was no obvious difference in the number of MVD between I group and C group on PID 3 (t = 0.247, P > 0.05). The number of MVD per 200 times visual field in I group was respectively 8.34 ± 0.48, 11.22 ± 0.97 on PID 5 and 7, which was respectively higher than that in C group (4.42 ± 0.14, 5.44 ± 1.13, with t value respectively 16.568, 27.664, P values all below 0.01).
Local injection of insulin has a significant effect on systemic blood glucose in patients with diabetic foot ulcer, and it can promote the growth of granulation tissue and wound healing.
探讨局部注射胰岛素对糖尿病足溃疡患者全身血糖水平及创面肉芽组织形成的影响。
选取2009年6月至2010年6月在我院住院的32例糖尿病足溃疡患者，按随机数字表法分为胰岛素组（I组，n = 16）和对照组（C组，n = 16）。I组患者清创后，将计算剂量一半的胰岛素用等量生理盐水稀释后均匀注射于溃疡基底部，另一半剂量胰岛素皮下注射于腹壁，共7天，每日2次。C组患者清创后，将胰岛素皮下注射于腹壁，将1 mL生理盐水皮下注射于溃疡基底层，共7天，每日2次。分别于注射前及注射后0.5、1.0、2.0和4.0小时测定空腹血糖水平。分别于注射前及注射后第3、5和7天评估肉芽组织生长情况，并取创面标本观察CD34表达及计算微血管密度（MVD）。数据采用t检验进行处理。
两组观察时间点空腹血糖水平均在6.6 mmol/L至12.8 mmol/L之间，平均为（10.0±2.2）mmol/L，差异无统计学意义（t值为0.000至2.209，P值均大于0.05）。I组肉芽组织从注射后第5天开始生长更旺盛，尤其在注射后第7天[（59.06±1.58）%]，明显高于C组[（23.61±1.57）%，t = 17.420，P = 0.000]。I组从注射后第3天可见CD34表达提示有新生血管。注射后第3天I组和C组MVD数量差异无明显统计学意义（t = 0.247，P>0.05）。I组注射后第5天和第7天每200倍视野MVD数量分别为8.34±0.48、11.22±0.97，分别高于C组（4.42±0.14、5.44±1.13，t值分别为16.568、27.664，P值均小于0.01）。
局部注射胰岛素对糖尿病足溃疡患者全身血糖有显著影响，且可促进肉芽组织生长及创面愈合。
