Wang Xue-Qin, Pu Dan-Lan, Leng Wei-Ling, Lei Xiao-Tian, Juan Jiang, La Zou, Yao Ding, Xi Jia-Zhuang, Jian Li, Miao Teng, Wu Qi-Nan
Endocrinology Department, The People's Hospital of Yubei District of Chongqing City, Chongqing 401120, China.
Department of Endocrinology, Chongqing Yubei District People's Hospital, Chongqing 400030, China.
World J Diabetes. 2024 May 15;15(5):923-934. doi: 10.4239/wjd.v15.i5.923.
Diabetes foot is one of the most serious complications of diabetes and an important cause of death and disability, traditional treatment has poor efficacy and there is an urgent need to develop a practical treatment method.
To investigate whether Huangma Ding or autologous platelet-rich gel (APG) treatment would benefit diabetic lower extremity arterial disease (LEAD) patients with foot ulcers.
A total of 155 diabetic LEAD patients with foot ulcers were enrolled and divided into three groups: Group A (62 patients; basal treatment), Group B (38 patients; basal treatment and APG), and Group C (55 patients; basal treatment and Huangma Ding). All patients underwent routine follow-up visits for six months. After follow-up, we calculated the changes in all variables from baseline and determined the differences between groups and the relationships between parameters.
The infection status of the three groups before treatment was the same. Procalcitonin (PCT) improved after APG and Huangma Ding treatment more than after traditional treatment and was significantly greater in Group C than in Group B. Logistic regression analysis revealed that PCT was positively correlated with total amputation, primary amputation, and minor amputation rates. The ankle-brachial pressure and the transcutaneous oxygen pressure in Groups B and C were greater than those in Group A. The major amputation rate, minor amputation rate, and total amputation times in Groups B and C were lower than those in Group A.
Our research indicated that diabetic foot ulcers (DFUs) lead to major amputation, minor amputation, and total amputation through local infection and poor microcirculation and macrocirculation. Huangma Ding and APG were effective attreating DFUs. The clinical efficacy of Huangma Ding was better than that of autologous platelet gel, which may be related to the better control of local infection by Huangma Ding. This finding suggested that in patients with DFUs combined with coinfection, controlling infection is as important as improving circulation.
糖尿病足是糖尿病最严重的并发症之一，也是导致死亡和残疾的重要原因，传统治疗效果不佳，迫切需要开发切实可行的治疗方法。
探讨黄麻酊或自体富血小板凝胶（APG）治疗对糖尿病下肢动脉疾病（LEAD）合并足部溃疡患者是否有益。
共纳入155例糖尿病LEAD合并足部溃疡患者，分为三组：A组（62例；基础治疗）、B组（38例；基础治疗+APG）和C组（55例；基础治疗+黄麻酊）。所有患者均接受为期6个月的常规随访。随访后，我们计算了所有变量相对于基线的变化，并确定了组间差异以及参数之间的关系。
三组治疗前感染状况相同。APG和黄麻酊治疗后降钙素原（PCT）改善程度高于传统治疗，且C组改善程度显著高于B组。逻辑回归分析显示，PCT与总截肢率、初次截肢率和小截肢率呈正相关。B组和C组的踝肱压和经皮氧分压高于A组。B组和C组的大截肢率、小截肢率和总截肢次数低于A组。
我们的研究表明，糖尿病足溃疡（DFU）通过局部感染以及微循环和大循环不良导致大截肢、小截肢和总截肢。黄麻酊和APG对DFU有效。黄麻酊的临床疗效优于自体血小板凝胶，这可能与黄麻酊能更好地控制局部感染有关。这一发现表明，在合并混合感染的DFU患者中，控制感染与改善循环同样重要。
