Campbell R K
College of Pharmacy, Washington State University, Pullman 99164.
Ann Pharmacother. 1993 Sep;27(9):1099-105. doi: 10.1177/106002809302700916.
To introduce readers to the use of pentoxifylline for diabetes-induced peripheral vascular disease. The article provides background on the pathophysiology of diabetic foot ulcers as well as a review of the literature on the therapeutic use of pentoxifylline for treating this disorder.
A MEDLINE search was used to identify pertinent literature, including review articles and case reports. Key index terms included pentoxifylline, diabetic foot ulcer, neuropathy, peripheral vascular disease, and intermittent claudication
Basic pharmacologic data regarding absorption, distribution, metabolism, and excretion were reported in normal subjects as well as in patients with renal impairment. Open and controlled clinical trials also were analyzed; subjective symptoms were reported. The economic implications also were reported. The pharmacist's role in patient education is discussed.
Pentoxifylline 800 mg/d was found to be effective in improving the symptoms in patients with noninsulin-dependent diabetes mellitus, including improvement in walking distance, paresthesia, skin temperature, and subjective overall response. In nondiabetic patients, statistically significant differences in leg-ulcer healing were found between the treatment and placebo groups. Case reports illustrated healing times, which ranged from two weeks to six months. Pentoxifylline use in both insulin-dependent and noninsulin-dependent patients was assessed in clinical trials, with improvement of symptoms in both patient types.
Studies show that pentoxifylline is an alternative to vascular surgery in the management of peripheral vascular disease in diabetic patients, particularly in those with chronic ulceration of the lower extremities that does not heal despite other optimal treatment regimens, including cessation of smoking, maintenance of normoglycemia, elimination of vasoconstrictive drugs, correctly fitted shoes, and appropriate would care. Pentoxifylline therapy may provide an appropriate, economical treatment modality by reducing the need for hospitalization and vascular surgery.
向读者介绍己酮可可碱在糖尿病性周围血管疾病中的应用。本文提供了糖尿病足溃疡病理生理学的背景知识，并综述了己酮可可碱治疗该疾病的相关文献。
使用MEDLINE检索来识别相关文献，包括综述文章和病例报告。关键索引词包括己酮可可碱、糖尿病足溃疡、神经病变、周围血管疾病和间歇性跛行。
报告了正常受试者以及肾功能损害患者有关吸收、分布、代谢和排泄的基本药理学数据。还分析了开放和对照临床试验；报告了主观症状。也报告了经济影响。讨论了药剂师在患者教育中的作用。
发现己酮可可碱800mg/d可有效改善非胰岛素依赖型糖尿病患者的症状，包括步行距离、感觉异常、皮肤温度和主观总体反应的改善。在非糖尿病患者中，治疗组和安慰剂组在腿部溃疡愈合方面存在统计学显著差异。病例报告说明了愈合时间，范围从两周到六个月。在临床试验中评估了己酮可可碱在胰岛素依赖型和非胰岛素依赖型患者中的应用，两种类型患者的症状均有改善。
研究表明，在糖尿病患者周围血管疾病的管理中，己酮可可碱是血管手术的替代方法，特别是对于那些尽管采用了其他最佳治疗方案（包括戒烟、维持血糖正常、停用血管收缩药物、穿合适的鞋子和进行适当的伤口护理）但下肢慢性溃疡仍未愈合的患者。己酮可可碱治疗可能通过减少住院需求和血管手术提供一种合适、经济的治疗方式。
