中西医结合治疗糖尿病下肢动脉病变介入术后再狭窄的临床研究  

Effect of Integrative Medical Therapy on Post-angioplasty Arterial Restenosis in Lower Limbs of Diabetic Patients

作　　者：姜涛[1] 文祯[1] 姜敏[1] 卢桂阳[1] 

机构地区：[1]北京世纪坛医院糖尿病中心,北京100038

出　　处：《中国中西医结合杂志》2011年第2期182-187,共6页Chinese Journal of Integrated Traditional and Western Medicine

基　　金：北京市中医药科技发展基金项目(No.JJ2006-23)

摘　　要：目的评价中西医结合治疗糖尿病下肢动脉病变球囊扩张成形术后再狭窄的疗效。方法选择2型糖尿病合并下肢动脉病变(FontaineⅢ/Ⅳ期)成功实行下肢动脉球囊扩张成形术后的患者共36例,随机分为对照组(18例)和治疗组(18例),对照组给予基础治疗,治疗组除基础治疗外加用中药汤剂口服,治疗时间均为3个月。两组于治疗前及治疗后3个月使用简化麦吉尔疼痛量表(simplifiedMcGillpain questionnaire,SF-MPQ)评估肢体疼痛程度,采用英国多普勒血容积测量仪测定踝肱指数(ankle brachial index,ABI)、趾肱指数(toe bra-chial index,TBI)、足背动脉及胫后动脉平均血流速度(mean flow velocity of dorsal artery and tibial artery,MDA,MTA)等血流动力学参数,并进行血液标本测定;治疗后6、12个月随访患者的足溃疡改善率及痊愈率、血管再狭窄率及截肢率。结果与治疗前比较,治疗后3个月对照组ABI、TBI、超敏C反应蛋白(high-sensitivity C-re-active protein,hs-CRP)及纤维蛋白原浓度(fibrinogen,FIB)有所改善,MDA、MTA稍有减慢,但差异均无统计学意义(P>0.05);治疗组ABI、TBI、MDA、MTA、hs-CRP及FIB均有显著改善,差异有统计学意义(P<0.05,P<0.01),且改善程度优于对照组,差异有统计学意义(P<0.05,P<0.01)。治疗后3个月,治疗组下肢缺血改善有效率及下肢疼痛缓解率均高于对照组,差异有统计学意义(P<0.05)。随访6个月两组间足溃疡改善率、截肢率比较差异无统计学意义(P>0.05),治疗组溃疡痊愈率高于对照组,血管再狭窄率低于对照组,差异均有统计学意义(P<0.05);随访12个月两组间足溃疡改善率及痊愈率、血管再狭窄率及截肢率比较,差异均无统计学意义(P>0.05)。治疗组总体不良事件发生率(33.3%)略高于对照组(22.2%),但差异无统计学意义(P>0.05)。结论中西医结合治疗可以显著改善2型糖尿病下肢动脉病变球囊扩张成形术后患者血流动力学指标和下肢�Objective To evaluate the effect of integrative medical therapy on lower limb post-angioplasty arterial restenosis in diabetes patients. Methods Thirty-six patients with lower limb diabetic arterial disease of Fontaine Ⅲ/Ⅳ stage after successful baloon angioplasty were assigned randomly and equally to two groups,the control group and the treatment group,both were treated with basic therapy for 3 months,but Chinese drugs were given to the treatment group additionally. Level of acroesthesia was determined before and after treatment with simplified McGill pain questionnaire （SF-MPQ） scoring,ankle brachial index （ABI）,toe brachial index （TBI）,mean flow velocity of dorsal artery （MDA） and tibial artery （MTA） were measured by ultrasound Doppler meter,and blood preparation was determined. Moreover,the ulcer remission rate,ulcer cure rate,restenosis rate,and amputation rate were determined in the 6-month and 12-month follow-up studies. Results Significant improvements of ABI,TBI,MDA and MTA,as well as on blood levels of high-sensitivity C-reactive protein （hs-CRP） and fibrinogen （FIB） were shown in the treatment group after treatment,showing significant difference in comparing with those before treatment （P0.05 or P0.01）,also in comparing with the control group （P0.05 or P0.01） respectively,while in the control group,although a trend of improvement was seen,these indices were insignificantly changed statistically （P0.05）. Comparisons between groups after 3-month treatment showed significant difference in ischemia remission rate and pain relief rate （P0.05）. Outcomes of 6-month follow-up displayed that the differences between groups were insignificant in terms of the ulcer cure rate the and amputation rate （P0.05）,but did show significance in the ulcer remission rate and the restenosis rate （P0.05）,while all the 4 parameters were insignificantly different between groups after 12-month follow-up （P0.05）. Overall incidence of adverse event was somewhat higher in th

关 键 词：2型糖尿病 下肢动脉病变 球囊扩张血管成形术 再狭窄 中西医结合治疗 

分 类 号：R587.1[医药卫生—内分泌] R543[医药卫生—内科学]