沙格雷酯与西洛他唑治疗2型糖尿病下肢血管病变的临床对照研究

目的 观察沙格雷酯治疗糖尿病下肢血管病变的效果.方法 40例患者按1:1随机进入沙格雷酯组(20例)和西洛他唑组(20例).沙格雷酯用量为300mg/d,西洛他唑100mg/d,共两个月.比较两组治疗前后及其组间下肢血管病变、神经病变的症状、无痛行走距离、能耐受疼痛的最大行走距离和踝/肱血压指数(ABI).结果 沙格雷酯组主观症状明显改善,最大行走和无痛行走距离、ABI及足背动脉血管流速均显著增加.结论 沙格雷酯对糖尿病下肢血管病变是一种安全有效的药物.     

血塞通治疗下肢血管病变的临床研究

选择糖尿病LEADDP患者176例。分为血塞通治疗组和对照组，均以饮食及胰岛素控制血糖。观察两组治疗前后足部病变改善、下肢动脉彩色，多普勒血液动力学改变以及治疗过程中出现的副作用。结果：治疗组总有效率显著高于对照组（P〈0．01）。彩色多普勒血液动力学改变有显著性差异（P〈0．05，P〈0，01），无明显的不良反应。结论：血塞通为一种安全、有效的治疗糖尿病LEADDP的药物。     

自体骨髓干细胞移植治疗糖尿病缺血性下肢血管病变临床研究

目的 观察自体骨髓干细胞移植治疗糖尿病(DM)下肢缺血性血管病的疗效及安全性.方法用自体骨髓干细胞移植治疗17例(28条)DM缺血性下肢血管病变患者,从髂骨取自体骨髓血300ml,体外分离单个核细胞悬浊液40 ml,多点肌注到缺血下肢.术后第1天至3个月观察各项指标.结果 移植后7～14 d患肢疼痛减轻,患足冷感改善;3个月疼痛明显缓解或消失,9条患肢行走间距延长.11例踝肱指数增加,溃疡面不同程度缩小;3例影像学复查示不同程度新生毛细血管形成.移植3个月后正中神经、腓总神经感觉及运动神经传导速度明显增加(P均<0.01);未出现并发症和明显不良反应.结论 自体骨髓干细胞移植治疗DM下肢缺血性血管病简单、安全、有效,能改善患者的生活质量.     

糖尿病下肢血管病变的介入治疗

约有2％～37％的糖尿病病人有周围神经一缺血问题。有关糖尿病足病介入治疗的研究很少。在文献复习的基础上，介绍了52例糖尿病合并下肢血管病变病人的临床特点和接受不同治疗的随访结果。52例病人中94％有下肢动脉粥样硬化阻塞性改变，34例有显著的股、胭、胫动脉病变，65％的病人的下肢动脉狭窄程度大于70％。其中12例进行了球囊扩张、18例支架治疗。治疗后的近期结果为手术成功26例(87％)，失败4例。随访7个月的伤15愈合率只有42％。     

糖尿病下肢动脉病变危险因素分析

糖尿病下肢血管病变是最为常见的糖尿病大血管病变之一，它可导致糖尿病足乃至引起坏疽截肢。因此预防与减少糖尿病下肢血管病变显得极为重要。本文着重讨论糖尿病下肢动脉血管病变的相关因素，其中搜集了2000年1月至2003年1月在我院住院的34例糖尿病人进行分析。     

血塞通治疗下肢血管病变的临床研究

选择糖尿病LEADDP患者176例,分为血塞通治疗组和对照组,均以饮食及胰岛素控制血糖.观察两组治疗前后足部病变改善、下肢动脉彩色,多普勒血液动力学改变以及治疗过程中出现的副作用.结果治疗组总有效率显著高于对照组(P＜0.01),彩色多普勒血液动力学改变有显著性差异(P＜0.05,P＜0.01),无明显的不良反应.结论血塞通为一种安全、有效的治疗糖尿病LEADDP的药物.     

络泰治疗糖尿病下肢血管病变118例

目的观察络泰（注射用血塞通）对糖尿病（DM）下肢血管病变的治疗作用.方法选择DM下肢血管病变病人176例,分为络泰组（治疗组）和对照组,均以饮食控制及应用胰岛素控制血糖.观察两组治疗前后足部病变改善、下肢动脉彩色多普勒血流动力学改变以及治疗过程中出现的副反应.结果治疗组总有效率为96.6%高于对照组89.6%（P〈0.01）,治疗组治疗后的下肢动脉彩色多普勒血流动力学改变与治疗前相比,具有统计学意义（P〈0.05或P〈0.01）,与对照组相比,组间比较无统计学意义,治疗期间,病人无明显的不良反应.结论络泰为一种安全、有效的治疗DM下肢血管病变的药物.     

下肢动脉血管病变对糖尿病足部溃疡疗效及预后的影响

对267例Ⅰ～Ⅴ期糖尿病足部溃疡患者用彩色多谱勒超声检测双下肢动脉血管情况.在全身综合治疗的基础上,溃疡局部彻底清创后用黄芪液加适量短效胰岛素外敷局部,观察溃疡处肉芽组织生长时间(GT),溃疡愈合时间(HT),治愈率,截肢率.结果①显著狭窄者19例,中度28例,轻度34例,血管病变发生率为30.34%.②其GT和HT均显著长于患肢无动脉血管病变者(均P＜0.05);③且有血管病变的患者截肢率高达35%,亦显著高于无血管病变的足部溃疡患者(P＜0.01),且严重血管病变时不仅溃疡病变严重,而且截肢率高达82%;④GT和HT与下肢血管狭窄的程度呈显著的正相关关系(r1=0.4679,P＜0.05,r2=0.5377,P＜0.05).结论下肢血管病变不仅是糖尿病足部溃疡的主要原因之一,而且也是影响疗效及预后非常重要因素,提示改善下肢血流状态将有助于足部溃疡的愈合.     

糖尿病下肢血管病变的彩色多普勒检查及治疗

糖尿病下肢血管病变(lower extremity arterialdisease in diabetic patients,LEADDP)是糖尿病的常见并发症.多年来,由于检测手段的限制,人们对本病认识不足,使之得不到及时有效的治疗,导致坏疽,严重者需要截肢治疗,严重影响糖尿病患者的生存时间及生存质量.作者对97例糖尿病患者的下肢动脉用彩色多普勒进行血液动力学检查并给予PGE_1治疗,结果证实彩色多普勒的敏感性高,重复性好、无创伤,是检查和诊断LEADDP的一种理想方法,而PGE_1是治疗LEADDP的有效选择.     

踝臂指数与糖尿病下肢动脉血管缺血病变关系的分析

目的探讨踝臂指数(ankle/brachialindex,ABI)与糖尿病下肢动脉血管缺血病变程度的差异。方法采用MD2型多普勒仪对60例糖尿病下肢动脉血管病变患者进行ABI测定。结果Wagner分级法0级34例,ABI(0.76±0.14)分,提示有下肢动脉阻塞;1～2级22例,ABI(0.41±0.08)分,提示患者下肢缺血程度严重;3～4级4例,ABI(0.26±0.03)分,均发生下肢溃疡或坏死。结论测定糖尿病患者ABI可客观评价其下肢外周血管功能状况,为临床治疗提供可靠依据。     

重视下肢动脉病变的诊治是降低糖尿病截肢率的重要措施

下肢动脉疾病(PAD)是常见的糖尿病并发症,具有多节段、更远端、病变更广泛等临床特点.该症起病缓慢而隐匿,临床上尚未受到足够重视,但危害性大,是糖尿病足的重要原因.该症诊断相对容易,触诊、踝肱动脉压指数测定、皮温测定、超声检查、CT或核磁共振都是有效的诊断技术,血管减数造影仍然是诊断的金标准.轻-中度病变采用药物治疗,重症患者需要外科手术治疗.介入治疗如深部球囊扩张术和血管内支架置放和干细胞移植治疗已在国内一些大医院开展并取得了相当疗效.     

国际糖尿病足工作组《糖尿病足溃疡周围动脉病变诊断、预后与管理指南(2019版)》解读

国际糖尿病足工作组《糖尿病足溃疡周围动脉病变诊断、预后与管理指南(2019版)》在2015版的基础上进行了内容的更新。按照患者-干预-比较-结局(PICO)原则,编委会提出8个临床问题,在循证医学基础上进行文献系统评价,从诊断、预后和管理3个方面提出了17条建议,从而指导从事糖尿病足的医护人员在周围动脉病变方面规范诊断...     

盐酸沙格雷酯对糖尿病伴膝下动脉病变球囊扩张成形术后疗效的影响

目的:观察盐酸沙格雷酯对糖尿病膝下动脉病变,球囊扩张成形术(PTA)后再狭窄的疗效。方法:选择我科2007年4月至2011年8月收治2型糖尿病合并重症下肢缺血患者46例,男性21例,女性25例,年龄49～93岁,平均73.03岁。所有患者均为单纯膝下3支动脉病变。按随机数字表法将入选患者按1∶1的比例随机分为对照组(拜阿斯匹林)和治疗组(拜阿司匹林联合盐酸沙格雷酯),每组23例。PTA术后基础治疗两组一致,治疗组加用盐酸沙格雷酯片(安步乐克,100 mg,每日3次,日本三菱制药),治疗时间为6个月。疗效观察时间为PTA治疗前、治疗后3个月、6个月。观察项目为静息痛缓解、溃疡愈合、术后成功开通血管通畅及再狭窄的情况,将静息痛完全缓解,或者溃疡愈合评为疗效显著。结果:糖尿病性膝下动脉病变PTA术后,治疗组的症状改善及疗效优于对照组。结论:盐酸沙格雷酯对糖尿病膝下血管病变PTA治疗后,再狭窄的预防、缺血症状的改善有较好的作用。     

糖尿病患者外周血管病变的特征

目的观察糖尿病患者的外周动脉的病变特征。方法采用彩色多普勒超声技术对糖尿病（DM）患者及非糖尿病（N-DM）患者的外周动脉粥样硬化斑块、狭窄以及闭塞性病变特征进行观察。结果与N-DM组比较,DM组外周动脉的内-中膜厚度（IMT）、狭窄血管大小、血管闭塞率、闭塞血管大小及闭塞血管回声差异无统计学意义,但斑块总面积显著增加（P〈0.05）,斑块回声积分显著减小（P〈0.01）,血管狭窄率显著增加（P〈0.01）。结论糖尿病可使患者的外周动脉粥样硬化病变更严重,使中型动脉的狭窄几率更高,但闭塞性病变与非糖尿病患者无差异。     

Low-grade albuminuria is associated with peripheral artery disease in Chinese diabetic patients

Background

Increasing studies have suggested that albuminuria might be an important risk factor for peripheral artery disease (PAD). However, studies focusing on the association between low-grade albuminuria and PAD are limited. It would be of great interest to elucidate the association between low-grade albuminuria and PAD in diabetic subjects.

Methods

A cross-sectional study was conducted in 1386 diabetic subjects (age ≥ 40 years) with normal urinary albumin levels from Shanghai, China. A first voided early morning spot urine sample was obtained for urinary albumin and creatinine measurements. Subjects were divided into three groups according to sex-specific cutoff points of urinary albumin–creatinine ratio (UACR) tertiles. Subjects in the upper tertile of UACR were classified as having low-grade albuminuria. PAD was defined by ankle–brachial index (ABI) <0.9 or >1.4.

Results

Overall, 106 (7.7%) of the study population had PAD. The prevalence of PAD in tertile 3 of UACR was higher than the prevalence in tertile 2 and tertile 1 (10.2%, 6.4% and 6.4%, respectively; P < 0.05). A fully adjusted logistic regression analysis revealed that compared with subjects in tertile 1 of normal UACR, those in tertile 3 had 1.7-fold increased risk for the presence of PAD.

Conclusions

In diabetic patients, high normal UACR level, which is below the current cutoff point of microalbuminuria, was associated with the increased prevalence of PAD. It suggested that low-grade albuminuria might be an early marker for the detection of PAD in diabetic patients.     

The effect of topical olive oil dressing on the healing of grade 1 and 2 diabetic foot ulcers: An assessor-blind randomized controlled trial in type 2 diabetes patients

Background and aimsWe aimed to compare the effect of topical olive oil dressing plus standard care with standard care alone on the treatment of grade 1 and 2 diabetic foot ulcers (DFUs) in type 2 diabetes mellitus (T2DM) patients.MethodsThis assessor-blind randomized controlled trial included 60 T2DM patients with DFU referred to the Diabetes Clinic of Shahid Mohammadi Hospital, Bandar Abbas, Iran, from February 21 to August 22, 2017. Patients were randomly assigned to intervention (n = 30) and control (n = 30) groups. The intervention group received standard care, including wound irrigation with normal saline and oral antibiotics plus daily topical olive oil dressing for four weeks, and the control group only received standard care. The wound healing assessment scale (wound degree, color, drainage, and surrounding tissue healing) was recorded weekly and the total wound status was determined at the end of the study.ResultsTreatment with olive oil led to significantly higher scores of ulcer degree, color, drainage, and surrounding tissue healing at weeks one, two, three and four in the olive oil group than in the control group (P < 0.001). Also, the total wound status score was higher in the olive oil group compared to the control group (P < 0.001). The proportions of completely healed, partially healed, and unhealed wounds were 76.6%, 23.3% and 0% in the intervention group, and 0%, 93.3% and 6.7% in the control group, respectively.ConclusionsTopical olive oil dressing promoted the healing of DFU and it can be recommended as a safe and effective treatment in this regard.Trial registrationIranian Registry of Clinical Trials (IRCT), IRCT20150607022585N4. Registered 05/12/2018. Retrospectively registered, https://www.irct.ir/trial/19460.     

老年2型糖尿病患者HRV与下肢动脉病变相关性分析(英文)

目的:探讨老年2型糖尿病患者心率变异性(HRV)与下肢动脉病变(LEAD)的关系及其临床意义。方法:选择老年糖尿病患者65例。根据下肢病变情况分为糖尿病合并下肢动脉病变组(LEAD组,36例)、糖尿病无下肢动脉病变组(NLEAD组,29例),另设正常对照组(23例),进行24h动态心电图检查,测定心率变异各指标;同时检测各组血压,糖、脂代谢指标,CRP,血浆脂联素等指标,进行相关及多元Logistic回归分析。结果:(1)糖尿病两组患者的SBP、HbA1c、LDL-C、CRP均显著高于正常对照组(P0.05),与NLEAD组比较,LEAD组病程[(3.00±2.00)年比(7.50±4.00)年]、SBP[(140.24±8.95)mmHg比(147.61±7.58)mmHg]、HbA1c[(6.40±0.70)%比(7.15±2.05)%]、血浆纤维蛋白原(Fg)[(2.57±0.51)g/L比(3.02±0.71)g/L]、LDL-C[(2.27±0.50)mmol/L比(2.81±0.71)mmol/L]、CRP[(2.01±1.79)mg/L比(3.14±2.92)mg/L]水平显著升高(P0.05);(2)LEAD组及NLEAD组的SDNN、SDANN、VLF及血浆脂联素含量均显著低于正常对照组(P0.05),与NLEAD组比较,LEAD组HRV指标除rMSSD外显著下降(P0.05);(3)糖尿病下肢病变的发生与病程、SBP、2hPG、HbA1c、LDL-C、Fg、CRP呈正相关(r=0.760~0.331,P均0.05),而与脂联素及心率变异指数呈负相关(r=-0.597~-0.317,P均0.05);(4)多元Logistic回归分析显示,糖尿病的病程、SBP、HbA1c、LDL-C、CRP、老年2型糖尿病下肢动脉病变的独立危险因素(OR=2.932~14.404,P0.05)。结论:(1)糖尿病的病程、SBP、HbA1c、LDL-C、CRP、脂联素、HRV与老年2型糖尿病患者下肢动脉病变相关;(2)HRV降低是老年2型糖尿病患者下肢动脉病变的独立危险因素。     

踝肱指数诊断糖尿病下肢动脉病变的临床意义

目的 了解踝肱动脉血压指数（ABI）在诊断T2DM患者下肢动脉病变中的意义及其影响因素。方法 采用多普勒血流探测仪测定糖尿病患者的足背动脉、胫后动脉与肱动脉的比值，以比值小于0．9为异常。结果 本组280例患者中检出ABI〈0．9者60例，占21．4％。合并下肢动脉病变组与正常组比较，前者的年龄大、病程长、餐后血糖、TG、LDL-C、UAlb／Cr比值的对数值、脉压差、吸烟率和合并冠心病率明显增高，DBP和HbA1c达标率明显降低。逐步回归分析显示，年龄、病程、TG、HbA1c是影响ABI的独立因素。结论 ABI是一项花费小、简单无创的诊断下肢动脉病变的可靠指标。增龄、病程长、高TG、高血糖是加剧下肢动脉硬化的主要因素。     

Treatment of peripheral arterial disease in diabetes: A consensus of the Italian Societies of Diabetes (SID,AMD), Radiology (SIRM) and Vascular Endovascular Surgery (SICVE)

Diabetic foot (DF) is a chronic and highly disabling complication of diabetes. The prevalence of peripheral arterial disease (PAD) is high in diabetic patients and, associated or not with peripheral neuropathy (PN), can be found in 50% of cases of DF. It is worth pointing out that the number of major amputations in diabetic patients is still very high. Many PAD diabetic patients are not revascularised due to lack of technical expertise or, even worse, negative beliefs because of poor experience. This despite the progress obtained in the techniques of distal revascularisation that nowadays allow to reopen distal arteries of the leg and foot. Italy has one of the lowest prevalence rates of major amputations in Europe, and has a long tradition in the field of limb salvage by means of an aggressive approach in debridement, antibiotic therapy and distal revascularisation. Therefore, we believe it is appropriate to produce a consensus document concerning the treatment of PAD and limb salvage in diabetic patients, based on the Italian experience in this field, to share with the scientific community.