一例糖尿病性类脂质渐进性坏死左小腿皮肤溃疡患者的循证治疗

目的针对近期收治的1例罕见糖尿病性类脂质渐进性坏死(necrobiosis lipoidica diabeticorum,NLD)左小腿皮肤溃疡患者,检索当前最佳证据,为临床合理治疗提供依据。方法计算机检索Cochrane图书馆(2006年第3期)、PubMed(1966～2006.7)、EMbase(1974～2006.7)、CBM(1978～2006.7),按证据级别高低查找相关证据,并对所获证据进行评价。结果共检索到153篇文献,无临床指南和系统评价,也无临床对照研究。有关临床治疗的文献共有30篇,共包括17种治疗措施。在这些治疗措施中,延胡索酸酯类、口服己酮可可碱、局部应用生长因子以及外科皮瓣移植等效果相对较好,副作用发生较低。根据患者意愿和我院实际,在严格控制血糖、血脂、抗血小板治疗及局部清创换药等常规治疗的基础上,对该患者溃疡处实施粒细胞集落刺激因子局部治疗,319天后患者小腿溃疡痊愈,随访157天,未见病灶复发。结论常规治疗加粒细胞集落刺激因子局部治疗是治疗糖尿病性类脂质渐进性坏死小腿皮肤溃疡的有效方法。

Evidence-Based Treatment of Chronic Leg Ulcers in A Patient with Necrobiosis Lipoidica Diabeticorum

Objective To identify the best therapy regimen for a patient with rare chronic leg ulcer in necrobiosis lipoidica diabeticorum(NLD).Methods We searched the Cochrane Library(Issue 3,2006),PubMed(1966-July 2006), EMbase(1974-July 2006)and CBM(1978-July 2006)to identify relevant evidence.The quality of the retrieved studies was critically assessed.Results A total of 153 records were retrieved.No clinical guidel ines,systematic reviews or clinical randomized studies were identified.Thirty treatment-related studies involving 17 interventions showed that,fumaric acid esters,oral pentoxifyll ine,topical use of growth factors and surgical skin flap transplant were relatively more effective and safer than conventional therapies.Conclusion After treatment with tropical granulocyte colony-stimulating factor,the patient with chronic legulcers was healed.