顾步汤联合复方黄柏液对糖尿病足干性坏疽介入术后创面改善的影响

康永; 李婵; 刘桂芳; 徐树彬; 万良硕; 吕延林; 刘青

doi:10.14148/j.issn.1672-0482.2023.0124

顾步汤联合复方黄柏液对糖尿病足干性坏疽介入术后创面改善的影响

doi: 10.14148/j.issn.1672-0482.2023.0124

河北省中医院介入血管外科, 河北石家庄 050000

基金项目:

河北省中医药管理局科研计划 2020113

详细信息

作者简介:
康永, 男, 主治医师, E-mail: double2015@126.com

通讯作者:
刘青, 男, 主治医师, 主要从事外周血管病变的临床研究, E-mail: liuqingjj@163.com

中图分类号: R261
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出版历程
- 收稿日期: 2022-08-20
- 网络出版日期: 2023-02-17
- 发布日期: 2023-02-10

Effect of Gubu Decoction Combined with Compound Huangbai Liquid on the Improvement of Wound in the Post-Interventional Operation for Dry Gangrene of Diabetic Foot

Department of Interventional Vascular Surgery, Hebei Province Hospital of Chinese Medicine, Shijiazhuang 050000, China

摘要

摘要: 目的观察顾步汤联合复方黄柏液对糖尿病足干性坏疽介入术后创面改善、肉芽组织生长和足部微血管循环的影响。方法选择糖尿病足干性坏疽患者80例, 以随机数字表法分组, 对照组和治疗组各40例。对照组在血管介入术后予复方黄柏液治疗, 治疗组予顾步汤联合复方黄柏液治疗，疗程4周。观察治疗前后2组患者血管内皮生长因子(VEGF)、转化生长因子β1(TGF-β1)、碱性成纤维生长因子(bFGF)、一氧化氮(NO)、内皮素(ET-1)、可溶性血管细胞黏附分子-1(sVCAM-1)、白细胞介素-13(IL-13)、肿瘤坏死因子(TNF-α)、纤维蛋白原水平变化及足部微血管血流灌注量、疼痛数字评价量表(NRS)评分、肉芽组织生长及足创面改善情况, 比较2组中医证候评分及临床疗效。结果治疗后, 2组足部微血管血流灌注增加(P < 0.01), 治疗组优于对照组(P < 0.01)；2组创面面积、中医证候、NRS评分较治疗前减少(P < 0.01), 治疗组优于对照组(P < 0.01)；治疗组肉芽组织生长面积、创面改善程度高于对照组(P < 0.01)，治疗组总有效率高于对照组(P < 0.05)；2组TNF-α、sVCAM-1、IL-13水平均较治疗前降低(P < 0.01), 治疗组优于对照组(P < 0.01)；2组纤维蛋白原、ET-1水平均较治疗前降低(P < 0.01), 治疗组优于对照组(P < 0.01)；NO水平均较治疗前升高(P < 0.01), 治疗组优于对照组(P < 0.05);2组VEGF、TGF-β1、bFGF水平较治疗前升高(P < 0.01), 治疗组优于对照组(P < 0.01)。结论糖尿病足干性坏疽介入术后患者采用顾步汤联合复方黄柏液治疗, 可提升生长因子水平, 抑制患者炎症, 改善足部微血管循环、血管内皮功能, 缓解患者疼痛, 促进患者肉芽组织生长及创面改善, 提升临床疗效。
- 顾步汤 /
- 复方黄柏液 /
- 糖尿病足干性坏疽介入术后 /
- 炎症 /
- 生长因子 /
- 血管内皮功能 /
- 足部微血管循环 /
- 肉芽组织
Abstract: OBJECTIVE To observe the effects of Gubu decoction combined with compound Huangbai liquid on wound repair, granulation tissue growth and microvascular circulation in the foot after intervention operation for dry gangrene of diabetic foot. METHODS A total of 80 patients with dry gangrene of diabetic foot were selected and grouped by random number table, 40 patients in the control group and 40 patients in the treatment group. The control group was treated with compound Huangbai liquid after vascular intervention operation, while the treatment group was given with Gubu decoction combined with compound Huangbai liquid. The treatment course was four weeks. Before and after the treatment, we observed and compared the changes of vascular endothelial growth factor (VEGF), transforming growth factor β1 (TGF-β1), basic fibroblast growth factor (bFGF), nitric oxide (NO), endothelin (ET-1), soluble vascular cell adhesion molecule-1 (sVCAM-1), interleukin-13 (IL-13), tumor necrosis factor (TNF-α), fibrinogen level, the microvascular blood perfusion in the foot, NRS score, granulation tissue growth, foot wound repairment, traditional Chinese medicine (TCM) syndrome scores, as well as the clinical efficacy of the two groups. RESULTS After treatment, microvascular blood perfusion in the foot increased in both groups (P < 0.01), but the result in the treatment group was better than that in the control group (P < 0.01). Besides, the area of wound, TCM syndrome scores and NRS score were reduced in both groups compared with those before treatment (P < 0.01). The patients in treatment group were fewer compared with the control group (P < 0.01), but the granulation tissue growth and wound repairment in the treatment group were better than in the control group (P < 0.01). The total efficiency of the treatment group was higher than that of the control group (P < 0.05). The levels of TNF-α, sVCAM-1 and IL-13 in both groups were lower than before treatment (P < 0. 01), but the treatment group showed better results (P < 0.01). The levels of fibrinogen and ET-1 in both groups were lower than before treatment (P < 0.01), but the treatment group showed better results (P < 0.01). The levels of NO were higher than before treatment (P < 0.01), but the result in the treatment group was higher than that in the control group (P < 0.05). The levels of VEGF, TGFβ1 and bFGFβ1 in both groups were higher than the control group (P < 0.05). The levels of VEGF, TGFβ1 and bFGF in the two groups were higher than before treatment (P < 0.01), but the levels in the treatment group were higher than those in the control group (P < 0.01). CONCLUSION The combination of Gubu decoction and Huangbai liquid in the post-interventional operation for dry gangrene of diabetic foot can enhance the level of growth factors, suppress inflammation, improve microvascular circulation and endothelial function of the foot, relieve pain, promote granulation tissue growth and wound repairment, and improve clinical efficacy.
- Gubu decoction /
- compound Huangbai liquid /
- post-interventional operation for dry gangrene of diabetic foot /
- inflammation /
- growth factor /
- vascular endothelial function /
- microvascular circulation in the foot /
- granulation tissue

HTML全文

表 1 2组患者基线资料比较(x±s, n=40)

Table 1. Comparison of baseline information of patients in both groups (x±s, n=40)

组别	男	女	年龄/岁	病程		足背动脉血流量/ (mL·min^-1)	糖化血红蛋白/%	创面大小/ cm²	Wagner分级
组别	男	女	年龄/岁	糖尿病/a	干性坏疽/月	足背动脉血流量/ (mL·min^-1)	糖化血红蛋白/%	创面大小/ cm²	4级	5级
对照组	24	16	65.96±5.27	4.73±0.66	10.09±2.16	58.36±5.29	8.15±0.47	23.47±6.43	27	13
治疗组	23	17	65.24±5.09	4.65±0.57	10.25±2.37	58.25±5.23	8.20±0.53	23.92±7.52	28	12

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表 2 2组患者治疗前后中医证候积分比较(x±s, n=40)

Table 2. Comparison of the TCM syndrome scores of both groups before and after treatment(x±s, n=40)

组别	时间	中医证候总评分	皮色潮红或紫红	灼热	周边呈实性漫肿	皮下积液
对照组	治疗前	14.77±2.52	3.53±1.05	3.76±1.01	3.86±0.94	3.62±1.03
	治疗后	4.40±0.71^**	1.08±0.31^**	1.12±0.32^**	1.15±0.27^**	1.05±0.26^**
治疗组	治疗前	14.09±2.55	3.45±1.01	3.54±1.03	3.47±0.97	3.63±1.11
	治疗后	3.21±0.41^**##	0.73±0.18^**##	0.83±0.15^**##	0.86±0.13^**##	0.79±0.34^**##
注: 组内比较, ^{* *}P < 0.01;组间比较, ^##P < 0.01。

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表 3 2组患者治疗前后NRS评分、肉芽组织生长面积、创面面积、创面改善程度比较(x±s, n=40)

Table 3. Comparison of NRS score, granulation tissue growth area, wound area and wound improvement before and after treatment in the two groups(x±s, n=40)

组别	时间	NRS(四分位距)	创面面积/cm²	创面改善程度/%	肉芽组织生长面积/cm²
对照组	治疗前治疗后	7.59(5.33-8.91) 5.27 (3.67-6.56)^**	23.92±7.52 5.59±1.49^**	70.48±11.93	0 9.47±2.37
治疗组	治疗前治疗后	7.47(5.42-8.87) 3.82 (2.01-4.78)^**##	23.47±6.43 4.47±1.31^**##	79.59±12.19^##	0 12.56 ±3.23^##
注: 组内比较, ^{* *}P < 0.01;组间比较, ^##P < 0.01。

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表 4 2组患者临床疗效比较(n=40)

Table 4. Comparison of clinical efficacy between the two groups (n=40)

组别	例数	显效	有效	无效	总有效率/%
对照组	40	12	21	7	82.5
治疗组	40	21	17	2	95.0^#
注: 组间相比, Zc=2.315，^#P < 0.05。

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表 5 2组患者治疗前后足部微血管血流灌注量比较(x±s, n=40)

Table 5. Comparison of blood flow perfusion of foot microvessels between two groups before and after treatment (x±s, n=40)

组别	时间	基础血流灌注量/ PU	加热后血流灌注量/ PU
对照组	治疗前	22.06±2.54	106.59±15.89
	治疗后	25.32±3.13^**	133.72±20.15^**
治疗组	治疗前	22.25±2.62	105.87±14.78
	治疗后	28.45±3.54^**##	164.27±25.65^**##
注: 组内比较, ^{* *}P < 0.01;组间比较, ^##P < 0.01。

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表 6 2组患者治疗前后IL-13、sVCAM-1、TNF-α、ET-1、NO、纤维蛋白原、VEGF、TGF-β1、bFGF水平比较(x±s, n=40)

Table 6. Comparison of IL-13, sVCAM-1, TNF-α, ET-1, NO, fibrinogen, VEGF, TGF-β1, bFGF level before and after treatment in both groups (x±s, n=40)

组别	时间	IL-13/(ng·L^-1)	sVCAM-1/(μg·L^-1)	TNF-α/(pg·mL^-1)
对照组	治疗前	40.53±12.65	362.19±41.53	36.31±6.92
	治疗后	31.31±10.13^**	223.12±35.03^**	20.61±4.52^**
治疗组	治疗前	40.18±12.39	360.17±40.51	36.05±6.82
	治疗后	23.66±6.94^**##	201.21±38.06^**##	15.19±2.96^**##

组别	时间	ET-1/(pg·mL^-1)	NO/(μmol·L^-1)	纤维蛋白原/(g·L^-1)
对照组	治疗前	83.13±19.11	63.31±15.01	7.83±1.35
	治疗后	66.31±17.89^**	77.93±17.26^**	4.46±0.84^**
治疗组	治疗前	83.69±20.23	62.20±15.45	8.09±1.31
	治疗后	50.07±12.23^**##	87.61±19.18^**#	3.18±0.51^**##

组别	时间	VEGF/(μg·L^-1)	TGF-β1/(pg·mL^-1)	bFGF/(ng·L^-1)
对照组	治疗前	3.31±1.01	21.03±6.35	38.61±11.52
	治疗后	5.93±1.26^**	24.31±7.73^**	51.61±13.52^**
治疗组	治疗前	3.20±0.95	20.85±6.19	39.05±11.34
	治疗后	7.61±2.18^**##	29.66±8.14^**##	62.19±15.06^**##
注: 组内比较, ^{* *}P < 0.01;组间比较, ^#P < 0.05, ^##P < 0.01。

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