洪兵　张翠平　陈耀凯　殷学超　于一江　张绿浪　陶兴宝　黄银秋

摘要：目的 觀察中药足浴辅助西药治疗2型糖尿病患者下肢动脉病变（LEPAD）的临床疗效。方法 采用随机数字表法将90例2型糖尿病LEPAD早期患者分为治疗组和对照组各45例。对照组采用常规治疗，包括健康教育，控制饮食，适量运动，控制血糖、血压、血脂及营养神经、扩张血管；治疗组在对照组基础上予中药足浴，每次浸泡双下肢30 min，每日1次。连续治疗12周。评价2组临床疗效，观察2组治疗前后中医证候积分、最大无痛行走距离、足趾皮肤温度、下肢动脉血管管径、下肢动脉血管血流量、踝肱指数（ABI）、血压（BP）、空腹血糖（FBG）、糖化血红蛋白（HbA1c）及血清脂联素、白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）水平，检测血常规，肝、肾功能并记录不良反应。结果 治疗组临床疗效总有效率为82.22%（37/45），对照组为68.89%（31/45），治疗组优于对照组（Z=-2.099，P=0.036）。与本组治疗前比较，2组治疗后中医证候积分、BP、FBG、HbA1c及血清IL-6、TNF-α水平显著下降（P<0.05），血清脂联素水平显著升高（P<0.05），最大无痛行走距离、足趾皮肤温度、下肢动脉血管管径、下肢动脉血管血流量及ABI显著改善（P<0.05）；治疗组治疗后中医证候积分及血清IL-6、TNF-α水平显著低于对照组（P<0.05），最大无痛行走距离、足趾皮肤温度、下肢动脉血管管径、下肢动脉血管血流量及ABI、血清脂联素水平显著优于对照组（P<0.05）。结论 中药足浴辅助西药治疗2型糖尿病LEPAD疗效显著，其作用机制可能与改善患者血清炎症因子水平表达，进而抑制血管炎症性损伤有关。

关键词：2型糖尿病；下肢动脉病变；中药足浴；炎症因子

DOI：10.3969/j.issn.1005-5304.2018.03.005

中图分类号：R259.872 文献标识码：A 文章编号：1005-5304（2018）03-0019-06

Abstract： Objective To observe the clinical efficacy of TCM foot bath in adjuvant treatment for early diabetic lower-extremity peripheral arterial disease （LEPAD）. Methods Totally 90 cases with early diabetic LEPAD were divided into treatment group and control group by random number table method， with 45 cases in each group. Control group was given routine treatment， including health education， diet control， proper exercise， control of blood sugar， blood pressure and blood lipids， nutritional nerves， dilation of blood vessels. On the basis of control group， the treatment group was given TCM foot bath， soaking the lower limbs for 30 minutes each time， once a day， for 12 weeks. The clinical efficacy of the two groups was evaluated. The TCM syndrome score， maximum painless walking distance， temperature of the toe skin， diameter of the lower extremity arterial blood vessels， lower extremity arterial blood flow， ankle brachial index （ABI）， blood pressure （BP）， FBG， HbA1c， serum adiponectin， IL-6 and TNF-α were detected. The blood routine， liver and kidney function were detected and adverse reactions were recorded. Results The total effective rate was 82.22% （37/45） in the treatment group and 68.89% （31/45） in the control group. The treatment group was significantly better than the control group （Z=-2.099， P=0.036）. Compared with before treatment， the levels of TCM syndromes， BP， FBG， HbA1c， serum IL-6 and TNF-α were significantly lower in both groups after treatment （P<0.05）； serum adiponectin level increased after treatment （P<0.05）； the maximum painless walking distance， the temperature of the toe skin， the diameter of the lower extremity arterial blood vessels， the lower extremity arterial blood flow and ABI were significantly improved. Compared with the control group， the scores of TCM syndromes in the treatment group were significantly lower （P<0.05）； the levels of IL-6 and TNF-α in the treatment group were significantly lower than those in the control group （P<0.05）； the maximum painless walking distance， the temperature of the toe skin， the diameter of the lower extremity arterial vessels， the lower extremity arterial blood flow and ABI， serum adiponectin level in the treatment group were significantly higher than those of the control group （P<0.05）. Conclusion TCM foot bath in adjuvant treatment for early diabetic LEPAD is with obvious efficacy， and the mechanism may be related to improving the level of serum inflammatory cytokines to inhibit the inflammatory injury of blood vessels.

Keywords： type 2 diabetes； lower extremity peripheral arterial disease； TCM foot bath； inflammatory cytokines

2型糖尿病患者下肢动脉病变（lower-extremity peripheral arterial disease，LEPAD）是糖尿病最常见的慢性并发症之一，其发病早、进展快，是导致患者截肢的主要原因[1]。早在2007年，我国7个大中城市15家三级甲等医院整群抽样研究显示，50岁以上糖尿病伴LEPAD现患率为19.47%[2]。研究表明，80%LEPAD患者虽然无明显症状，但心血管缺血事件和脑卒中事件的风险分别为年龄相仿的无LEPAD者的2.8倍和4.8倍[3]。LEPAD发病机理目前未完全阐明，至今尚无有效的治疗药物和方法[4-5]。扩张血管、活血化瘀药虽能改善下肢动脉病变，但糖尿病下肢肢端血运差，单纯药物注射等内治疗法难以取得满意疗效[6-8]。……