牛学瑞 董伟杰 高少科 郑斯玉

〔摘要〕 目的 觀察中药辨证内服联合温针灸、局部清创治疗糖尿病足患者的临床疗效。方法 采用随机数字表法将本院收治的76例糖尿病足患者分为观察组和对照组，各38例。对照组在西医基础治疗的基础上给予局部清创，观察组在对照组的基础上加用中药辨证内服和温针灸治疗。于治疗前后检测足背动脉血流速度、腓总神经传导速度、溃疡总面积，采用酶联免疫吸附法检测炎性细胞因子肿瘤坏死因子（tumor necrosis factor-？琢， TNF-？琢）、白介素-6 （interleukin 6， IL-6）及晚期糖基化终末产物的水平，比较治疗后两组的临床疗效。结果 （1）治疗后，两组患者的足背动脉血流速度、腓总神经传导速度较治疗前增快，溃疡总面积较治疗前减少，差异有统计学意义（P<0.05）;且观察组的足背动脉血流速度及腓总神经传导速度快于对照组、溃疡总面积小于对照组（P<0.05）。（2）治疗后，两组患者的TNF-？琢、IL-6及晚期糖基化终末产物水平均较治疗前下降（P<0.05）;且观察组低于对照组（P<0.05）。（3）观察组总有效率为94.74%，高于对照组的81.58%（P<0.05）。结论 中药辨证内服联合温针灸、局部清创治疗糖尿病足患者可改善足部血液循环和神经传导速度，下调相关炎性细胞因子和晚期糖基化终末产物水平，有效缓解临床症状且优于西医基础治疗联合局部清创。

〔关键词〕 糖尿病足;中药;辨证;温针灸;足背动脉血流速度;腓总神经传导速度;溃疡总面积;炎性细胞因子

〔中图分类号〕R259       〔文献标志码〕B       〔文章编号〕doi：10.3969/j.issn.1674-070X.2020.07.020

〔Abstract〕 Objective To observe the clinical efficacy of internal administration of Chinese materia medica based on syndrome differentiation combined with warming needle moxibustion and local debridement in the treatment of diabetic foot. Methods A total of 76 patients with diabetic foot treated in our hospital were divided into an observation group and a control group by random number table method， with 38 cases in each group. The control group was given local debridement on the basis of basic treatment of western medicine， while the observation group was treated with internal administration of Chinese materia medica based on syndrome differentiation and warming needle moxibustion on the basis of the control group. The blood flow velocity of dorsal pedal artery， common peroneal nerve conduction velocity and total ulcer area were measured before and after treatment. The levels of inflammatory cytokines tumor necrosis factor-？琢 （TNF-？琢）， interleukin 6 （IL-6） and advanced glycation end products were detected by enzyme-linked immunosorbent assay. The clinical efficacy of the 2 groups was compared after treatment. Results （1） After treatment， the blood flow velocity of dorsalis pedis artery and the conduction velocity of common peroneal nerve in the 2 groups increased， and the total area of ulcer decreased. The differences were statistically significant （P<0.05）. The blood flow velocity of dorsalis pedis artery and the conduction velocity of common peroneal nerve in the observation group were higher than those in the control group， and the total area of ulcer was lower than that in the control group （P<0.05）. （2） After treatment， the levels of TNF-？琢， IL-6 and advanced glycation end products in the 2 groups were significantly decreased than those before treatment， and the difference was statistically significant （P<0.05）， and the observation group was lower than the control group （P<0.05）. （3） The total effective rate of the observation group was 94.74%， which was higher than 81.58% of the control group （P<0.05）. Conclusion Internal administration of Chinese materia medica based on syndrome differentiation combined with warming needle moxibustion and local debridement can improve the blood circulation and nerve conduction velocity of diabetic foot， reduce the levels of related inflammatory cytokines and advanced glycation end products， effectively alleviate clinical symptoms and is superior to basic treatment of western medicine combined with local debridement.

〔Keywords〕 diabetic foot; Chinese materia medica; syndrome differentiation; warming needle moxibustion; blood flow velocity of dorsal foot artery; common peroneal nerve conduction velocity; total ulcer area; inflammatory cytokines

糖尿病足是糖尿病常见的四大慢性并发症之一，是由于糖尿病性周围神经病变、血管病变及感染等多种因素导致的下肢感染、皮肤组织深部溃疡以及肢端坏疽等异常病变的统称[1]。该病临床主要表现为肢体感觉减退、麻木、肢端发凉、静息痛及间歇性跛行等，可进展形成肢端溃疡、坏疽，严重者需进行截肢手术，给患者家庭和社会都带来沉重的负担[2]。据统计，我国糖尿病患者中糖尿病足发病率呈逐年增加趋势，且高达5%～20%[3]，如何防治糖尿病足已经成为临床关注的热点。……