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目的观察小牛血清去蛋白注射液(DCBSI)对糖尿病下肢动脉病变患者早期动脉硬化指标的影响,为糖尿病并发下肢动脉病变的治疗提供依据。方法选取48例糖尿病并发下肢动脉病变患者(PAD组),随机分为加用DCBSI治疗组24例和对照组24例,并选取未并发PAD的糖尿病患者32例(非PAD组)作为基线时指标对照。治疗前后测定空腹血糖、餐后血糖、糖化血红蛋白(HAb1C)、总胆固醇、甘油三酯、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、空腹胰岛素水平,计算胰岛素抵抗指数(HOMA-IR),并检测颈股脉搏波传导速度(cf-PWV)、心踝血管指数(CAVI)、踝臂指数(ABI)及依赖性血管内皮舒张功能(EDD)。结果 PAD组Hb A1C、甘油三酯、LDL-C、空腹胰岛素及cf-PWV、CAVI均明显高于非PAD组,HDL-C、ABI、EDD均明显低于非PAD组,差异均有统计学意义(P<0.05,P<0.01)。应用DCBSI治疗前后比较,治疗组甘油三酯[(2.5±0.52)mmol/L]、空腹胰岛素[(10.2±0.35)m U/L]、HOMA-IR(0.9±0.67)、cf-PWV[(10.0±2.80)m/s]和CVAI(8.2±0.74)较治疗前[分别为(3.0±0.85)mmol/L、(13.9±4.60)m U/L、1.4±0.46、(11.8±3.00)m/s和9.6±1.70]明显降低,EDD(10.3%±2.50%)较治疗前(8.0%±3.20%)明显升高,差异均有统计学意义(P<0.05,P<0.01)。对照组治疗后cf-PWV也较治疗前降低,差异有统计学意义(P<0.05),但CVAI和EDD差异无统计学意义(P>0.05)。两组治疗前后ABI指标无明显变化。结论糖尿病确诊初期部分患者已出现动脉粥样硬化和下肢动脉病变,早期检测和干预十分必要。DCBSI是治疗糖尿病下肢动脉病变的有效药物。
Objective To observe the influence of DCBSI on the early arteriosclerosis index in patients with diabetic lower extremity arterial disease and provide basis for the treatment of diabetic lower extremity arterial disease. Methods Forty-eight patients with diabetic lower extremity arterial disease (PAD) were randomly divided into 24 patients in the DCBSI group and 24 in the control group. Thirty-two diabetic patients without PAD (non-PAD group) were selected as the baseline indicators Control. The levels of fasting blood glucose, postprandial blood glucose, HAb1C, total cholesterol, triglycerides, HDL-C, LDL-C and fasting insulin were measured before and after treatment. Insulin resistance index (HOMA-IR), cf-PWV, CAVI, ABI and EDD were measured. Results The levels of Hb A1C, triglyceride, LDL-C, fasting insulin, cf-PWV and CAVI in PAD group were significantly higher than those in non-PAD group, and HDL-C, ABI and EDD were significantly lower in PAD group than in non-PAD group Significance (P <0.05, P <0.01). The levels of triglyceride (2.5 ± 0.52 mmol / L), fasting insulin (10.2 ± 0.35) mU / L and HOMA-IR of 0.9 ± 0.67 and cf-PWV [ (3.0 ± 0.85) mmol / L, (13.9 ± 4.60) mU / L, 1.4 ± 0.46, (11.8 ± 3.00) m / s and 9.6 ± 1.70], EDD (10.3% ± 2.50%) were significantly higher than those before treatment (8.0% ± 3.20%), the differences were statistically significant (P <0.05, P <0.01). The cf-PWV in the control group was also lower than that before treatment, the difference was statistically significant (P <0.05), but there was no significant difference between CVAI and EDD (P> 0.05). There was no significant change in ABI before and after treatment in both groups. Conclusion Some patients with initial diagnosis of diabetes have developed atherosclerosis and arterial disease of the lower extremities. Early detection and intervention are necessary. DCBSI is an effective drug for the treatment of diabetic lower extremity arterial disease.