标题：自体富血小板凝胶联合负压引流对糖尿病足患者胰岛素抵抗水平及创面愈合状况的影响

      作者：付鹏 1，苗婷 2，营在道 3    山东省立第三医院内分泌科 1、心内科 2、门诊部 3，山东 济南 250031

      卷次： 2019年30卷4期

      【摘要】 目的 探讨自体富血小板凝胶(APG)联合负压引流对糖尿病足患者胰岛素抵抗水平及创面愈合状况的影响。方法 选取 2016年 1月至 2018年 5月山东省立第三医院内分泌科收治的 94例糖尿病足溃疡患者为研究对象，采用随机数字表法分为观察组和对照组，每组 47例，对照组采用常规治疗，观察组采用APG联合负压引流治疗，治疗 4周后，比较两组患者的临床疗效、临床指标变化、创面愈合时间、住院时间、住院费用及不良反应。结果 治疗前，两组患者的空腹血糖(FPG)、餐后 2 h血糖(2 hPG)、糖化血红蛋白(HbAlc)、胰岛素抵抗指数(HOMA-IR)、总胆固醇(TC)比较，差异均无统计学意义(P>0.05)；治疗后，观察组患者的 FPG、2 hPG、HOMA-IR、HbAlc水平分别为(8.53±1.06) mmol/L、(9.31±1.03) mmol/L、(0.51±0.23)、(6.53±0.51)%，明显低于对照组的(11.26±3.13) mmol/L、(14.52±3.12) mmol/L、(1.20±0.25)、(8.87±1.96)%，TC水平为(5.24±1.05) mmol/L，明显高于对照组的(4.79±1.07) mmol/L，差异均有统计学意义(P<0.05)；观察组患者的治疗总有效率为 95.74%，明显高于对照组的72.34%，差异有统计学意义(P<0.05)；观察组患者的创面愈合时间、住院时间、住院费用分别为(36.42±3.41) d、(41.95±3.27) d、(4 593.62±453.73)元，均明显低于对照组的(47.28±3.52) d、(56.37±3.96) d、(5 785.76±547.83)元，差异均有统计学意义(P<0.05)；治疗期间，对照组患者不良反应发生率为14.89%；略高于观察组的4.26%，但差异无统计学意义(P>0.05)。结论 APG联合负压引流治疗糖尿病足溃疡患者临床疗效较佳，其能降低胰岛素抵抗水平，改善血糖水平，创面愈合率高，不良反应少。
      【关键词】 糖尿病足；自体富血小板凝胶；负压引流；胰岛素抵抗；创面愈合
      【中图分类号】 R587.2 【文献标识码】 A 【文章编号】 1003—6350（2019）04—448—04E

ffects of autologous platelet-rich gel combined with negative pressure drainage on insulin resistance level andwound healing in diabetic foot patients.
FU Peng 1, MIAO Ting 2, YING Zai-dao 3. Department of Endocrinology 1,Department of Cardiology 2, Outpatient Department 3, Shandong Provincial Third Hospital, Jinan 250031, Shandong, CHINA
【Abstract】 Objective To investigate the effects of autologous platelet-rich gel (APG) combined with negativepressure drainage on insulin resistance level and wound healing in diabetic foot patients. Methods A total of 94 pa-tients with diabetic foot ulcer from January 2016 to May 2018 in Department of Endocrinology, Shandong ProvincialThird Hospital were selected and randomly divided into study group and control group, with 47 cases in each group. Pa-tients in the control group received routine treatment, while those in the study group were treated with APG combinedwith negative pressure drainage. After 4 weeks of treatment, the clinical efficacy, clinical indexes changes, wound heal-ing time, length of hospital stay, hospitalization expenses, and adverse reactions were compared between the two groups.Results Before treatment, there were no significant differences in fasting blood glucose (FPG), postprandial 2 h bloodglucose (2 hPG), glycosylated hemoglobin (HbAlc), insulin resistance index (HOMA-IR), total cholesterol (TC) betweenthe two groups (P>0.05). After treatment, the levels of FPG, 2 hPG, HOMA-IR and HbAlc in the study group were (8.53±1.06) mmol/L, (9.31 ± 1.03) mmol/L, (0.51 ± 0.23), (6.53 ± 0.51)% , respectively, which were significantly lower than(11.26±3.13) mmol/L, (14.52±3.12) mmol/L, (1.20±0.25), (8.87±1.96)% in the control group (P<0.05), and TC level was(5.24±1.05) mmol/L, which was significantly higher than (4.79±1.07) mmol/L in the control group (P<0.05). The total ef-fective rate of treatment in the study group was 95.74%, which was significantly higher than 72.34% in the control group(P<0.05). The wound healing time, length of hospital stay, and hospitalization expenses of the study group were (36.42±3.41) d, (41.95 ± 3.27) d, (4 593.62 ± 453.73) yuan respectively, which were significantly lower than (47.28 ± 3.52) d,(56.37±3.96) d, (5 785.76±547.83) yuan in the control group (P<0.05). During the treatment period, the incidence of ad-verse reactions in the control group was 14.89%, which was slightly higher than 4.26% in the study group (P>0.05).Conclusion APG combined with negative pressure drainage in the treatment of diabetic foot ulcer patients has betterclinical efficacy. It can reduce insulin resistance level, improve blood glucose levels, and has high wound healing rateand fewer adverse reactions.
      【Key words】 Diabetic foot; Autologous platelet rich gel; Negative pressure drainage; Insulin resistance; Wound healing