本研究旨在确定依帕司他对糖尿病足感染(DFI)患者的疗效及其对患者血清炎症因子的影响。
方法:对2020年5月至2022年5月江西医学院第一附属医院收治的80例DFI患者资料进行回顾性分析。其中,将接受常规综合治疗的患者纳入对照组(n=37),将在常规综合治疗基础上接受依帕司他的患者纳入研究组(n=43)。治疗前后血清炎症因子的变化,分析比较两组肉芽组织分级及疗效,和伤口愈合的时间,住院时间和不良反应(包括恶心和呕吐,头晕,头痛,瘙痒,等。)对两组进行统计学分析。分析患者治疗后1年内的预后,采用logistic回归分析预后不良的独立危险因素。
结果:治疗前,两组患者的肿瘤坏死因子-α(TNF-α)水平无显著差异,高敏C反应蛋白(hs-CRP),和白细胞介素-6(IL-6),治疗后,两组的水平均显着下降,研究组的水平明显低于对照组。研究组患者0级/1级肉芽组织比例明显低于对照组,2级/4级肉芽组织的患者比例明显高于对照组,但两组中3级肉芽组织的患者比例差异不大。研究组创面愈合时间和住院时间明显短于对照组。研究组的总有效率明显高于对照组。此外,两组不良反应总发生率差异不大。BMI,糖尿病类型,Wagner分级和分型是影响糖尿病足感染患者预后的危险因素,Wagner分级是影响患者预后的独立危险因素。
结论:依帕司他可有效治疗DFI,因为它可以降低血清炎症因子的水平,缩短伤口愈合和住院时间,促进颗粒的生长和恢复,不增加不良反应。因此,值得临床推广。
This study was designed to determine the efficacy of epalrestat on patients with diabetic foot infection (DFI) and its effects on serum inflammatory factors in the patients.
METHODS: The data of 80 patients with DFI treated in the First Affiliated Hospital of Jiangxi Medical College from May 2020 to May 2022 were analyzed retrospectively. Among them, patients who received routine comprehensive treatment were enrolled into the control group (n=37), and those who received epalrestat on the basis of routine comprehensive treatment were enrolled into the study group (n=43). The changes of serum inflammatory factors before and after treatment, granulation tissue grading and efficacy in the two groups were analyzed and compared, and the wound healing time, hospitalization time and adverse reactions (including nausea and vomiting, dizziness, headache, pruritus, etc.) of the two groups were statistically analyzed. The prognosis of the patients within 1 year after treatment was analyzed, and the independent risk factors of poor prognosis were analyzed through logistic regression.
RESULTS: Before treatment, the two groups were not significantly different in the levels of tumor necrosis factor-α (TNF-α), high sensitivity C-reactive protein (hs-CRP), and interleukin-6 (IL-6), while after treatment, the levels decreased significantly in both groups, with significantly lower levels in the study group than those in the control group. The study group had a significant lower proportion of patients with grade 0/grade 1 granulation tissue than the control group, and had a significantly higher proportion of patients with grade 2/grade 4 granulation tissue than the control group, but the proportion of patients with grade 3 granulation tissue in the two groups was not greatly different. The study group experienced notably shorter wound healing time and hospitalization time than the control group. A notably higher overall response rate was found in the study group than that in the control group. In addition, the total incidence of adverse reactions was not greatly different between the two groups. BMI, diabetes mellitus type, Wagner grading and classification of diabetic foot infection were found to be the risk factors affecting the prognosis of patients, and Wagner grading was an independent risk factor affecting the prognosis of patients.
CONCLUSIONS: Epalrestat is effective in treating DFI, because it can lower the levels of serum inflammatory factors, shorten the time of wound healing and hospitalization, and promote the growth and recovery of granulation, without increasing adverse reactions. Therefore, it is worthy of clinical promotion.