银杏叶片对糖尿病下肢动脉硬化闭塞症患者 腔内介入术后的影响

Effect of Ginkgo biloba leaves on diabetic lower extremity arteriosclerosis after intracavitary intervention

摘要:

目的 探讨银杏叶片对糖尿病下肢动脉硬化闭塞症（DLASO）患者腔内介入术后的临床治疗效 果和预后情况及对炎症因子的影响。方法 选取2014 年11 月至2016 年10 月在该院住院的DLASO 患者84 例， 随机分为银杏叶片治疗组（治疗组）和对照组，每组42 例。对照组行基础治疗，包括稳定血糖、血压，择期进 行腔内介入手术治疗，在手术前3 天及术后6 个月口服硫酸氢氯吡格雷75 mg/d，阿司匹林肠溶片0.1 g/d ；治疗 组在对照组的基础上术前3 天及术后6 个月加用银杏叶片2 片/ 次，3 次/d。观察两组患者术前及术后12 h 炎 症因子白细胞介素6（IL-6）、肿瘤坏死因子α（TNF-α）及C 反应蛋白（CRP）情况；记录两组患者介 入术前及术后6 个月时的糖尿病足Wagner 分级及踝肱指数（ABI）和术后6 个月临床症状、再狭窄及截肢情况。 结果 腔内介入术后12 h，两组患者IL-6、TNF-α、CRP 水平与术前比较，差异有统计学意义（P <0.05），术 后12 h 均升高；治疗组的IL-6、TNF-α、CRP 水平与对照组比较，差异有统计学意义（P <0.05），治疗组 低于对照组。术后6 个月两组患者的糖尿病足ABI 水平及临床症状与腔内介入术前比较，差异有统计学意义 （P <0.05），改善情况治疗组优于对照组；腔内介入术后6 个月，治疗组的临床疗效总有效率优于对照组（χ2= 6.222，P =0.013）；但两组间血管再狭窄及截肢差异无统计学意义（χ2=0.718 和2.049，P =0.397 和0.152）。 结论 银杏叶片对DLASO 患者腔内介入再狭窄和截肢的预后改善作用并不明显，但能降低术后12 h 炎症因 子水平，能有效改善介入术后的炎症状态、Wagner 分级、ABI 和临床症状，具有较高的临床意义。

Abstract:

Objective To investigate the effect of Ginkgo biloba leaves on clinical treatment, prognosis and inflammatory status of patients with diabetic lower extremity arteriosclerosis obliterans (DLASO) after intracavitary intervention. Methods A total of 84 patients with DLASO after intracavitary intervention in the First Affiliated Hospital of Henan Polytechnic University from November 2014 to October 2016 were randomly divided into a Ginkgo biloba leaf treatment group (treatment group) and a control group with 42 cases in each group. The patients in the control group received basic treatment, including stabilizing blood glucose and blood pressure, elective intracavitary interventional therapy, oral administration of Clopidogrel 75 mg/d combined with aspirin entericcoated tablets 0.1 g/d for 3 d before surgery and 6 m after operation. On the basis of the control group, the treatment group was treated with Ginkgo biloba leaves 40 mg, 3 times/d. Inflammatory factors (IL-6, TNF-α and CRP) were observed before operation and 12 h after operation. The Wagner grade and ankle brachial index (ABI) were recorded in the two groups before operation and 6 m after operation. The clinical symptoms, restenosis and amputation were also recorded 6 m after operation. Results At the 12th h after intracavitary intervention, IL-6, TNF-α and CRP significantly increased in both groups (P < 0.05), and the levels of IL-6, TNF-α and CRP in the treatment group were lower than those in the control group (P < 0.05). At 6 m after operation, the ABI and clinical symptoms of diabetic feet were significantly improved in both groups, and the improvement of the treatment group was superior to that of the control group, the differences were statistically significant (P < 0.05); the total effective rate of the treatment group was higher than that of the control group (χ2 = 6.222, P = 0.013), but there was no significant difference in vascular restenosis rate or amputation rate between the two groups (χ2 = 0.718 and 2.049, P = 0.397 and 0.152). Conclusions Ginkgo biloba leaves do not have obvious effect on lowering the rates of vascular restenosis and amputation in the patients with DLASO after intracavitary intervention. However, they could reduce the levels of inflammatory factors 12 h after surgery and improve the inflammatory status, Wagner grade, ABI and clinical symptoms after intervention, therefore, have great clinical significance.