| As one of the most common macroangiopathy, the incidence of diabetic lowerextremity arteriosclerosis obstruction (DLASO) is gradually increased in recentyears. The numb, cool, painful feeling of lower extremities sometimes can becomegangrene, and even be amputated, which make seriously negative impact on normalwork and life. So it’s important to find the risk factors and effective medicineof DLASO, in order to prevent occurrence of the disease, and relieveindisposition from patients. As following there are four parts in our thesis.First review: The research progress of DLASO on the treatmentof Traditional Chinese Medicine (TCM) and Western MedicineThis part is the literature review of Traditional Chinese Medicine (TCM),Western Medicine and integration of them, which is about the treatment of DLASO.It also contains the importance of regulating physical and mental health.Second review: The research is about the risk factors andpathological mechanism of DLASO.This part is a literature summary about the recognized risk factors of DLASO,such as age, sex, course of disease, smoking, blood glucose, blood pressure,lipids, UA, fibrinogen (Fib) and CRP as well as the pathological mechanism ofthem.Text one: The retrospective study of clinical cases about DLASO.Purpose: To find the risk factors, clinical treatment, guiding basis forclinical trials of DLASO, we analyzed and compared part of4788medical recordsof diabetes mellitus (DM) on multiple exposure factors and the results ofphysical and chemical examinations from2009to2012in our Department ofEndocrinology.Methods: In4788patients there were476patients had been diagnosed as DLASOby color Doppler ultrasound. On the one hand we chose305medical records from 476records, which had comparatively complete informations, on the other hand305medical records were randomly selected from the4788patients of DM whohaven’t LASO (NDLASO). We not only made contrast of parameters, which includingage, course of disease, history of smoking and drinking, BMI, SBP, DBP, FPG,2hPG, HbA1C, TG, CHOL, HDL-C, LDL-C, UA, CREA, UREA, CRP, the ABI of bilaterallimb, but also respectively compared the age and lipids of DLASO group throughsex and smoking history. The results were treated statistically.Results:1. The prevalence of DLASO was more than9.9%from2009to2012in our Departmentof Endocrinology.2. The two groups had Statistically significant differences in aspects of age,course of disease, history of smoking，SBP, DBP, UA, CREA, UREA and the ABI ofbilateral limbs, through the analysis of wilcoxon rank sum test, which gave theresult of P<0.05. It also revealed that the condition of DLASO was worse thanthat of NDLASO depending on the mean rank.3. P<0.05showed that there was remarkable difference in age between men andwomen of DLASO group. The average age of onset of women is elder than men.4. Among multiple observed indexes, just age, course of disease, smoking, SBPand UA were selected into regression equation by way of Logistic regressionanalysis. The regression equation had Statistically significant with75.1%accuracy and test indicators,which is P<0.05.The equation was that: LogitP=-7.690+0.52age+0.128course+0.593smoke+0.002UA+0.021SBP.Conclusion:1. This study found that the prevalence of DLASO was nearly more than one tenthin our Department of Endocrinology from2009to2012.The digital indicated thatthere were plenty of DLASO patients in this region. To comparing with thepatients of NDLASO, people who had DLASO usually accompanied with older age,longer course of disease, higher value of BP, UA, BMI, CREA and UREA. They oftenhad history of smoking. In order to defer the happening of DLASO, we proposed that keeping effectively control of BP, UA, BMI, CREA as well as UREA and avoidingsmoking for NDLASO patients.2. In variety of parameters, just age, course of disease, smoking, SBP, and UAwere statistically analyzed to be the risk factors of DLASO, especially the firstthree of them had remarkable relationship with DLASO.3. The average age of women was elder than men in DLASO group, which indicatesthat gender differences had a significant impact on the occurrence of DLASO. Text two： The clinical trial research about DLASO.Purpose: As an effective Chinese patent medicine，which was developed fromProfessor Yu Shijia for diabetic peripheral neuropathy(DPN), Mudan granula(MDG)had obtained the batch production certificate from State Food and DrugAdministration（SFDA） in2008. It has the function of supplementing Qi,promoting blood circulation, dredging meridian and relieving pain.DLASO has thesimilar clinical manifestations and principles of treatment like DPN. Accordingto the theory of TCM, which indicates that treating different diseases with thesame method, we can infer that MDG may be has effect on the treatment of DLASO.So we designed this clinical trial in order to observe the efficacy of MDG forDLASO.Methods:47patients were randomly assigned to the treatment group and thecontrol group. The former with31patients took MDG, while the latter with16patients took Tongsemai tablets(TSMT) on the basic therapy of hypoglycemic,hypotensive, regulating blood lipids, anti-platelet aggregation andtherapeutic apparatus. After four weeks, the integration and efficacy ofclinical symptom as well as the parameters were observed, which including FPG,2hPG, TG, CHOL, LDL-C, HDL-C, whole blood viscosity, plasma viscosity of bloodcapillary, hematocrit(HCT), fibrinogen(Fib), and blood dynamics of lower limbs．The results were treated statistically．Results:1. MDG group reaches the total efficiency as high as77.41%, while in TSMT groupthe total effective rate is68.75%. Chi-square(X2) analysis gives the result ofP>0．05，without significant difference．2. After treatment, the statistical comparison of TG, CHOL, LDL-C, HDL-C, FPG,2hPG, whole blood viscosity, plasma viscosity of blood capillary, HCT, Fib, theinner diameter as well as peak velocity of blood flow of bilateral dorsalis pedisand anterior tibial artery between before and after treatment showed that P＜0.05, which had Statistically significant differences.3. After treatment, P<0.05showed the significant differences between two groupsin the inner diameter and peak velocity of blood flow of bilateral posteriortibial artery, however we found that the diversity had already existed beforetherapy.Conclusion:1. MDG showed obvious efficacy in the treatment of DLASO with the syndrome ofQi deficiency and blood stasis on the basic therapy．MDG had similar efficacyas TSMT which is specially used on DLASO’s therapy.2. The effective mechanism of MDG may not only contain regulating blood lipids，reducing whole blood viscosity, plasma viscosity of blood capillary, dissolvingFib, but also conclude accelerating blood flow and dilating blood vessels. Allof these are useful to reach the therapeutic purpose of improving the blood supplyof lower limbs．... |
PDF Full Text Request