目的 針對(duì)近期收治的1例罕見(jiàn)糖尿病性類脂質(zhì)漸進(jìn)性壞死(necrobiosis lipoidica diabeticorum,NLD)左小腿皮膚潰瘍患者,檢索當(dāng)前最佳證據(jù),為臨床合理治療提供依據(jù)。
方法 計(jì)算機(jī)檢索Cochrane圖書館(2006年第3期)、PubMed(1966~2006.7)、EMbase(1974~2006.7)、CBM(1978~2006.7),按證據(jù)級(jí)別高低查找相關(guān)證據(jù),并對(duì)所獲證據(jù)進(jìn)行評(píng)價(jià)。
結(jié)果 共檢索到153篇文獻(xiàn),無(wú)臨床指南和系統(tǒng)評(píng)價(jià),也無(wú)臨床對(duì)照研究。有關(guān)臨床治療的文獻(xiàn)共有30篇,共包括17種治療措施。在這些治療措施中,延胡索酸酯類、口服己酮可可堿、局部應(yīng)用生長(zhǎng)因子以及外科皮瓣移植等效果相對(duì)較好,副作用發(fā)生較低。根據(jù)患者意愿和我院實(shí)際,在嚴(yán)格控制血糖、血脂、抗血小板治療及局部清創(chuàng)換藥等常規(guī)治療的基礎(chǔ)上,對(duì)該患者潰瘍處實(shí)施粒細(xì)胞集落刺激因子局部治療,319天后患者小腿潰瘍?nèi)S訪157天,未見(jiàn)病灶復(fù)發(fā)。
結(jié)論 常規(guī)治療加粒細(xì)胞集落刺激因子局部治療是治療糖尿病性類脂質(zhì)漸進(jìn)性壞死小腿皮膚潰瘍的有效方法。
引用本文: 王維萍,袁南兵,王椿,王艷,余婷婷,吳雪艷,冉興無(wú). 一例糖尿病性類脂質(zhì)漸進(jìn)性壞死左小腿皮膚潰瘍患者的循證治療. 中國(guó)循證醫(yī)學(xué)雜志, 2007, 07(11): 320-325. doi: 復(fù)制
版權(quán)信息: ?四川大學(xué)華西醫(yī)院華西期刊社《中國(guó)循證醫(yī)學(xué)雜志》版權(quán)所有,未經(jīng)授權(quán)不得轉(zhuǎn)載、改編
1. | Xiang J, Wei L, Wang JM, et al. Necrobiosis lipodica: a case report.Chin J Derm Venereol, 2001, 15(3): 198, 208. |
2. | Li YL, Wang L, Li YP. Necrobiosis Lipodica: A Case Report andLiterature Review. Chin Gen Pract, 2006, 9(18): 1559. |
3. | Paron NG, Lambert PW. Cutaneous manifestations of diabetes mellitus. Prim Care, 2000, 27(2): 371-383. |
4. | Romano G, Moretti G, Di Benedetto A, et al. Skin lesions in diabetes mellitus: prevalence and clinical correlations. Diabetes Res Clin Pract, 1998, 39(2): 101-106. |
5. | Jel inek JE. Cutaneous manifestations of diabetes mellitus. Int J Dermatol, 1994, 33(9): 605-617. |
6. | Muller SA, Winkelman RK. Necrobiosis lipoidica diabeticorum, a clinical and pathological examination of 171 cases. Arch Dermatol,1966, 93: 272-281. |
7. | O’Toole EA, Kennedy U, Nolan JJ, et al. Necrobiosis lipoidica: onlya minority of patients have diabetes mellitus. Br J Dermatol, 1999,140(2): 283-286. |
8. | Heng MC, Allen SG, Song MK, et al. Focal endothelial celldegeneration and proliferative endarteritis in trauma-induced early lesions of necrobiosis lipoidica diabeticorum. Am J Dermatopathol,1991, 13(2): 108-114. |
9. | Koh MS, Majewski BB, Barter S, et al. Increased plasma fibronectin in diabetes mellitus, necrobiosis lipoidica and widespread granuloma annulare. Clin Exp Dermatol, 1984, 9(3): 293-297. |
10. | Quimby SR, Muller SA, Schroe t e r AL. The cutaneous immunopathology of necrobiosis lipoidica diabeticorum. Arch Dermatol, 1988, 124(9): 1364-1371. |
11. | Imakado S, Satomi H, Iskikawa M, et al. Diffuse necrobiosis lipoidica diabeticorum associated with non-insulin dependent diabetes mellitus. Clin Exp Dermatol, 1998, 23(6): 271-273. |
12. | Kobbah M, Ewald U, Tuvemo T. Vascular reactivity during the first year of diabetes in children. Acta Paediatr Scand Suppl, 1985, 320:. |
13. | Jel inek JE. Cutaneous aspects of diabetes mellitus. In: Bowker JH,Pfeiffer MA, editors. Levin and O’Neal’s the diabetic foot. 6th ed. St Louis (MO): Mosby, 2001: 197-211. |
14. | Kreuter A, Knierim C, Stücker M, et al. Fumaric acid esters innecrobiosis lipoidica: results of a prospective noncontrolled study.Br J Dermatol, 2005, 153(4): 802-807. |
15. | Tan E, Patel V, Berth-Jones J. Systemic corticosteroids for the outpatient treatment of necrobiosis lipoidica in a diabetic patient. J Dermatolog Treat, 2007, 18(4): 246-248. |
16. | Hocqueloux L, Gautier JF, Lebbe C, et al. Ulcerated necrobiosis lipoidica associated with insulin-dependent diabetes mellitus.Beneficial effect of corticosteroid therapy by oral administration.Presse Med, 1996, 25(1): 25-27. |
17. | Petzelbauer P, Wolff K, Tappeiner G. Necrobiosis lipoidica:treatment with systemic corticosteroids. Br J Dermatol, 1992, 126(6):. |
18. | Stanway A, Rademaker M, Newman P. Healing of severe ulcerative necrobiosis lipoidica with cyclosporin. Australas J Dermatol, 2004,. |
19. | Basaria S, Braga-Basaria M. Necrobiosis lipoidica diabeticorum:response to pentoxi phyll ine. J Endocrinol Invest, 2003, 26(10): 1037-1040. |
20. | Kolde G, Muche JM, Schulze P, et al. Infliximab: a promising new treatment option for ulcerated necrobiosis lipoidica. Dermatology,2003, 206(2): 180-181. |
21. | 向進(jìn), 衛(wèi)利, 王俊民, 等. 類脂質(zhì)漸進(jìn)性壞死1例. 中國(guó)皮膚性病學(xué)雜志, 2001, 15(3): 198, 208. |
22. | 李艷玲, 王凌, 李玉平. 類脂質(zhì)漸進(jìn)性壞死一例及文獻(xiàn)回顧. 中國(guó)全科醫(yī)學(xué), 2006, 9(18): 1559. |
23. | Boyd AS. Tretinoin treatment of necrobiosis lipoidica diabeticorum.Diabetes Care, 1999, 22(10): 1753-1754. |
24. | Stephens E, Robinson JA, Gottlieb PA. Becaplermin and necrobiosis lipoidicum diabeticorum: results of a case control pilot study. J Diabetes Complications, 2001, 15(1): 55-56. |
25. | . Remes K, Rönnemaa T. Healing of chronic leg ulcers in diabetic necrobiosis lipoidica with local granulocyte-macrophage colonystimulating factor treatment. J Diabetes Complications, 1999, 13(2):115-118. |
26. | Evans AV, Atherton DJ. Recalcitrant ulcers in necrobiosis lipoidica diabeticorum healed by topical granulocyte-macrophage colonystimulating factor. Br J Dermatol, 2002, 147(5): 1023-1025. |
27. | Owen CM, Murphy H, Yates VM. Tissue-engineered dermal skin grafting in the treatment of ulcerated necrobiosis lipoidica. Clin Exp Dermatol, 2001, 26(2): 176-178. |
28. | Youshock E, Beninson J. Necrobiosis lipoidica: treatment with porcine dressings, spl it-thickness skin grafts and pressure garments.A case report and review of treatment modalities. Angiology, 1985,36(11): 821-826. |
29. | Dubin BJ, Kaplan EN. The surgical treatment of necrobiosis lipoidica diabeticorum. Plast Reconstr Surg, 1977, 60(3): 421-428. |
30. | Heidenheim M, Jemec GB. Successful treatment of necrobiosis lipoidica diabeticorum with photodynamic therapy. Arch Dermatol,2006, 142(12): 1548-1550. |
31. | Cianfarani F, Tommasi R, Failla CM, et al. Granulocyte/macrophage colony-stimulating factor treatment of human chronic ulcers promotes angiogenesis associated with de novo vascular endothelial growth factor transcription in the ulcer bed. Br J Dermatol, 2006,154(1): 34-41. |
32. | Stagno F, Gugl ielmo P, Consol i U, et al. Successful healing of hydroxyurea-related leg ulcers with topical granulocyte-macrophagecolony-stimulating factor. Blood, 1999, 94(4): 1479-1480. |
33. | (2): 119-122. |
34. | -63. |
35. | -545. |
- 1. Xiang J, Wei L, Wang JM, et al. Necrobiosis lipodica: a case report.Chin J Derm Venereol, 2001, 15(3): 198, 208.
- 2. Li YL, Wang L, Li YP. Necrobiosis Lipodica: A Case Report andLiterature Review. Chin Gen Pract, 2006, 9(18): 1559.
- 3. Paron NG, Lambert PW. Cutaneous manifestations of diabetes mellitus. Prim Care, 2000, 27(2): 371-383.
- 4. Romano G, Moretti G, Di Benedetto A, et al. Skin lesions in diabetes mellitus: prevalence and clinical correlations. Diabetes Res Clin Pract, 1998, 39(2): 101-106.
- 5. Jel inek JE. Cutaneous manifestations of diabetes mellitus. Int J Dermatol, 1994, 33(9): 605-617.
- 6. Muller SA, Winkelman RK. Necrobiosis lipoidica diabeticorum, a clinical and pathological examination of 171 cases. Arch Dermatol,1966, 93: 272-281.
- 7. O’Toole EA, Kennedy U, Nolan JJ, et al. Necrobiosis lipoidica: onlya minority of patients have diabetes mellitus. Br J Dermatol, 1999,140(2): 283-286.
- 8. Heng MC, Allen SG, Song MK, et al. Focal endothelial celldegeneration and proliferative endarteritis in trauma-induced early lesions of necrobiosis lipoidica diabeticorum. Am J Dermatopathol,1991, 13(2): 108-114.
- 9. Koh MS, Majewski BB, Barter S, et al. Increased plasma fibronectin in diabetes mellitus, necrobiosis lipoidica and widespread granuloma annulare. Clin Exp Dermatol, 1984, 9(3): 293-297.
- 10. Quimby SR, Muller SA, Schroe t e r AL. The cutaneous immunopathology of necrobiosis lipoidica diabeticorum. Arch Dermatol, 1988, 124(9): 1364-1371.
- 11. Imakado S, Satomi H, Iskikawa M, et al. Diffuse necrobiosis lipoidica diabeticorum associated with non-insulin dependent diabetes mellitus. Clin Exp Dermatol, 1998, 23(6): 271-273.
- 12. Kobbah M, Ewald U, Tuvemo T. Vascular reactivity during the first year of diabetes in children. Acta Paediatr Scand Suppl, 1985, 320:.
- 13. Jel inek JE. Cutaneous aspects of diabetes mellitus. In: Bowker JH,Pfeiffer MA, editors. Levin and O’Neal’s the diabetic foot. 6th ed. St Louis (MO): Mosby, 2001: 197-211.
- 14. Kreuter A, Knierim C, Stücker M, et al. Fumaric acid esters innecrobiosis lipoidica: results of a prospective noncontrolled study.Br J Dermatol, 2005, 153(4): 802-807.
- 15. Tan E, Patel V, Berth-Jones J. Systemic corticosteroids for the outpatient treatment of necrobiosis lipoidica in a diabetic patient. J Dermatolog Treat, 2007, 18(4): 246-248.
- 16. Hocqueloux L, Gautier JF, Lebbe C, et al. Ulcerated necrobiosis lipoidica associated with insulin-dependent diabetes mellitus.Beneficial effect of corticosteroid therapy by oral administration.Presse Med, 1996, 25(1): 25-27.
- 17. Petzelbauer P, Wolff K, Tappeiner G. Necrobiosis lipoidica:treatment with systemic corticosteroids. Br J Dermatol, 1992, 126(6):.
- 18. Stanway A, Rademaker M, Newman P. Healing of severe ulcerative necrobiosis lipoidica with cyclosporin. Australas J Dermatol, 2004,.
- 19. Basaria S, Braga-Basaria M. Necrobiosis lipoidica diabeticorum:response to pentoxi phyll ine. J Endocrinol Invest, 2003, 26(10): 1037-1040.
- 20. Kolde G, Muche JM, Schulze P, et al. Infliximab: a promising new treatment option for ulcerated necrobiosis lipoidica. Dermatology,2003, 206(2): 180-181.
- 21. 向進(jìn), 衛(wèi)利, 王俊民, 等. 類脂質(zhì)漸進(jìn)性壞死1例. 中國(guó)皮膚性病學(xué)雜志, 2001, 15(3): 198, 208.
- 22. 李艷玲, 王凌, 李玉平. 類脂質(zhì)漸進(jìn)性壞死一例及文獻(xiàn)回顧. 中國(guó)全科醫(yī)學(xué), 2006, 9(18): 1559.
- 23. Boyd AS. Tretinoin treatment of necrobiosis lipoidica diabeticorum.Diabetes Care, 1999, 22(10): 1753-1754.
- 24. Stephens E, Robinson JA, Gottlieb PA. Becaplermin and necrobiosis lipoidicum diabeticorum: results of a case control pilot study. J Diabetes Complications, 2001, 15(1): 55-56.
- 25. . Remes K, Rönnemaa T. Healing of chronic leg ulcers in diabetic necrobiosis lipoidica with local granulocyte-macrophage colonystimulating factor treatment. J Diabetes Complications, 1999, 13(2):115-118.
- 26. Evans AV, Atherton DJ. Recalcitrant ulcers in necrobiosis lipoidica diabeticorum healed by topical granulocyte-macrophage colonystimulating factor. Br J Dermatol, 2002, 147(5): 1023-1025.
- 27. Owen CM, Murphy H, Yates VM. Tissue-engineered dermal skin grafting in the treatment of ulcerated necrobiosis lipoidica. Clin Exp Dermatol, 2001, 26(2): 176-178.
- 28. Youshock E, Beninson J. Necrobiosis lipoidica: treatment with porcine dressings, spl it-thickness skin grafts and pressure garments.A case report and review of treatment modalities. Angiology, 1985,36(11): 821-826.
- 29. Dubin BJ, Kaplan EN. The surgical treatment of necrobiosis lipoidica diabeticorum. Plast Reconstr Surg, 1977, 60(3): 421-428.
- 30. Heidenheim M, Jemec GB. Successful treatment of necrobiosis lipoidica diabeticorum with photodynamic therapy. Arch Dermatol,2006, 142(12): 1548-1550.
- 31. Cianfarani F, Tommasi R, Failla CM, et al. Granulocyte/macrophage colony-stimulating factor treatment of human chronic ulcers promotes angiogenesis associated with de novo vascular endothelial growth factor transcription in the ulcer bed. Br J Dermatol, 2006,154(1): 34-41.
- 32. Stagno F, Gugl ielmo P, Consol i U, et al. Successful healing of hydroxyurea-related leg ulcers with topical granulocyte-macrophagecolony-stimulating factor. Blood, 1999, 94(4): 1479-1480.
- 33. (2): 119-122.
- 34. -63.
- 35. -545.