一例糖尿病性類脂質漸進性壞死左小腿皮膚潰瘍患者的循證治療_《中國循證醫學雜志》

作者：

王維萍 ¹ , 袁南兵 ¹ , 王椿 ¹ , 王艷 ¹ , 余婷婷 ¹ , 吳雪艷 ² ,  冉興無 ¹

1.四川大學華西醫院內分泌科，糖尿病足診治中心（成都 610041）2. 廣元市人民醫院內分泌科;

關鍵詞：

糖尿病性類脂質漸進性壞死潰瘍粒細胞集落刺激因子循證治療

視頻：

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目的　針對近期收治的1例罕見糖尿病性類脂質漸進性壞死（necrobiosis lipoidica diabeticorum，NLD）左小腿皮膚潰瘍患者，檢索當前最佳證據，為臨床合理治療提供依據。
方法　計算機檢索Cochrane圖書館（2006年第3期）、PubMed（1966～2006.7）、EMbase（1974～2006.7）、CBM（1978～2006.7），按證據級別高低查找相關證據，并對所獲證據進行評價。
結果　共檢索到153篇文獻，無臨床指南和系統評價，也無臨床對照研究。有關臨床治療的文獻共有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、局部應用生長因子以及外科皮瓣移植等效果相對較好，副作用發生較低。根據患者意愿和我院實際，在嚴格控制血糖、血脂、抗血小板治療及局部清創換藥等常規治療的基礎上，對該患者潰瘍處實施粒細胞集落刺激因子局部治療，319天后患者小腿潰瘍痊愈，隨訪157天，未見病灶復發。
結論　常規治療加粒細胞集落刺激因子局部治療是治療糖尿病性類脂質漸進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. 一例糖尿病性類脂質漸進性壞死左小腿皮膚潰瘍患者的循證治療. 中國循證醫學雜志, 2007, 07(11): 320-325. doi: 復制

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, 衛利, 王俊民, 等. 類脂質漸進性壞死1例. 中國皮膚性病學雜志, 2001, 15(3): 198, 208.
22.	李艷玲, 王凌, 李玉平. 類脂質漸進性壞死一例及文獻回顧. 中國全科醫學, 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, 衛利, 王俊民, 等. 類脂質漸進性壞死1例. 中國皮膚性病學雜志, 2001, 15(3): 198, 208.
22. 李艷玲, 王凌, 李玉平. 類脂質漸進性壞死一例及文獻回顧. 中國全科醫學, 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.

《中國循證醫學雜志》

一例糖尿病性類脂質漸進性壞死左小腿皮膚潰瘍患者的循證治療

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《中國循證醫學雜志》

一例糖尿病性類脂質漸進性壞死左小腿皮膚潰瘍患者的循證治療

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

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Content

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