High-dose prostaglandin E1 pulse therapy improves the healing rate of foot ulcer complicated with peripheral vascular disease in diabetic patients

Abstract

Objective To observe the clinical efficacy and security of high-dose prostaglandin E1 pulse therapy in the diabetic foot patients with peripheral vascular disease. Methods Based on the same treatment including dressing change, anti-inflammatory and glycemic control, 151 patients with diabetic foot (Wagner grade 1-3) treated from January 2009 to July 2014 in the Sixth People's Hospital in Shanghai were divided into two groups: treatment group (n=85, treated with high-dose prostaglandin E1 (40 μ g/d) for 1 week), and the control group (n=66, treated with conventional dose of prostaglandin E1 (10 μ g/d) for 2 weeks). Then the healing rate, healing time, amputation rate, ankle-brachial index (ABI), numbness, pain and coldness visual analogue scale (VAS) score and adverse reactions were recorded and analyzed after 3 months of therapy. The t test or Chi-square test was used when data were compared between groups. Results The healing rate in Wagner grade 2 and 3 patients in treatment group increased significantly when compared with that in relevant control group (76.0% vs 61.1% and 69.6% vs 42.1%, χ2=5.21, 15.90, both P<0.05). And the healing time in Wagner grade 2 patients in treatment group was obviously shorter than that in the counterparts in control group ((10.9±4.3) weeks vs (7.7±3.4) weeks,t=2.225,P<0.05). After 3 months of treatment, the ABI increased in the two groups, but only significant difference in ABI was found in Wagner grade 2 patients in treatment group before and after the therapy (0.60±0.21 vs 0.75±0.22,t=2.432,P<0.05). The VAS scores in Wagner grade 1-3 patients in treatment group were all significantly lower than those before the therapy (t=2.292, 2.553, 2.985, all P<0.05), and VAS scores decreased significantly only in Wagner grade 2 and 3 patient in control group (t=2.120, 2.086, both P<0.05). Meanwhile there was no significant differences in the adverse reactions rates between the two groups during the observation period. Conclusion High-dose prostaglandin E1 pulse therapy can improve the wound healing rate in Wagner grade 2 and 3, shorten the healing time in Wagner grade 2, relieve lower limbs pain with safety for diabetic foot patients. Key words: Diabetic foot; Prostaglandin E1; Peripheral vascular disease; Wound healing