اثر پنتوكسي فيلين خوراكي بر بهبودي زخم هاي پا در بيماران ديابتي

Effects of oral pentoxyphylline on the healing of foot ulcers in the diabetic patients

ﺳﺎﺑﻘﻪ و ﻫﺪف: زﺧﻢ ﭘﺎي دﯾﺎﺑﺘﯽ از ﻋﻮارض دﯾﺎﺑﺖ اﺳﺖ ﮐﻪ در ﺑﺴﯿﺎري از ﻣﻮارد ﻣﻨﺠﺮ ﺑﻪ آﻣﭙﻮﺗﺎﺳﯿﻮن اﻧـﺪام ﺗﺤﺘـﺎﻧﯽ ﻣﯽ ﺷﻮد. ﯾﮑﯽ از داروﻫﺎﯾﯽ ﮐﻪ ﺑﻪ ﺻﻮرت ﺳﯿﺴﺘﻤﯿﮏ در ﺑﻬﺒﻮد زﺧﻢ ﻫﺎي ﻣﺨﺘﻠﻒ ﻣﻮرد ﻣﻄﺎﻟﻌﻪ اﺳـﺖ، ﭘﻨﺘﻮﮐﺴـﯽ ﻓﯿﻠـﯿﻦ ﻣﯽ ﺑﺎﺷﺪ. در اﯾﻦ ﻣﻄﺎﻟﻌﻪ اﺛﺮ آن در ﺑﻬﺒﻮد زﺧﻢ ﻫﺎي دﯾﺎﺑﺘﯽ ﺑﺮرﺳﯽ ﺷﺪ. ﻣﻮاد و روش ﻫﺎ: در ﯾﮏ ﻣﻄﺎﻟﻌﻪ ﺑﺎﻟﯿﻨﯽ ﺗﺼﺎدﻓﯽ ﺷﺪه دو ﺳﻮ ﮐﻮر، ﺑﯿﻤﺎران ﺑﺎ زﺧﻢ دﯾﺎﺑﺘﯽ ﭘﺎ ﮐـﻪ ﺑـﻪ ﮐﻠﯿﻨﯿـﮏ دﯾﺎﺑـﺖ ﺑﯿﻤﺎرﺳﺘﺎن ﻓﺎﻃﻤﯿﻪ ﺷﻬﺮﺳﺘﺎن ﺳﻤﻨﺎن ﻣﺮاﺟﻌﻪ ﮐﺮدﻧﺪ، ﺑﺮرﺳﯽ ﺷﺪﻧﺪ. در ﯾـﮏ ﮔـﺮوه، ﭘﻨﺘﻮﮐﺴـﯽ ﻓﯿﻠـﯿﻦ ﺧـﻮراﮐﯽ، 400 ﻣﯿﻠﯽ ﮔﺮم ﺳﻪ ﺑﺎر در روز، ﺑﻪ ﻣﺪت 3 ﻣﺎه و در ﮔﺮوه ﺷﺎﻫﺪ داروﻧﻤﺎ ﺗﺠﻮﯾﺰ ﮔﺮدﯾﺪ. ﻣﯿـﺰان ﮐـﺎﻫﺶ اﻧـﺪازه زﺧـﻢ و ﻣﯿـﺰان ﺑﻬﺒﻮدي ﮐﺎﻣﻞ آن ﺑﻪ ﻋﻨﻮان ﻣﻌﯿﺎرﻫﺎي ﺑﺮآورد ﺑﻬﺒﻮدي در ﻧﻈﺮ ﮔﺮﻓﺘﻪ ﺷﺪ. ﯾﺎﻓﺘﻪ ﻫﺎ: از 110 ﺑﯿﻤﺎر ﻣﻮرد ﻣﻄﺎﻟﻌﻪ، 30 ﺑﯿﻤﺎر ﺑﻪ دﻟﯿﻞ ﺳﺮﮔﯿﺠﻪ ﻏﯿﺮ ﻗﺎﺑﻞ ﺗﺤﻤﻞ، ﺧﻮن رﯾﺰي رﺗﯿﻦ، ﻧﯿﺎز ﺑﻪ دﺑﺮﯾـﺪﻣﺎن و ﻋﺪم ﻣﺮاﺟﻌﻪ، ﺣﺬف ﺷﺪﻧﺪ. در ﻧﻬﺎﯾﺖ 80 ﺑﯿﻤﺎر در دو ﮔﺮوه 40 ﻧﻔﺮي ﻣﻮرد ﺑﺮرﺳﯽ ﻗﺮار ﮔﺮﻓﺘﻨﺪ. درﺻﺪ ﺑﻬﺒﻮدي زﺧـﻢ در ﭘﺎﯾﺎن ﻣﺎه اول و دوم در ﮔﺮوه ﭘﻨﺘﻮﮐﺴﯽ ﻓﯿﻠﯿﻦ ﺑﻪ ﻃﻮر ﻗﺎﺑﻞ ﺗﻮﺟﻬﯽ ﺑﯿﺶ ﺗﺮ ﺑﻮد. ﻣﯿـﺰان ﺑﻬﺒـﻮدي ﮐﺎﻣـﻞ زﺧـﻢ در ﮔـﺮوه ﭘﻨﺘﻮﮐﺴﯽ ﻓﯿﻠﯿﻦ ﺑﯿﺶ ﺗﺮ ﺑﻮد وﻟﯽ از ﻧﻈﺮ آﻣﺎري اﺧـﺘﻼف ﻣﻌﻨـﯽ داري ﻧﺪاﺷـﺖ. ﺑـﻪ ﻋـﻼوه ﺗﻬـﻮع و ﺳـﺮﮔﯿﺠﻪ در ﮔـﺮوه ﭘﻨﺘﻮﮐﺴﯽ ﻓﯿﻠﯿﻦ ﺷﯿﻮع ﻗﺎﺑﻞ ﺗﻮﺟﻬﯽ داﺷﺖ. ﻧﺘﯿﺠﻪ ﮔﯿﺮي: ﭘﻨﺘﻮﮐﺴﯽ ﻓﯿﻠﯿﻦ ﺑﺎ ﮐﺎﻫﺶ اﻧﺪازه زﺧﻢ در ﺑﻬﺒﻮدي زﺧﻢ ﭘﺎي دﯾﺎﺑﺘﯽ در ﺑﯿﻤـﺎران ﺑـﺪون ﺑﯿﻤـﺎري ﻋـﺮوق ﻣﺤﯿﻄﯽ ﻣﺆﺛﺮ اﺳﺖ. وﻟﯽ ﺑﻪ دﻟﯿﻞ ﻋﻮارض ﺟﺎﻧﺒﯽ اﺣﺘﻤﺎﻟﯽ، ﺑﺎﯾﺪ ﻣﺼﺮف آن در ﺑﯿﻤﺎران دﯾﺎﺑﺘﯽ ﺑﺎ ﺗﺈﻣﻞ ﺻﻮرت ﮔﯿﺮد.

Introduction: Diabetic foot ulcer is the complication of diabetes that commonly led to lower limb amputation. Pentoxyphylline is one of the systemic drugs suggested in the healing of different wounds. In the present study, its effect on healing of the diabetic foot ulcer was evaluated. Materials and Methods: In a double blind randomized clinical trial, patients with diabetic foot ulcer referred to diabetes clinic of Fatemieh hospital, Semnan, Iran, evaluated. In one group oral Pentoxyphylline 400 mg, three times a day and in the control group placebo prescribed. Reduction of the wound size and the incidence of complete wound healing considered as the indicators of wound healing. Results: From 110 patients enrolled in the study, 30 patients excluded because of unbearable dizziness, retinal hemorrhage, need to debridement and loss to follow up. At the end, 80 patients in two groups (each with 40 patients) evaluated. In Pentoxyphylline group, the percentage of wound healing at the end of the first and second months was significantly higher. The rate of complete wound healing was higher but not statistically significant. In addition, the prevalence of nausea and dizziness in Pentoxyphylline group, was significant. Conclusion: Pentoxyphylline is effective in the healing of diabetic foot ulcer by decreasing the wound size in patients without peripheral vascular diseases. However, because of the probable adverse effects, it should used with caution.