观察针对不同病情和感染程度的糖尿病足患者，脾多肽治疗前后，对患者免疫功能和创面转归的影响。

从第二军医大学附属长海医院、解放军海军四一三医院2010年5月至2014年5月入院治疗的2型糖尿病患者中选取78例符合纳入与排除标准的糖尿病足患者，糖尿病足Wagner分级2～3级划分为感染，4～5级为坏疽，采用随机数字表法分为感染对照组(n＝21)、感染治疗组(n＝21)，坏疽对照组(n＝18)和坏疽治疗组(n＝18)，感染对照组与坏疽对照组依照指南原则给予常规治疗，感染治疗组与坏疽治疗组患者除常规治疗外，自入院后第2天起接受为期14 d的脾多肽注射液治疗。比较4组患者治疗前、治疗第14天血糖控制情况、免疫功能情况、创面细菌培养阳性率及全身性感染发生率、药物安全性评估结果；观察比较创面转归及预后，并记录不良反应事件。

经过治疗，4组患者的空腹血糖水平都能控制在较好的范围内，感染治疗组、坏疽治疗组平均胰岛素日用量分别低于感染对照组、坏疽对照组；感染治疗组、坏疽治疗组患者的CD3增加值、CD4增加值、CD4/CD8、IgA增加值、IgG增加值均分别高于感染对照组、坏疽对照组，差异有统计学意义(均P<0.05)；感染治疗组、坏疽治疗组患者的全身性感染发生率、治疗时间均分别低于感染对照组、坏疽对照组，差异有统计学意义(均P<0.05)；坏疽治疗组的手术率、重复截肢率指标低于坏疽对照组，差异有统计学意义(P<0.05)；其中，感染治疗组的平均胰岛素日用量(40.12±9.65)IU低于坏疽治疗组(51.67±10.85)IU，差异有统计学意义(t＝2.96, P＝0.031)；感染治疗组的CD4的增加水平(7.16±1.13)%高于坏疽治疗组(6.49±1.51)%，差异有统计学意义(t＝2.18，P＝0.037)；感染治疗组的IgG的增加水平(2.96±0.09)mg/mL高于坏疽治疗组(1.60±0.17)mg/mL，差异有统计学意义(t＝3.14，P＝0.007)。

脾多肽能促进糖尿病足患者免疫功能的恢复并降低感染发生率，促进创面愈合，缩短治疗时间。早期使用脾多肽，可能会改善糖尿病足预后。

To observe the effects of lienal polypeptide on the immune function and wound outcome in treating diabetic foot patients of different grades.

According to the Wagner Grading System, seventy-eight eligible diabetic foot patients from two hospitals in shanghai were divided into infection treatment group (21 patients), infection control group (21 patients), gangrene treatment group (18 patients) and gangrene control group (18 patients). Infection treatment group and gangrene treatment group were given 14 days′ lienal polypeptide injection treatment from the second day after admission, while infection control group and gangrene control group were given routine treatment. Blood glucose, immune function, infection rate and prognosis were evaluated and compared between the four groups.

After treatment, the blood glucose of all groups was controlled at an acceptable level and the treatment groups consumed less insulin comparing to the control groups. The treatment groups were also exceed to the control groups in CD3 increment, CD4 increment, CD4/CD8, IgA increment, IgG increment, infection rate, treatment period, the difference was statistically significant (P<0.05). The gangrene treatment group was superior to the gangrene control group in the number of operation and amputation rate, the difference was statistically significant (P<0.05). In addition, the insulin consuming of the infection treatment group was less than that of the gangrene treatment group(51.67±10.85)IU, the difference was statistically significant(t=2.96, P=0.031). The CD4 increasing of the infection treatment group (7.16±1.13)% was more than that of the gangrene treatment group (6.49±1.51) %, the difference was statistically significant (t=2.18, P=0.037). The IgG increasing of the infection treatment group (40.12±9.65) mg/mL was more than that of the gangrene treatment group (51.67±10.85) mg/mL, the difference was statistically significant(t=3.14, P=0.007).

For the diabetic foot patients, lienal polypeptide can accelerate the recovery of immune function, reduce the infection rate, promote wound healing, shorten the treatment time and improve the prognosis. If lienal polypeptide is used in early phase, the effects can be more significant.