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

目的 　針對近期收治的1例罕見糖尿病性類脂質(zhì)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(jù)，為臨床合理治療提供依據(jù)。
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(jù)級別高低查找相關(guān)證據(jù)，并對所獲證據(jù)進行評價。
結(jié)果 　共檢索到153篇文獻，無臨床指南和系統(tǒng)評價，也無臨床對照研究。有關(guān)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(fā)生較低。根據(jù)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(chuàng)換藥等常規(guī)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?nèi)?，隨訪157天，未見病灶復發(fā)。
結(jié)論 　常規(guī)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(zhì)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(zhì)漸進性壞死左小腿皮膚潰瘍患者的循證治療. 中國循證醫(yī)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(wèi)利, 王俊民, 等. 類脂質(zhì)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(zhì)漸進性壞死一例及文獻回顧. 中國全科醫(yī)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. 1. Xiang J, Wei L, Wang JM, et al. Necrobiosis lipodica: a case report.Chin J Derm Venereol, 2001, 15(3): 198, 208.
  2. 2. Li YL, Wang L, Li YP. Necrobiosis Lipodica: A Case Report andLiterature Review. Chin Gen Pract, 2006, 9(18): 1559.
  3. 3. Paron NG, Lambert PW. Cutaneous manifestations of diabetes mellitus. Prim Care, 2000, 27(2): 371-383.
  4. 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. 5. Jel inek JE. Cutaneous manifestations of diabetes mellitus. Int J Dermatol, 1994, 33(9): 605-617.
  6. 6. Muller SA, Winkelman RK. Necrobiosis lipoidica diabeticorum, a clinical and pathological examination of 171 cases. Arch Dermatol,1966, 93: 272-281.
  7. 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. 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. 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. 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. 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. 12. Kobbah M, Ewald U, Tuvemo T. Vascular reactivity during the first year of diabetes in children. Acta Paediatr Scand Suppl, 1985, 320:.
  13. 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. 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. 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. 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. 17. Petzelbauer P, Wolff K, Tappeiner G. Necrobiosis lipoidica:treatment with systemic corticosteroids. Br J Dermatol, 1992, 126(6):.
  18. 18. Stanway A, Rademaker M, Newman P. Healing of severe ulcerative necrobiosis lipoidica with cyclosporin. Australas J Dermatol, 2004,.
  19. 19. Basaria S, Braga-Basaria M. Necrobiosis lipoidica diabeticorum:response to pentoxi phyll ine. J Endocrinol Invest, 2003, 26(10): 1037-1040.
  20. 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. 21. 向進, 衛(wèi)利, 王俊民, 等. 類脂質(zhì)漸進性壞死1例. 中國皮膚性病學雜志, 2001, 15(3): 198, 208.
  22. 22. 李艷玲, 王凌, 李玉平. 類脂質(zhì)漸進性壞死一例及文獻回顧. 中國全科醫(yī)學, 2006, 9(18): 1559.
  23. 23. Boyd AS. Tretinoin treatment of necrobiosis lipoidica diabeticorum.Diabetes Care, 1999, 22(10): 1753-1754.
  24. 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. 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. 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. 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. 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. 29. Dubin BJ, Kaplan EN. The surgical treatment of necrobiosis lipoidica diabeticorum. Plast Reconstr Surg, 1977, 60(3): 421-428.
  30. 30. Heidenheim M, Jemec GB. Successful treatment of necrobiosis lipoidica diabeticorum with photodynamic therapy. Arch Dermatol,2006, 142(12): 1548-1550.
  31. 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. 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. 33. (2): 119-122.
  34. 34. -63.
  35. 35. -545.