糖尿病足抗菌疗法的最新进展和新兴疗法

刘晗 琳1, 赵宇 辉2
1.华北理工大学；2.唐山工人医院

摘要

目的：糖尿病感染性足溃疡（DFUs）是糖尿病最常见和最严重的血管并发症之一，可导致严重的身体后果，如截肢，以及同样严重的社会、心理和经济后果。据统计，高达25%的糖尿病患者在最终发展成DFUs。因此，防止不良后果产生最重要的是控制感染和加速溃疡恢复。可用的信息让医生和患者在了解针对DFUs的新兴疗法方面发挥着重要作用。本综述的目的是汇编目前治疗DFUs可用的方法，包括分子和再生医学、抗微生物和基于能量的治疗，以及植物提取物、抗微生物肽、生长因子、臭氧、设备和纳米医学的使用，以提供对这种情况的评估的概述。

关键词

糖尿病足；溃疡；清创；生物制剂；干细胞

参考

[1]Hulshof CM，van Netten JJ，Pijnappels M，Bus SA. The Role of Foot-Loading Factors and Their Associations with Ulcer Development and Ulcer Healing in People with Diabetes：A Systematic Review. J Clin Med. 2020 Nov 7；9（11）：3591. doi：10.3390/jcm9113591. PMID：33171726；PMCID：PMC7694972. [2]Kaminski MR，Golledge J，Lasschuit JWJ，Schott KH，Charles J，Cheney J，Raspovic A；Australian Diabetes-related Foot Disease Guidelines & Pathways Project. Australian guideline on prevention of foot ulceration：part of the 2021 Australian evidence-based guidelines for diabetes-related foot disease. J Foot Ankle Res. 2022 Jul 6；15（1）：53. doi ： 10.1186/s13047-022-00534-7. PMID ： 35791023 ； PMCID ：PMC9258081. [3]Armstrong DG，Boulton AJM，Bus SA. Diabetic Foot Ulcers and Their Recurrence. N Engl J Med. 2017 Jun 15；376（24）：2367-2375. doi：10.1056/NEJMra1615439. PMID：28614678. [4]Zhang Y，Lazzarini PA，McPhail SM，van Netten JJ，Armstrong DG ， Pacella RE. Global Disability Burdens of Diabetes-Related Lower-Extremity Complications in 1990 and 2016. Diabetes Care. 2020 May；43（5）：964-974. doi：10.2337/dc19-1614. Epub 2020 Mar 5. PMID：32139380. [5]Lavery LA，Armstrong DG，Wunderlich RP，Mohler MJ，Wendel CS，Lipsky BA. Risk factors for foot infections in individuals with diabetes. Diabetes Care. 2006 Jun；29（6）：1288-93. doi：10.2337/dc05-2425. PMID：16732010. [6]Lazzarini PA，Crews RT，van Netten JJ，Bus SA，Fernando ME，Chadwick PJ，Najafi B. Measuring Plantar Tissue Stress in People With Diabetic Peripheral Neuropathy：A Critical Concept in Diabetic Foot Management. J Diabetes Sci Technol. 2019 Sep；13（5）：869-880. doi：10.1177/1932296819849092. Epub 2019 Apr 29. PMID：31030546；PMCID：PMC6955461. [7]Moher D，Liberati A，Tetzlaff J，Altman DG；PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses：the PRISMA statement. J Clin Epidemiol. 2009 Oct；62（10）：1006-12. doi：10.1016/j.jclinepi.2009.06.005. Epub 2009 Jul 23. PMID：19631508. [8]Murray HJ，Young MJ，Hollis S，Boulton AJ. The association between callus formation，high pressures and neuropathy in diabetic foot ulceration. Diabet Med. 1996 Nov；13（11）：979-82. doi：10.1002/（SICI）1096-9136（199611）13：11<979：AID-DIA267>3.0.CO；2-A. PMID：8946157. [9]Lim JZ，Ng NS，Thomas C. Prevention and treatment of diabetic foot ulcers. J R Soc Med. 2017 Mar；110（3）：104-109. doi：10.1177/0141076816688346. Epub 2017 Jan 24. PMID：28116957；PMCID：PMC5349377. [10]Medical Advisory Secretariat. Hyperbaric oxygen therapy fornon-healing ulcers in diabetes mellitus：an evidence-based analysis. Ont Health Technol Assess Ser. 2005；5（11）：1-28. Epub 2005 Sep 1. PMID：23074462；PMCID：PMC3382405. [11]Martí-Carvajal AJ，Gluud C，Nicola S，Simancas-Racines D，Reveiz L，Oliva P，Cedeño-Taborda J. Growth factors for treating diabetic foot ulcers. Cochrane Database Syst Rev. 2015 Oct 28；2015（10）：CD008548. doi：10.1002/14651858.CD008548.pub2. PMID：26509249；PMCID：PMC8665376. [12]Ji JY ， Ren DY ， Weng YZ. Efficiency of Multifunctional Antibacterial Hydrogels for Chronic Wound Healing in Diabetes：AComprehensive Review. Int J Nanomedicine. 2022 Jul 22；17：3163-3176. doi：10.2147/IJN.S363827. PMID：35909814；PMCID：PMC9326039. [13]Zhou W，Zhao X，Shi X，Chen C，Cao Y，Liu J. Constructing Tissue-Engineered Dressing Membranes with Adipose-Derived Stem Cells and Acellular Dermal Matrix for Diabetic Wound Healing：A Comparative Study of Hypoxia- or Normoxia-Culture Modes. Stem Cells Int. 2022 May 5；2022：2976185. doi：10.1155/2022/2976185. PMID：35571531；PMCID：PMC9098365. [14]Krasilnikova OA，Baranovskii DS，Lyundup AV，Shegay PV，Kaprin AD，Klabukov ID. Stem and Somatic Cell Monotherapy for the Treatment of Diabetic Foot Ulcers：Review of Clinical Studies and Mechanisms of Action. Stem Cell Rev Rep. 2022 Aug；18（6）：1974-1985. doi ： 10.1007/s12015-022-10379-z. Epub 2022 Apr 27. PMID ：35476187. [15]Lopes L，Setia O，Aurshina A，Liu S，Hu H，Isaji T，Liu H，Wang T，Ono S，Guo X，Yatsula B，Guo J，Gu Y，Navarro T，Dardik A. Stem cell therapy for diabetic foot ulcers：a review of preclinical and clinical research. Stem Cell Res Ther. 2018 Jul 11；9（1）：188. doi：10.1186/s13287-018-0938-6. PMID：29996912；PMCID：PMC6042254. [16]Liu L，Chen R，Jia Z，Li X，Tang Y，Zhao X，Zhang S，Luo L，Fang Z，Zhang Y，Chen M. Downregulation of hsa-miR-203 in peripheral blood and wound margin tissue by negative pressure wound therapy contributes to wound healing of diabetic foot ulcers. Microvasc Res. 2022 Jan；139：104275. doi：10.1016/j.mvr.2021.104275. Epub 2021 Oct 28. PMID：34717969. [17]Yuan L，Sun Y，Xu M，Zeng F，Xiong X. miR-203 Acts as an Inhibitor for Epithelial-Mesenchymal Transition Process in Diabetic Foot Ulcers via Targeting Interleukin-8. Neuroimmunomodulation. 2019；26（5）：239-249. doi：10.1159/000503087. Epub 2019 Nov 8. PMID：31707396.