原位定型微囊化载体制剂在糖尿病大鼠皮肤溃疡中的作用

背景：原位定型微囊化载体制剂成分之一胰岛素可以促进溃疡愈合。目的：观察原位定型微囊化载体制剂在糖尿病大鼠皮肤溃疡中的疗效。方法：腹腔内注射链脲佐菌素建立糖尿病大鼠模型,应用外科方法建立全层皮肤缺损模型。根据皮肤溃疡处干预方式将实验动物分为4组。①空白对照组用生理盐水处理创面。②一般制剂组应用甲硝唑＋山莨菪硷1＋普通短效胰岛素处理创面。③单纯微囊组创面外敷不含有效药物成分的微囊化载体膜。④微囊化有效制剂组溃疡处外涂微囊化载体制剂膜,内含药物成分与一般制剂组相同。定时测量溃疡面积,记录溃疡愈合时间,取创面全层组织进行组织学观察,测定表皮生长因子受体、纤维连接蛋白阳性细胞数量。结果与结论：微囊化有效制剂组大鼠溃疡愈合时间短于其他3组（P〈0.05或P〈0.01）,微囊化有效制剂组表皮生长因子受体和纤维连接蛋白阳性细胞数目高于其他各组（P〈0.05或P〈0.01）。结果表明,原位定型微囊化载体制剂能够缩短愈合时间和促进糖尿病大鼠皮肤溃疡愈合。     

化疽生新膏对糖尿病大鼠创面愈合中EGFR、FN的影响

[目的]研究化疽生新膏对糖尿病难愈性溃疡的作用机制。[方法]将Wistar大鼠制成糖尿病溃疡模型,分为治疗组、对照组,治疗组创面外敷化疽生新膏,对照组创面常规消毒,不予敷药,于第7天、第14天取创面全层组织进行组织学观察并测定表皮生长因子受体(EGFR)、纤维连接蛋白(FN)阳性细胞数量。[结果]治疗组溃疡面组织中EGFR、FN阳性细胞较对照组明显增多,两组比较有统计学意义。[结论]外用化疽生新膏能促进糖尿病难愈性溃疡创面愈合,其作用机制之一是促进EGFR、FN的形成。     

化疽生新膏对糖尿病大鼠创面愈合中EGFR、FN的影响

[目的]研究化疽生新膏对糖尿病难愈性溃疡的作用机制。[方法]将Wistar大鼠制成糖尿病溃疡模型．分为治疗组、对照组，治疗组创面外敷化疽生新膏，对照组创面常规消毒，不予敷药，于第7天、第14天取创面全层组织进行组织学观察并测定表皮生长因子受体（EGFR）、纤维连接蛋白（FN）阳性细胞数量。[结果]治疗组溃疡面组织中EGFR、FN阳性细胞较对照组明显增多，两组比较有统计学意义。[结论]外用化疽生新膏能促进糖尿病难愈性溃疡创面愈合，其作用机制之一是促进EGFR、FN的形成。     

重组人表皮生长因子联合前列地尔作用于糖尿病溃疡创面

背景:人内源性表皮生长因子的缺乏以及血流动力学的改变会导致创面不愈合的发生。目的:观察重组人表皮生长因子联合前列地尔作用于糖尿病溃疡动物模型创面的疗效。方法:Wistar大鼠40只建立糖尿病溃疡动物模型,随机等分为模型组、重组人表皮生长因子组、前列地尔组和重组人表皮生长因子+前列地尔组,分别予以1%碘伏清创、重组人表皮生长因子凝胶外敷、前列地尔静脉滴注、重组人表皮生长因子凝胶外敷和前列地尔静脉滴注联合治疗。结果与结论:干预后3,7,10,14d观察发现,相比于模型组,重组人表皮生长因子和/或前列地尔治疗后,糖尿病皮肤溃疡大鼠溃疡面积减小、愈合时间缩短、创面动态愈合率上升(P<0.01),且两者联合治疗的效果优于重组人表皮生长因子和前列地尔单独治疗(P<0.01),而重组人表皮生长因子或前列地尔单独治疗的效果接近,提示重组人表皮生长因子与前列地尔联合使用比单纯使用前列地尔或单纯使用重组人表皮生长因子更能显著促进糖尿病溃疡创面的愈合。     

羊膜负载表皮干细胞促进糖尿病大鼠创面的愈合

背景:表皮干细胞作为皮肤组织的特异性干细胞,具有强大增殖及多向分化潜能,与创面修复紧密相关.近期研究表明糖尿病皮肤创面愈合过程中表皮干细胞数量减少、活性降低是导致其创面难愈的重要原因.目的:观察表皮干细胞在糖尿病大鼠创面愈合中的作用.方法:分离培养及鉴定SD大鼠表皮干细胞,并以BrdU标记.建立糖尿病SD大鼠创面模型,抽签法随机分为3组:表皮干细胞组创面移植羊膜负载BrdU标记的表皮干细胞;羊膜组创面移植羊膜;空白对照组创面未给予干预. 观察创面愈合情况、计算创面愈合率,苏木精-伊红及免疫组织化学SP法检测创面愈合组织中BrdU及增殖细胞核抗原表达.用图像分析软件测量阳性细胞积分吸光度平均值.结果与结论:表皮干细胞组治疗后7d创面缩小明显,治疗后14 d创面基本愈合,创面愈合率明显高于羊膜组、空白对照组 (P < 0.01).表皮干细胞组创面及新生表皮中可见BrdU阳性细胞,而另两组皮肤创面组织中始终未见BrdU阳性细胞.各组创面组织中可见增殖细胞核抗原阳性细胞表达,但表皮干细胞组的阳性细胞积分吸光度平均值与羊膜组、空白对照组比较差异有显著性意义(P < 0.01).结果证实糖尿病大鼠创面愈合过程中表皮干细胞与创缘表皮移行、创面的上皮化有直接关联,可有效促进其创面愈合.     

胰岛素与重组人表皮生长因子局部联合应用对大鼠深Ⅱ度烫伤创面愈合的影响

目的:观察局部联合应用胰岛素与重组人表皮生长因子对烫伤大鼠创面愈合的影响。方法:96只SD大鼠随机分为4组,制作深Ⅱ度烫伤大鼠模型。创面下浸润注射等渗盐水(A组)作为对照组,B组烫伤大鼠创面下浸润注射0.1U胰岛素,C组创面下浸润注射600IU重组人表皮生长因子,D组予B、C组相同剂量二者联合治疗。记录各组创面愈合时间,伤后3d起隔日计算4组的创面愈合百分率。观察各组创面愈合后的组织形态学改变,并测定血糖浓度的变化。结果:D组创面愈合时间较其他3组明显缩短(P<0.05)。伤后第7、11、14、17、21天D组创面愈合率高于其他组(P<0.05)。组织学检查D组创面收缩与再上皮化明显,新生上皮向创面中心爬行较快,成纤维细胞与毛细血管肉芽数量明显多于其他组。注射后7h,A组和C组血糖浓度变化不大(P>0.05),B、D两组注射后1h血糖浓度下降(P<0.05),注射后5h开始恢复正常。结论:局部联合应用重组人表皮生长因子和胰岛素可通过协同作用加速深度烫伤大鼠创面愈合。目的:观察局部联合应用胰岛素与重组人表皮生长因子对烫伤大鼠创面愈合的影响。方法:96只SD大鼠随机分为4组,制作深Ⅱ度烫伤大鼠模型。创面下浸润注射等渗盐水(A组)作为对照组,B组烫伤大鼠创面下浸润注射0.1U胰岛素,C组创面下浸润注射600IU重组人表皮生长因子,D组予B、C组相同剂量二者联合治疗。记录各组创面愈合时间,伤后3d起隔日计算4组的创面愈合百分率。观察各组创面愈合后的组织形态学改变,并测定血糖浓度的变化。结果:D组创面愈合时间较其他3组明显缩短(P<0.05)。伤后第7、11、14、17、21天D组创面愈合率高于其他组(P<0.05)。组织学检查D组创面收缩与再上皮化明显,新生上皮向创面中心爬行较快,成纤维细胞与毛细血管肉芽数量明显多于其他组。注射后7h,A组和C组血糖浓度变化不大(P>0.05),B、D两组注射后1h血糖浓度下降(P<0.05),注射后5h开始恢复正常。结论:局部联合应用重组人表皮生长因子和胰岛素可通过协同作用加速深度烫伤大鼠创面愈合。     

糖尿病大鼠表皮干细胞的分离培养及特性

背景:表皮干细胞作为皮肤组织特异性干细胞,在创面修复中发挥关键作用。但有关糖尿病皮肤来源的表皮干细胞体外分离培养及生物特性研究较少。目的:探索糖尿病大鼠表皮干细胞体外分离培养的方法及其生物特性,为糖尿病难愈创面的防治及机制研究提供实验依据。方法:SD大鼠随机分成糖尿病组和正常对照组。糖尿病组采用一次性腹腔注射链脲佐菌素制备糖尿病大鼠模型,正常对照组不作处理。分别取成模糖尿病和正常大鼠背部全层皮肤,采用酶消化联合Ⅳ型胶原黏附法分离培养大鼠表皮干细胞。倒置相差显微镜下观察细胞形态变化和细胞克隆形成,细胞计数绘制生长曲线,计算克隆形成率,免疫细胞化学染色和图像分析软件鉴定K19、β1-integrin阳性表达和测定阳性细胞的积分吸光度(IA)值。结果与结论:糖尿病组大鼠表皮干细胞原代贴壁数量较少,其克隆形成率明显低于正常对照组(P<0.01)。表皮干细胞的K19、β1-integrin均呈阳性表达,糖尿病组阳性细胞的IA值均低于正常对照组(P<0.01)。结果提示,运用酶消化联合Ⅳ型胶原黏附法可以实现糖尿病大鼠表皮干细胞的体外分离培养;糖尿病大鼠表皮干细胞体外增殖能力较正常皮肤增殖能力弱,这可能是导致糖尿病创面难愈合的重要因素之一。     

康肤霜对大鼠放射性皮肤损伤创面愈合的影响

背景:放疗中引起的放射性皮肤损伤,常使用重组人表皮生长因子和聚维酮碘治疗,但两者均有一定缺陷.而康肤霜能促进细胞分裂增殖,具有一定的抗菌消炎作用,可能对放射性皮肤损伤有很好的疗效.目的:观察康肤霜对大鼠放射性皮肤损伤创面愈合的影响.方法:高能X射线照射Wistar大鼠臀部皮肤建立深II度皮肤烧伤创面模型.照射后12d创面出现后,将损伤动物随机分为康肤霜组,重组人表皮生长因子组和聚维酮碘组.各组每日将药物均匀涂抹在创面,直至创面取材或创面愈合.观察创面愈合率及愈合时间.各组动物分别于创面治疗后7,14,21d取创面组织,观察病理组织学变化、创面组织增殖细胞核抗原的表达,以标记指数法测定增殖细胞核抗原阳性细胞数,评估组织创面的修复情况.结果与结论:康肤霜组与重组人表皮生长因子组创面愈合时间、愈合率均优于聚维酮碘组(P<0.01),但两组间无显著差异(P>0.05)且两组创面组织标本中增殖细胞核抗原表达量也明显高于聚维酮碘组(P<0.01),但其两组间比较差异无显著性意义(P>0.05).说明康肤霜能减轻创面早期的炎症反应,促进创面的再上皮化和表皮各层的分化,加速大鼠放射性皮肤损伤创面的愈合.     

复方茶多酚软膏对放射性皮炎大鼠伤口愈合和表皮生长因子表达的影响

背景:研究表明复方茶多酚软膏对急性放射性皮炎的伤口有愈合作用,但具体机制尚未阐明.目的:探讨复方茶多酚软青对大鼠放射性皮炎创面愈合及表皮生长因子表达的影响.方法:清洁级雄性成年Wistar大鼠随机分成3组:实验组和对照组大鼠通过60 Co γ射线照射建立大鼠放射性皮炎模型,实验组大鼠采用常规护理后用复方茶多酚软膏外涂辐射伤口区,对照组涂抹凡士林软膏:简单皮肤伤口组大鼠采用1.5 cm2皮肤全切除,仅接受常规护理.通过放射免疫法测定伤后5,10,20和40 d时创面组织的表皮生长因子表达、观测创面愈合率和愈合时间,并与简单伤口组比较.结果与结论:实验组和对照组在V射线照射后5 d创面组织表皮生长因子表达弱于简单皮肤伤口组,提示放射性皮炎与简单皮肤切口损失不同,创面恢复期创面组织表皮生长因子呈弱表达,愈合缓慢:实验组创伤后10和20 d时创面组织表皮生长因子表达显著高于对照组(P＜0.05):实验组在10和20 d时的创面愈合率明显高于对照组(P＜0.05);实验组愈合时间明显短于对照组的愈合时间(P＜0.05),实验组和对照组的愈合时间均明显长于简单皮肤伤口组(P＜0.05).结果表明复方茶多酚软膏外涂对大鼠放射性皮炎的愈合有促进作用,其机制可能与促进创面组织表皮生长因子的表达有关.     

深Ⅱ度烫伤创面早期应用重组人表皮生长因子后表皮生长因子受体的表达

背景：有研究表明重组人表皮生长因子能促进烧伤创面愈合,内源性表皮生长因子通过与表皮生长因子受体结合发挥生物学效应。目的：观察局部应用重组人表皮生长因子对大鼠烫伤创面表皮生长因子受体的影响,分析其促进创面愈合的可能机制。方法：制备Wistar大鼠背部深Ⅱ度烫伤模型,分为2组,对照组于创面喷洒生理盐水,实验组喷洒重组人表皮生长因子。烫伤后0,1,3,5,7,10,14,21d取创面组织,采用Western blot检测表皮生长因子受体蛋白表达,并测定两组大鼠创面愈合率。结果与结论：烫伤后7-21d实验组创面愈合率高于对照组（P〈0.05）。两组表皮生长因子受体蛋白表达在1d明显降低（P〈0.05）,随后又升高,7d达峰值且对照组比实验组高（P〈0.05）;峰值过后,对照组逐渐下降,21d接近烫伤前水平,实验组迅速下降,14d达谷值,随后上升,21d接近烫伤前水平,两组差异有显著性意义（P〈0.05）。说明早期局部应用重组人表皮生长因子可影响表皮生长因子受体的表达规律,并显著促进大鼠深Ⅱ度烫伤创面愈合。     

超短波对糖尿病大鼠创面愈合的影响

目的：探讨超短波治疗对糖尿病大鼠创面局部不同时间点溃疡面积、创面愈合率的影响。方法：健康成年雄性SD大鼠90只,随机分为正常组、糖尿病组和超短波组各30只。糖尿病组和超短波组建立糖尿病模型,3组大鼠制作皮肤溃疡模型,正常组、糖尿病组大鼠不进行任何干预,超短波组大鼠行超短波治疗。结果：在伤后第3、7、14及21天,超短波组及糖尿病组不同时间点创面面积均明显大于正常组（ P＜0．05,0．01）,超短波组不同时间点创面面积均明显小于糖尿病组（P＜0．01）;超短波组及糖尿病组不同时间点创面愈合率均明显低于正常组（P＜0．05,0．01）,超短波组不同时间点创面愈合率明显高于糖尿病组（ P＜0．01）。结论：超短波治疗可促进糖尿病溃疡创面缩短愈合时间,加快愈合速度,为其在促进糖尿病患者创面愈合的治疗中提供理论依据。     

基于伤口护理研究的糖尿病大鼠难愈性溃疡模型的建立

目的为伤口护理研究建立一种稳定的糖尿病难愈性溃疡动物模型。方法选用240～260g雄性SD大鼠60只,以链脲佐菌素腹腔注射,1周后测血糖,将血糖〉16．7mmol／L大鼠纳入糖尿病溃疡造模组,给予普通饲料喂养16周,每周监测血糖及其他糖尿病表现。在大鼠脊柱腰背部两侧手术造成直径1．8cm的圆形缺损创面;连续3d用冰醋酸涂抹创面,2次／d;用钢针刺入创面5mm肉眼观察有无出血及脓性分泌物。结果2周后实验大鼠血糖升高,且稳定大于16．7mmol／L,体重较前明显下降（P〈0．01）;创面形成3d后,96个创面针刺无出血,49个针刺有脓性分泌物;最终,糖尿病大鼠皮肤溃疡模型成功48只,成功率为80％;结论采用腹腔注射链脲佐菌素、外科手术开创、冰醋酸涂抹创面可成功建立糖尿病大鼠难愈性溃疡模型,为伤口护理研究提供了动物模型支持。     

A prospective study of risk factors for diabetic foot ulcer. The Seattle Diabetic Foot Study.

OBJECTIVE: Little prospective research exists on risk factors for diabetic foot ulcer that considers the independent effects of multiple potential etiologic agents. We prospectively studied the effects of diabetes characteristics, foot deformity, behavioral factors, and neurovascular function on foot ulcer risk among 749 diabetic veterans with 1,483 lower limbs. RESEARCH DESIGN AND METHODS: Eligible subjects included all diabetic enrollees of a general internal medicine clinic without foot ulcer, of whom 83% agreed to participate. Baseline assessment included history and lower-limb physical examination, tests for sensory and autonomic neuropathy, and measurements of macro- and microvascular perfusion in the foot. Subjects were followed for the occurrence of a full thickness skin defect on the foot that took > 14 days to heal, with a mean follow-up of 3.7 years. RESULTS: Using stepwise Cox regression analysis, the following factors were independently related to foot ulcer risk: foot insensitivity to the 5.07 monofilament (relative risk [95% CI]) 2.2 (1.5-3.1), past history of amputation 2.8 (1.8-4.3) or foot ulcer 1.6 (1.2-2.3), insulin use 1.6 (1.1-2.2), Charcot deformity 3.5 (1.2-9.9), 15 mmHg higher dorsal foot transcutaneous PO2 0.8 (0.7-0.9), 20 kg higher body weight 1.2 (1.1-1.4), 0.3 higher ankle-arm index 0.8 (0.7-1.0), poor vision 1.9 (1.4-2.6), and 13 mmHg orthostatic blood pressure fall 1.2 (1.1-1.5). Higher ulcer risk was associated with hammer/claw toe deformity and history of laser photocoagulation in certain subgroups. Unrelated to foot ulcer risk in multivariate models were diabetes duration and type, race, smoking status, diabetes education, joint mobility, hallux blood pressure, and other foot deformities. CONCLUSIONS: Certain foot deformities, reduced skin oxygenation and foot perfusion, poor vision, greater body mass, and both sensory and autonomic neuropathy independently influence foot ulcer risk, thereby providing support for a multifactorial etiology for diabetic foot ulceration.     

Healing of diabetic foot ulcers in L-arginine-treated patients

Experimentally, we demonstrated the beneficial effects of L-arginine on regulation of hyperglycemia and dyslipidemia in experimental diabetes, in addition to a positive anti-aggregating effect in platelets in animals and humans. Here, the effect of L-arginine on foot ulcers from diabetic patients was studied. Three groups of diabetic patients were included: 11 patients without ulcer received neither treatment and served as controls. Eleven patients with diabetic ulcer received the standard treatment, this group served as diabetic control with diabetic ulcer. Eleven remain patients with diabetic ulcer received 10 mM L-arginine subcutaneously on the site of the wound. Biopsy with punch number 5 on wound site comprising both ulcerative and contiguous undamaged skin were performed in all patients with ulcerative lesions before any treatment. Patients with intact skin had biopsy performed with punch number 5 on external malleolar region of right lower limb. Biopsies were examined by light and confocal microscopy utilizing histochemical and immunohistochemical methods. Initial and final blood samples were collected to determine glucose, triglycerides, total cholesterol, glycated hemoglobin (HbA(1c)), low (LDL), and high density lipoproteins (HDL). Significant differences (P < 0.05) were observed between initial and final serum glucose levels for treated patients, and initial serum glucose levels between treated and control patients without diabetic ulcer. Glycated hemoglobin, triglycerides, cholesterol, and lipoprotein levels showed no significant changes. Eight patients treated with L-arginine reached total wound healing and the remaining three who abandoned the study because of change of residence showed relevant improvement. Histochemistry and immunohistochemistry methods have shown vascular impairment in both patients with diabetic ulcer (prior to treatment) and control patients without diabetic ulcer. Our observations strongly support efficacy of L-arginine for successful wound healing of diabetic ulcers.     

2型糖尿病非收缩性难愈伤口模型的建立

背景:目前糖尿病创口的难愈性给临床的治疗增加了极大地困难。目的:建立2型糖尿病状态下非收缩性难愈伤口的动物模型。方法:高脂饮食喂养联合低剂量链脲佐菌素诱导形成大鼠2型糖尿病模型,在其背部造成圆形创面,用硅树脂固定伤口,模拟人类创面愈合过程,病理切片检查创面周缘肉芽组织皮肤厚度、微血管密度、胶原纤维及胶原蛋白水平的变化。结果与结论:与正常组相比,链脲佐菌素注射72h后高脂饮食喂养大鼠的空腹血糖、血清三酰甘油及胆固醇均明显增加,差异有显著性意义(P<0.05～0.01);创伤后第1,3,5,7,14天,糖尿病组与正常组相比皮肤厚度、微血管密度、胶原纤维及胶原蛋白水平均有明显下降(P<0.01)。提示高脂喂养联合链脲佐菌素诱导大鼠2型糖尿病的方法简便有效;创伤后检测指标均证明糖尿病大鼠比正常大鼠创面难愈。     

Transcutaneous oxygen tension and toe blood pressure as predictors for outcome of diabetic foot ulcers.

OBJECTIVE: The present study was undertaken to compare the predictive values of transcutaneous oxygen tension (TcPO2) and toe blood pressure (TBP) measurements for ulcer healing in patients with diabetes and chronic foot ulcers. RESEARCH DESIGN AND METHODS: Investigated prospectively were 50 diabetic patients (37 men) with chronic foot ulcers. The age was 61 +/- 12 (mean +/- SD), and the diabetes duration was 26 +/- 14 years. TBP (mmHg) was measured in dig I and TcPO2 (mmHg) at the dorsum of the foot. Ulcer healing was continuously evaluated by measuring the ulcer area every 4-6 weeks. After a follow-up time of 12 months, the patients were divided into three groups according to clinical outcome: healed with intact skin, improved ulcer healing, or impaired ulcer healing. RESULTS: Of the 13 patients who deteriorated, 11 had TcPO2 < 25 mmHg, while 34 of the 37 patients who improved had TcPO2 > or = 25 mmHg. The sensitivity and specificity for TcPO2 were 85 and 92%, respectively, when a cutoff level of 25 mmHg was used for determination of outcome of ulcer healing (healing or nonhealing). The corresponding values for TBP at 30 mmHg were 15 and 97%. Measurement of TcPO2 provided a higher positive predictive value (79%) than TBP (67%). CONCLUSIONS: The results indicate that TcPO2 is a better predictor for ulcer healing than TBP in diabetic patients with chronic foot ulcers, and that the probability of ulcer healing is low when TcPO2 is < 25 mmHg.     

The impact of the Micro-Lightguide O2C for the quantification of tissue ischemia in diabetic foot ulcers

OBJECTIVE: Tissue oxygen supply is crucial for wound healing. Especially in diabetic foot lesions, the chances for healing are mainly dependent on the presence or absence of ischemia. This study investigates the impact of the tissue O2 analysis system "O2C" for noninvasive quantification of tissue oxygenation in diabetic foot ulcer patients. RESEARCH DESIGN AND METHODS: O2C assessed relative blood flow (flow), flow velocity (velo), and hemoglobin concentration (rHb) and hemoglobin oxygenation (SO2) at 2 and 6 mm depth (means +/- SE). 1) Measurements were performed on intact skin of the forefoot and forearm of 20 healthy volunteers on 2 consecutive days. 2) Parameters were assessed on intact skin of the forefoot of diabetic foot ulcer patients (n=14). 3) Measurements were performed directly at the wound site in diabetic patients (n = 14). RESULTS: 1) Flow, velo, rHb, and SO2 at 2 and 6 mm depth were not significantly different when measured at 2 consecutive days. 2) There were no significant differences between diabetic subjects and healthy volunteers. Only flow in 6 mm depth was significantly higher in diabetic subjects (75 +/- 13 vs. 51 +/- 0.4 arbitrary units [AU], P <0.05). When diabetic foot ulcer patients were split into healers and nonhealers, initial readings of SO2 at 2 mm (32 +/- 6 vs. 44 +/- 3%, P <0.05) and flow in 6 mm (28 +/- 1 vs. 51 +/- 0.6 AU, P <0.05) were significantly reduced in nonhealers compared with control subjects, whereas in healers flow in 6 mm (70 +/- 0.6 vs. 51 +/- 0.6 AU, P <0.05) was significantly higher than that in control subjects. 3) Initial SO2, rHb, flow, and velo were significantly lower in nonhealing compared with healing wounds. CONCLUSIONS: O2C is a new reliable and valid method for noninvasive measurement of tissue oxygenation and microvascular blood flow in patients with diabetic foot ulcers.     

自然重建与动静结合理论下运用海桐皮汤熏洗治疗糖尿病足溃疡疗效研究

目的:观察在自然重建及动静结合理论指导下,胫骨横向骨搬移术后联合海桐皮汤熏洗治疗糖尿病足溃疡的临床疗效。方法:选取2017年5月—2019年01月本院足踝外科糖尿病足单侧溃疡住院患者共30例,溃疡创面均在踝关节以下,根据Wagner经典分级法属于1~4级,其中男性20例,女性10例,年龄(65.22±3.14)岁,病程(13.19±4.21)年,运用以上理论方法治疗,于治疗前后观察对比其溃疡创面愈合时间,皮温改变,下肢血管血流超声分析变化,踝肱指数(ABI)改变,密歇根神经病变筛选法(Michigan neuropathy screening instrument,MNSI)评分评定患者外周血管和外周神经恢复情况以及观察并发症情况。结果:治疗后,在为期18个月的随访中,除1例意外事故死亡患者外,其余29例患者均获得有效随访,29位患者患肢溃疡创面均愈合,下肢功能得到有效改善,未出现复发。结论:在自然重建动静结合理论指导下的胫骨横向骨搬移配合海桐皮汤熏洗治疗糖尿病足溃疡,可促进患肢外周血管修复再生和外周神经功能修复,且并发症少,此方法可靠有效,临床值得推广。     

Daptomycin for treating infected diabetic foot ulcers: evidence from a randomized, controlled trial comparing daptomycin with vancomycin or semi-synthetic penicillins for complicated skin and skin-structure infections

OBJECTIVES: The predominant pathogens causing diabetic foot infections are Gram-positive cocci, many of which are now resistant to commonly prescribed antibiotics. Daptomycin is a new agent that is active against most Gram-positive pathogens. To compare the effectiveness of daptomycin against semi-synthetic penicillins or vancomycin, we analysed the subset of diabetic patients with an infected ulcer enrolled in two randomized, controlled investigator-blind trials of patients with complicated skin and soft-tissue infections presumptively caused by Gram-positive organisms. PATIENTS AND METHODS: Patients with a diabetic ulcer infection were prospectively stratified to ensure they were equally represented in the treatment groups, then randomized to either daptomycin [4 mg/kg every 24 h intravenously (iv)] or a pre-selected comparator (vancomycin or a semi-synthetic penicillin) for 7-14 days. RESULTS: Among 133 patients with a diabetic ulcer infection, 103 were clinically evaluable; 47 received daptomycin and 56 received a comparator. Most infections were monomicrobial, and Staphylococcus aureus was the predominant pathogen. Success rates for patients treated with daptomycin or the comparators were not statistically different for clinical (66% versus 70%, respectively; 95% CI, -14.4, 21.8) or microbiological (overall or by pathogen) outcomes. Both treatments were generally well tolerated, with most adverse events of mild to moderate severity. CONCLUSIONS: The clinical and microbiological efficacy and safety of daptomycin were similar to those of commonly used comparator antibiotics for treating infected diabetic foot ulcers caused by Gram-positive pathogens. Daptomycin should be considered for treating these infections, especially those caused by resistant Gram-positive pathogens.