Clinical Observation of Zinc Hyaluronate in the Treatment of Diabetic Foot Wound_West China Medical Journal

Authors：

LI Wei , ZHANG Bing , GAO Bing

Department of Burning Wounds, Sichuan Academy of Medical Sciences & Sichuan Provincial People′s Hospital, Chengdu, Sichuan 610072, P. R. China;

Corresponding author：

Keywords：

透明质酸锌; 糖尿病足; 创面愈合

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【摘要】　目的　观察透明质酸锌凝胶治疗糖尿病足创面的疗效。　方法　 2009年6月—2010年6月收治60例创面面积≤6 cm2的糖尿病足患者，其中男41例，女19例；年龄 49～80岁，平均58岁。糖尿病病程4～20年，糖尿病足病程2～12周。按照糖尿病足Wagner分级标准进行分级为Ⅰ、Ⅱ、Ⅲ级（每级各20例）。将患者随机分为治疗组和对照组，每组30例，每级各10例。两组患者性别、年龄、病程及创面比较差异均无统计学意义（P gt;0.05），具有可比性。两组患者均常规给予胰岛素或降糖药控制血糖，并同时给予抗炎、改善微循环及营养支持治疗。处理上治疗组加用透明质酸锌凝胶，对照组仅常规换药，治疗后4、8周观察两组创面愈合情况。　结果　治疗组8周时治愈率为53.3%，总有效率为96.7%；对照组治愈率为30.0%，总有效率为60.0%；两组总有效率比较差异有统计学意义（P lt;0.05）。治疗组对于Ⅱ、Ⅲ级创面的治愈率和有效率均明显优于对照组（P lt;0.01）。治疗组创面愈合时间为（23.25±8.52） d，对照组为（29.16±9.20） d，差异有统计学意义（P lt;0.05）。两组治疗后细菌培养结果无明显差异。　结论　透明质酸锌凝胶制剂应用于糖尿病足的创面治疗，能起到保护创面和促进创面愈合的作用，为治疗糖尿病足创面提供了一种新的方法。
【Abstract】　Objective　 To explore the curative effect of zinc hyaluronate in the treatment of diabetic foot wound.　Methods　 Sixty patients with a diabetic foot wound area ≤6 cm2 were treated in our hospital from June 2009 to June 2010. There were 41 males and 19 females with their ages ranged from 49 to 80 years old, averaging at 58. The course of diabetes ranged from 4 to 20 years, and diabetic foot 2 to 12 weeks. According to diabetic foot Wagner grading standards, the patients were classified as grade Ⅰ, Ⅱ and Ⅲ (with 20 patients for each grade). They were randomly divided into the treatment group and the control group with 30 patients in each group and for both groups, there were 10 patients for each Wagner grade. There were no statistically significant differences between the two groups of patients in gender, age, duration of the disease course, and wound area (P gt;0.05) so that they were comparable. All patients were routinely offered with insulin or other medicine to control blood sugar level, and at the same time they accepted anti-inflammatory, microcirculation improving and nutrition supporting treatments. Zinc hyaluronate was added to the treatment of the patients in the treatment group, while the control group underwent conventional treatment. Wound healing condition was observed 4 and 8 weeks after the beginning of the treatment.　Results　 At week eight, the cure rate for the treatment group was 53.3%, and the total effective rate was 96.7%; the two numbers for the control group were respectively 30.0% and 60.0%. There was a significant difference between the two groups in the total effectiveness (P lt;0.05). The cure rate and total effective rate for grade Ⅱ and Ⅲ wound in the treatment group were better than those in the control group (P lt;0.01). Coagulant time for the treatment group and the control group was respectively (23.25±8.52) days and (29.16±9.20) days with a significant difference (P lt;0.05). No statistical difference was found in the bacteria cultures between the two groups after treatment.　Conclusions　 Using zinc hyaluronate in diabetic foot treatment can obviously protect the wound and promote wound healing. It is a good choice for diabetic foot wound healing.

Citation： LI Wei,ZHANG Bing,GAO Bing. Clinical Observation of Zinc Hyaluronate in the Treatment of Diabetic Foot Wound. West China Medical Journal, 2011, 26(6): 845-847. doi: Copy

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11.	Lobmann R, Pittasch D, Muhlen I, et al. Autologous human keratinocytes cultured on membranes composed of benzyl ester of hyaluronic acid for grafting in nonhealing diabetic foot lesions: a pilot study[J]. J Diabetes Complicatians, 2003, 17(4): 199-204.
12.	Hollander DA, Soranzo C, Falk S, et al. Extensive traumatic soft tissue loss: reconstruction in severely injured patients using cultured Hyaluronan-based three-dimensional dermal and epidermal autografts[J]. J Trauma, 2001, 50(6): 1125-1136.
13.	Vazquez JR, Short B, Findlow AH, et al. Outcomes of hyaluronan therapy in diabetic foot wounds[J]. Diabetes Res Clin Pract, 2003, 59(2): 123-127.
14.	Lansdown AB, Mirastschijski U, Stubbs N, et al. Zinc in wound healing: theoretical, experimental, and clinical aspects [J]. Wound Repair Regen, 2007, 15(1): 2-16.
15.	Lansdown AB. Zinc in the healing wound[J]. Lancet,1996, 347(9003): 706-707.
16.	Kaji T, Fujiwara Y, Yamamoto C, et al. Stimulation by zinc of cultured vascular endothelial cell proliferation: possible involvement of endogenous basic fibroblast growth factor[J]. Life Sci, 1994, 55(23): 1781-1787.
17.	Fujiwara Y, Watanabe S, Sakamoto M, et al. Repair of wounded monolayers of cultured vascular endothelial cells after simultaneous exposure to lead and zinc[J]. Toxicol Lett, 1998, 94(3): 181-188.

1. 　国际糖尿病足工作组. 糖尿病足国际临床指南[M].北京: 人民军医出版社, 2003: 6.
2. 　Boulton AJ, Vileikyte L, Ragnarson-Tennvall G, et al. The global burden of diabetic foot disease[J]. Lancet, 2005, 366(9498): 1719-1724.
3. 　许曼音. 糖尿病学[M]. 上海: 上海科学技术出版社, 2003: 518.
4. 　谷涌泉, 张健, 许樟荣, 等. 糖尿病足病诊疗新进展[M]. 北京: 人民卫生出版社, 2006: 45.
5. 　王艳, 刘关键, 袁南兵, 等. 数码照相结合Image J医学图像分析软件法与无菌薄膜勾边法测量糖尿病皮肤溃疡面积的可靠性比较[J]. 中国修复重建外科杂志, 2008, 22(5): 563-566.
6. 　陈玉林, 黄康. 创面愈合的评价指标[J]. 中国临床康复, 2002, 6(8): 1080-1081.
7. 　铁璐, 伊利夏提•肖开提, 王宪, 等. 糖尿病伤口愈合的分子机制[J]. 生理科学进展, 2010, 41(6): 407-412.
8. 　朱斌, 朱家源, 唐庆, 等. 湿性环境在创面愈合中的作用[J]. 广州医学院学报, 1999, 27(3): 53-55.
9. 　何祯平, 孙广慈, 王原路, 等. Hyaluronan对创面组织中生长因子含量的影响[J]. 中国美容医学, 2004, 13(3): 282-284.
10. 　傅力, 吴海文. 透明质酸( HA)的功能性及生产技术研究进展[J]. 新疆农业科学, 2004, 41(专刊): 97-100.
11. 　Lobmann R, Pittasch D, Muhlen I, et al. Autologous human keratinocytes cultured on membranes composed of benzyl ester of hyaluronic acid for grafting in nonhealing diabetic foot lesions: a pilot study[J]. J Diabetes Complicatians, 2003, 17(4): 199-204.
12. 　Hollander DA, Soranzo C, Falk S, et al. Extensive traumatic soft tissue loss: reconstruction in severely injured patients using cultured Hyaluronan-based three-dimensional dermal and epidermal autografts[J]. J Trauma, 2001, 50(6): 1125-1136.
13. 　Vazquez JR, Short B, Findlow AH, et al. Outcomes of hyaluronan therapy in diabetic foot wounds[J]. Diabetes Res Clin Pract, 2003, 59(2): 123-127.
14. 　Lansdown AB, Mirastschijski U, Stubbs N, et al. Zinc in wound healing: theoretical, experimental, and clinical aspects [J]. Wound Repair Regen, 2007, 15(1): 2-16.
15. 　Lansdown AB. Zinc in the healing wound[J]. Lancet,1996, 347(9003): 706-707.
16. 　Kaji T, Fujiwara Y, Yamamoto C, et al. Stimulation by zinc of cultured vascular endothelial cell proliferation: possible involvement of endogenous basic fibroblast growth factor[J]. Life Sci, 1994, 55(23): 1781-1787.
17. 　Fujiwara Y, Watanabe S, Sakamoto M, et al. Repair of wounded monolayers of cultured vascular endothelial cells after simultaneous exposure to lead and zinc[J]. Toxicol Lett, 1998, 94(3): 181-188.

West China Medical Journal

Clinical Observation of Zinc Hyaluronate in the Treatment of Diabetic Foot Wound

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