摘要:目的:探讨2型糖尿病合并糖尿病足患者与胰岛素抵抗的关系。方法:205例2型糖尿病患伴糖尿病足患者作为观察组,无足部病变的糖尿病患者作为对照组,观察其体重指数、空腹血糖、胰岛素、血脂等指标,两组间进行比较并相关性分析、多元回归分析。胰岛素抵抗指数(HOMAIR)=FPG×FIns/22.5。结果:糖尿病足患者的HOMAIR显著高于无糖尿病的患者(Plt;0.05)。多元回归分析显示糖尿病病程、LDL及BMI是影响2型糖尿病足患者胰岛素抵抗的主要危险因素。结论:糖尿病足患者存在着更严重的胰岛素抵抗。Abstract: Objective: To discuss the relationship between diabetes and pedopathy of type II diabetes and insulin resistance. Methods:The diabetes type II patients were divided into group A (combined with pedopathy) and group B (without pedopathy). The blood glucose and insulin of empty stomach, BMI,Alc and lipid were detected. The insulin resistance index (HOMAIR) was calculated and compared between two groups. Results:The HOMAIR was higher in group A than that in group B (Plt;0.05).The duration of disease,LDL and BMI was positive related with diabetes pedopathy. Conclusion:The insulin resistance was more worse in pedopathy of Type II diabetes.
Objective To investigate the clinical features and risk factors of diabetic foot. Methods A total of 100 patients with diabetic foot and 158 diabetic patients without diabetic foot were selected from April 2012 to May 2015 in Meishan Hospital of Traditional Chinese Medicine. Clinical data of the patients in the two groups was comparatively analyzed. Multiple logistic regression analysis was used to explore the risk factors. Results The age, duration of diabetes, incidences of complications, count of white blood cells, level of fibrinogen, level of high-sensitivity C-reactive protein (hs-CRP) and level of glycated hemoglobin (HbA1c) in diabetic foot group were significantly higher than those in non-diabetic foot group (P<0.05), while the ankle-brachial index, level of hemoglobin and level of albumin in diabetic foot group were significantly lower than those in non-diabetic foot group (P<0.05). The independent risk factors of diabetic foot were Wanger grade, age, ankle-brachial index, hs-CRP, albumin and HbA1c (P<0.05). HbA1c and hs-CRP level were independent risk factors of disease severity in patients with diabetic foot; the difference of prognosis in patients with different Wanger grading was statistically significant (Z=–4.394, P<0.001). Conclusions The risk of diabetic foot in diabetic patients increases with older age, the more serious Wanger grade, the higher hs-CRP and HbA1c level, and the lower ankle-brachial index and albumin level. Taking precautions based on the patient’s situation is conducive to early prevention of amputation in diabetic patients with diabetic foot.
ObjectiveTo investigate the effect of α-lipoic acid on the oxidative stress of wound tissues and diabetic wound healing in mice with diabetic feet. MethodsSixty male C57BL/6J mice weighting 200-300 g were randomly divided into model group (control group, n=15), α-lipoic acid-treated model group (n=15), miR-29b mimic group (n=15), and miR-29b mimic negative control group (NC group, n=15). All animals received intraperitoneal injection of streptozocin to establish the diabetic model. Then, a full thickness wound of 5 mm×2 mm in size was created at 4 weeks after modeling. All mice were administrated with high-sugar-fat-diet. At the same day after modeling, α-lipoic acid-treated model group was continuously given intravenous injection of 100 mg/(kg·d) α-lipoic acid for 14 days; miR-29b mimic group and NC group received the tail intravenous injection of lentiviral vector for miR-29b mimic and miR-29b mimic negative control (a total of 2×107 TU), respectively, with the treatment of α-lipoic acid. The wound healing was observed and wound area was measured at 7 and 14 days. The wound tissues were harvested to detect the levels of superoxide dismutase (SOD) and glutathione (GSH) using xanthine oxidase method and 5, 5-dithiobis-2-nitrobenzoic acid staining method at 14 days. At the same day, 7, and 14 days after modeling, the relative miR-29b expression in wound tissues from control and α-lipoic acid-treated model groups was detected by real-time fluorescence quantitative PCR. ResultsAll mice survived to the experiment end. The wound healing was faster in α-lipoic acid-treated group than control group. At 7 and 14 days, the relative wound area and miR-29b expression level were significantly lower, while the contents of SOD and GSH were significantly higher in α-lipoic acid-treated group than control group (P < 0.05). In addition, miR-29b mimic group had significantly increased relative wound area and significantly decreased the contents of SOD and GSH when compared with NC group at 7 and 14 days (P < 0.05). Conclusionα-lipoic acid could inhibit oxidative stress and promote diabetic wound healing by suppressing expression of miR-29b in mice.
Objective To analyze the methods of treating diabetic feet and to evaluate the optimal method. Methods The clinical data of 115 patients (137 legs) with diabetic feet were retrospectively analyzed. Results Seventy-one affected legs were treated with balloon dilation or stenting (11 with additional debridement of local ulcer), 12 legs were treated by femoral-popliteal arterial bypass (5 with additional debridement of local ulcer), and 31 legs were treated by debridement of local ulcer or amputation merely, and another 23 legs were treated by medical therapy. All diabetic feet treated by surgical treatment were improved obviously without death and severe complications, while 2 cases with medicine therapy died. Conclusion Because of the complexion of the diabetic foot, it should be treated individually, and the key point is to deal with the vascular lesions.
ObjectiveTo evaluate the effectiveness of the nose ring drain (NRD) in treatment of severe diabetic foot infection.MethodsThe clinical data of 35 patients with severe diabetic foot infection who were treated with NRD between June 2017 and June 2019 were analyzed retrospectively. There were 24 males and 11 females with an average age of 54.5 years (range, 28-82 years). All of them were type 2 diabetic patients. The diabetes duration was 3-20 years, with an average of 9.4 years. The diabetic foot duration was 4 months to 2 years, with an average of 1.16 years. There were 16 cases of left foot and 19 cases of right foot. According to Wagner’s grading, there were 11 cases of grade 2, 20 cases of grade 3, and 4 cases of grade 4, all of which were moderate and severe infection of diabetic foot wound. Postoperative wounds were treated with “nibble-like” debridement until the patient’s epidermis regenerated and healed. During the treatment process, the indexes of bacterial culture type of wound secretions, duration of antibiotic therapy, wound healing method, healing time, amputation rate, and other indicators were analyzed and summarized.ResultsAll 35 patients were followed up 3-6 months, with an average of 4.5 months. Postoperative bacterial culture of wounds showed that 5 cases of Staphylococcus aureus, 4 cases of Pseudomonas aeruginosa, 5 cases of Escherichia coli, 3 cases of Enterobacter cloacae, 3 cases of coagulase-negative Staphylococcus, and 15 cases of other types were detected. The duration of antibiotic therapy ranged from 3 to 15 days, with an average of 9.1 days. The wound was autolytically healed without skin grafting, and the healing time was 62-82 days, with an average of 72.3 days. During the follow-up, 3 cases (8.6%) had amputation due to the patient’s poor blood glucose control, which led to a large spread of infection. In addition, among the other patients with wound healing, there was no recurrence of wound infection or new ulcer on the original surface.ConclusionThe NRD is a simple operation for treatment of severe diabetic foot infection, which can effectively control wound infections and promote wound healing and regeneration without skin grafting.
Objective To investigate the effectiveness of free anterolateral thigh flap (ALTF) with fascia lata in repairing diabetic foot ulcers (DFUs) with bone exposure. Methods Between January 2019 and January 2021, 20 patients with DFUs with bone exposure were admitted. There were 17 males and 3 females with a median age of 57.5 years (range, 48-76 years). There were 10 cases of Wagner grade 3 and 10 cases of grade 4. The DFUs formed 1 to 14 months, with a median time of 3 months. The patients underwent CT angiography, which showed extensive atherosclerosis in both lower limbs; 6 of them were severely narrowed or occluded and underwent percutaneous transluminal angioplasty. The size of wound ranged from 7 cm×6 cm to 27 cm×10 cm after applied first-stage debridement combined with vacuum sealing drainage treatment. In the second-stage, free ALTF with fascia lata was used to repair wounds and partial defects of tendons. The size of flap ranged from 8 cm×5 cm to 28 cm×11 cm. The wound of the donor site was sutured directly. The survival of the flap, the healing time of the wound, and the complications were recorded. The laser speckle blood flow imaging system was used to detect the blood perfusion of the flap and the skin around the flap at 2 weeks and 6 months after operation. The foot function was evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) score at 6 months after operation. Results After operation, effusion under the flap happened in 6 cases, which cured after symptomatic treatment. Flaps survived completely in 14 cases. The tissue necrosis at the edges of the flaps occurred in 3 cases and healed after dressing changes. Venous crisis of flaps occurred in 3 cases, of which 1 case was completely necrotic after exploration, and the other 2 cases were partially alive. The wounds of 3 cases were repaired with skin grafts after debridement and dressing. The flap survival rate was 95.0%, and the limb salvage rate was 100%. The wound healing time after flap transplantation was 14-30 days, with an average of 19.1 days. Two patients had recurrence of peripheral skin ulcers of the flaps within 1 month after healing, which healed after conservative dressing changes. Eighteen cases of incisions at donor site healed by first intention, 2 cases had local skin necrosis and healed by debridement and suture. All patients were followed up 6-30 months, with a median time of 11 months. The texture, appearance, and elasticity of the flaps were good. All patients could walk alone without pain. At 6 months after operation, the AOFAS score was 75.9±11.9, which was significantly different from that (44.7±18.4) before operation (t=−7.025, P=0.000). The blood perfusion value increased from (38.1±7.8) PU at 2 weeks to (42.7±10.3) PU, and the difference was significant (t=−4.680, P=0.001). Conclusion Free ALTF with fascia lata has a rich blood supply and a high survival rate. It can be used to repair DFUs with bone exposure. After the free skin flap healed, it can promote revascularization of the affected foot, reduce the probability of ulcer recurrence, and avoid amputation.
Objective To investigate the changes of transforming growth factor β1 (TGF- β1) and type Ⅱ of TGF-β-receptor (TβRⅡ) expressions in wound tissue after the treatment of diabetic foot with vaccum sealing drainage (VSD), and to analyze the mechanism of accelerating wound healing. Methods Between May 2012 and May 2016, 80 patients with diabetic foot were randomly divided into 2 groups, 40 cases in each group. After the same basic treatment, the wounds of VSD group and control group were treated with VSD and external dressing, respectively. There was no significant difference in gender, age, disease duration, body mass, foot ulcer area, and Wagner grade between 2 groups (P>0.05). The time of foundation preparation and hospitalization stay of 2 groups were recorded. The wound tissue was collected before treatment and at 7 days after treatment, and the positive indexes of TGF-β1 and TβRⅡexpressions were measured by immunohistochemical staining. Results Before skin grafting, the patients in VSD group were treated with VSD for 1 to 3 times (mean, 2 times), and the patients in control group were treated with dressing change for 1 to 6 times (mean, 4 times). The time of foundation preparation and hospitalization stay in VSD group were significantly shorter than those in control group (t=–13.546, P=0.036; t=–12.831, P=0.041). The skin grafts of both groups survived smoothly and the wound healed well. Before treatment, immunohistochemical staining results showed that the positive indexes of TGF-β1 and TβRⅡ expressions in VSD group were 5.3±2.4 and 14.0±2.6, while those in control group were 4.4±2.3 and 14.7±3.1, respectively. There was no significant difference between 2 groups (t=1.137, P=0.263; t=1.231, P=0.409). At 7 days after treatment, the positive indexes of TGF-β1 and TβRⅡ expressions in VSD group were 34.3±2.9 and 41.7±3.7, respectively, and those in control group were 5.8±2.0 and 18.1±2.5. There were significant differences between 2 groups (t=–35.615, P=0.003; t=23.725, P=0.002). Conclusion VSD can increase the expressions of TGF-β1 and TβRⅡ in diabetic ulcer tissue, promote granulation tissue growth, and accelerate wound healing.
The 8th World International Symposium on the Diabetic Foot (ISDF) Conference which was sponsored by the International Working Group on Diabetic Foot (IWGDF) was held in the Hague between May 22nd and May 25th, 2019. The conference issued the 2019 IWGDF guidelines on the prevention and management of diabetic foot disease. The update to the 2015 edition of the guidelines involves the following 6 chapters: prevention of foot ulcers in patients with diabetes; offloading foot ulcers in patients with diabetes; diagnosis, prognosis, and management of peripheral arterial disease in patients with a foot ulcer and diabetes; diagnosis and treatment of foot infection in patients with diabetes; interventions to enhance healing of foot ulcers in patients with diabetes; classification of diabetic foot ulcers. This guideline has been changed more than the previous edition. In this paper, the guidelines will be interpreted to provide cutting-edge information for domestic diabetic foot researchers.
Objective To introduce the basic research and cl inical appl ication of stem cells transplantation for treating diabetic foot. Methods The recent original articles about the stem cells transplantation for treating diabetic foot were extensively reviewed. Results Transplanted different stem cells in diabetic foot could enhanced ulceration heal ing in certain conditions, increase neovascularization and avoid amputation. Conclusion Stem cells transplantation for treating diabeticfoot may be a future approach．