糖尿病足溃疡相关的问题及治疗研究进展
DOI:
https://doi.org/10.62177/fcdt.v1i5.784Keywords:
糖尿病足溃疡, 钙化防御, 糖尿病肾病, 脊髓电刺激, 维生素DAbstract
糖尿病足溃疡(diabetic foot ulcer，DFU)的常规治疗包括血糖控制、合理清创、缓解疼痛、血运重建、感染管理、营养支持。辅助治疗包括负压吸引、高压氧治疗、体外冲击波治疗等。本文重点回顾了DFU诊治中不能忽视的钙化防御问题以及合并糖尿病肾病(diabetic kidney disease，DKD)时对溃疡愈合的影响机制。此外，总结了脊髓电刺激(spinal cord stimulation，SCS)、富血小板血浆(platelet-rich plasma，PRP)、胰岛素局部应用、补充维生素D以及调节铁死亡等DFU治疗方式的相关文献。希望能为更加深入的关于DFU的基础及临床试验提供参考，以期促进DFU的愈合及提高患者生活质量。
References
Yu MG, Gordin D, Fu J, et al. Protective Factors and the Pathogenesis of Complications in Diabetes[J].Endocr Rev,2024,45(2):227-252.
Armstrong DG, Tan TW, Boulton AJM, et al. Diabetic Foot Ulcers:A Review[J].JAMA,2023,330(1):62-75.
Mohsin F, Javaid S, Tariq M, et al. Molecular immunological mechanisms of impaired wound healing in diabetic foot ulcers (DFU),current therapeutic strategies and future directions[J].Int Immunopharmacol,2024,139:112713.
陈明卫,许樟荣.糖尿病足病:时代在改变[J].中华糖尿病杂志,2020,12(06)：359-363.
McDermott K, Fang M, Boulton AJM, et al. Etiology,Epidemiology,and Disparities in the Burden of Diabetic Foot Ulcers[J].Diabetes Care,2023,46(1):209-221.
黄辉,张爱华,陈靖,等.血管钙化研究进展和临床实践的共识与争议[J].生理学报,2022,74(06):859-884.
Rick J, Strowd L, Pasieka HB, et al. Calciphylaxis:Part I.Diagnosis and pathology[J].J Am Acad Dermatol,2022,86(5):973-982.
Kodumudi V, Jeha GM, Mydlo N, et al. Management of Cutaneous Calciphylaxis[J].Adv Ther,2020,37(12):4797-4807.
Gallo Marin B, Aghagoli G, Hu SL, et al. Calciphylaxis and Kidney Disease:A Review[J].Am J Kidney Dis,2023,81(2):232-239.
Wipattanakitcharoen A, Takkavatakarn K, Susantitaphong P. Risk factors,treatment modalities,and clinical outcomes of penile calciphylaxis:systematic review[J].World J Urol,2023,41(11):2959-2966.
Liu Y, Zhang X, Xie X, et al.Risk factors for calciphylaxis in Chinese hemodialysis patients:a matched case-control study[J].Ren Fail,2021,43(1):406-416.
Stępień A, Koziarska-Rościszewska M, Rysz J, et al. Biological Role of Vitamin K-With Particular Emphasis on Cardiovascular and Renal Aspects[J].Nutrients,2022,14(2):262.
Rick J, Rrapi R, Chand S, et al. Calciphylaxis:Treatment and outlook-CME part II[J].J Am Acad Dermatol,2022,86(5):985-992.
Ogah CO, Mohammed H, Gabra IM, et al. Risk Factors Associated With the Development of Calciphylaxis in Patients With Chronic Kidney Disease:A Systematic Review[J].Cureus,2024,16(12):e75314.
Ruderman I, Toussaint ND, Hawley CM, et al. The Australian Calciphylaxis Registry:reporting clinical features and outcomes of patients with calciphylaxis[J]. Nephrol Dial Transplant,2021,36(4):649-656.
Lu Y, Shen L, Zhou L, et al. Success of small-dose fractionated sodium thiosulfate in the treatment of calciphylaxis in a peritoneal dialysis patient[J].BMC Nephrol,2022,23(1):4.
Zakher M, Chaudhry RI, Monrroy M, et al. Clinical Characteristics and Outcomes of Patients with Calciphylaxis[J].Am J Med Sci,2021,361(1):132-134.
Teh YK, Renaud CJ. Clinical experience with intraperitoneal sodium thiosulphate for calciphylaxis in peritoneal dialysis:A case series[J].Perit Dial Int,2024,44(1):66-69.
Hackett BC, McAleer MA, Sheehan G, et al. Calciphylaxis in a patient with normal renal function:response to treatment with sodium thiosulfate[J].Clin Exp Dermatol,2009,34(1):39-42.
杨璨粼,张晓良.SNF472:一种新型血管钙化和钙化防御治疗药物[J].中华肾脏病杂志,2022,38(11):1011-1015.
Chinnadurai R, Sinha S, Lowney AC, et al. Pain management in patients with end-stage renal disease and calciphylaxis-a survey of clinical practices among physicians[J].BMC Nephrol,2020,21(1):403.
Kawai Y, Banshodani M, Moriishi M, et al. Penile calciphylaxis in patients with end-stage kidney disease undergoing dialysis:Invasive treatment and pain management[J].Ther Apher Dial,2022,26(5):950-959.
Yang C, Liu Y, Ni H, et al. Potential effect of sodium thiosulfate in calciphylaxis:remission of intractable pain[J].J Pak Med Assoc,2021,71(1(B)):367-369.
Brandenburg VM, Sinha S, Torregrosa JV, et al. Improvement in wound healing,pain,and quality of life after 12 weeks of SNF472 treatment:a phase 2 open-label study of patients with calciphylaxis[J].J Nephrol,2019,32(5):811-821.
Wu J, Chen L, Dang F, et al. Refractory wounds induced by normal-renal calciphylaxis:An under-recognised calcific arteriolopathy[J].Int Wound J,2023,20(4):1262-1275.
Sandepudi K, Shah KV, Melnick BA, et al. Pathophysiology of Wound Development and Chronicity in Renal Disease:A Narrative Review[J].Int Wound J,2025,22(7):e70713.
Wojtaszek E, Oldakowska-Jedynak U, Kwiatkowska M,et al. Uremic Toxins,Oxidative Stress,Atherosclerosis in Chronic Kidney Disease,and Kidney Transplantation[J].Oxid Med Cell Longev,2021,2021:6651367.
Sugahara M, Tanaka S, Tanaka T, et al. Prolyl Hydroxylase Domain Inhibitor Protects against Metabolic Disorders and Associated Kidney Disease in Obese Type 2 Diabetic Mice[J].J Am Soc Nephrol,2020,31(3):560-577.
Liu H, Li Y, Xiong J. The Role of Hypoxia-Inducible Factor-1 Alpha in Renal Disease[J].Molecules,2022,27(21):7318.
Slee A, Reid J. Disease-related malnutrition in chronic kidney disease[J].Curr Opin Clin Nutr Metab Care,2022,25(3):136-141.
Cohen G. Immune Dysfunction in Uremia 2020[J].Toxins (Basel),2020,12(7):439.
Mima A. A Narrative Review of Diabetic Kidney Disease:Previous and Current Evidence-Based Therapeutic Approaches[J].Adv Ther,2022,39(8):3488-3500.
Yamazaki T, Mimura I, Tanaka T, et al. Treatment of Diabetic Kidney Disease:Current and Future[J].Diabetes Metab J,2021,45(1):11-26.
Petersen EA, Stauss TG, Scowcroft JA, et al. Effect of High-frequency (10-kHz) Spinal Cord Stimulation in Patients With Painful Diabetic Neuropathy:A Randomized Clinical Trial[J].JAMA Neurol,2021,78(6):687-698.
Xu X, Fu Y, Bao M. Comparison Between the Efficacy of Spinal Cord Stimulation and of Endovascular Revascularization in the Treatment of Diabetic Foot Ulcers:A Retrospective Observational Study[J].Neuromodulation,2023,26(7):1424-1432.
Zhou PB, Sun HT, Bao M. Comparative Analysis of the Efficacy of Spinal Cord Stimulation and Traditional Debridement Care in the Treatment of Ischemic Diabetic Foot Ulcers:A Retrospective Cohort Study[J].Neurosurgery,2024,95(2):313-321.
Yao XC, Liu JP, Xu ZY, et al. Short-term spinal cord stimulation versus debridement for the treatment of diabetic foot:A retrospective cohort study[J].Asian J Surg,2024,48(1):387-393.
OuYang H, Tang Y, Yang F, et al. Platelet-rich plasma for the treatment of diabetic foot ulcer:a systematic review[J].Front Endocrinol (Lausanne),2023,14:1256081.
Izzo P, De Intinis C, Molle M, et al. Case report:The use of PRP in the treatment of diabetic foot:case series and a review of the literature[J].Front Endocrinol (Lausanne),2023,14:1286907.
Qu W, Wang Z, Hunt C, et al. The Effectiveness and Safety of Platelet-Rich Plasma for Chronic Wounds:A Systematic Review and Meta-analysis[J].Mayo Clin Proc,2021,96(9):2407-2417.
Shi HS, Yuan X, Wu FF, et al. Research progress and challenges in stem cell therapy for diabetic foot: Bibliometric analysis and perspectives[J].World J Stem Cells,2024,16(1):33-53.
Mastrogiacomo M, Nardini M, Collina MC, et al. Innovative Cell and Platelet Rich Plasma Therapies for Diabetic Foot Ulcer Treatment:The Allogeneic Approach[J].Front Bioeng Biotechnol,2022,10:869408.
王素莉,姥勇,陈伟,等.创面局部注射胰岛素对糖尿病足溃疡患者全身血糖水平及创面的影响[J].中国老年学杂志,2015,35(03):614-615.
戈欣,周一彤.胰岛素局部应用在糖尿病足负压治疗中的疗效观察[J].解放军预防医学杂志,2019,37(12):22-24.
Meng F, Qian L, Gao JF, et al. Application and mechanism analysis of platelet-rich plasma (PRP) combined with local insulin application in the wound repair of diabetic foot[J].China Healthcare Nutr,2023,33(12):178-180.
Stergioti A, Karra V, Chatzopoulou M, et al. The Effect of Local Use of Insulin on Wound-Ulcer in Diabetic or Non-Diabetic Patients:A Scoping Review[J].Int J Low Extrem Wounds,2025,15347346251338182.
Tang W, Chen S, Zhang S, et al. The Multi-Dimensional Role of Vitamin D in the Pathophysiology and Treatment of Diabetic Foot Ulcers:From Molecular Mechanisms to Clinical Translation[J].Int J Mol Sci,2025,26(12):5719.
Tang Y, Huang Y, Luo L, et al. Level of 25-hydroxyvitamin D and vitamin D receptor in diabetic foot ulcer and factor associated with diabetic foot ulcers[J].Diabetol Metab Syndr,2023 Feb,15(1):30.
Halschou-Jensen PM, Sauer J, Bouchelouche P, et al. Improved Healing of Diabetic Foot Ulcers After High-dose Vitamin D:A Randomized Double-blinded Clinical Trial[J].Int J Low Extrem Wounds,2023,22(3):466-474.
Kamble A, Ambad R, Padamwar M, et al. To study the effect of oral vitamin D supplements on wound healing in patient with diabetic foot ulcer and its effect on lipid metabolism[J].Int J Res Pharm Sci,2020,11:2701-2706.
Lu X, Chen Z, Lu J, et al. Effects of Topical 1,25 and 24,25 Vitamin D on Diabetic,Vitamin D Deficient and Vitamin D Receptor Knockout Mouse Corneal Wound Healing[J].Biomolecules,2023,13(7):1065.
Erdem HA, Yalçın N, Kaya A, et al. Vitabiotic:An alternative approach to diabetic foot[J].Wound Repair Regen,2024,32(6):890-894.
Jiang X, Stockwell BR, Conrad M. Ferroptosis:mechanisms,biology and role in disease[J].Nat Rev Mol Cell Biol,2021,22(4):266-282.
Qiao J, Zhou H, Wang J, et al. Analysis of ferroptosis-related key genes and regulatory networks in diabetic foot ulcers[J].Gene,2025,950:149375.
Xiao K, Wang S, Li G, et al. Resveratrol promotes diabetic wound healing by inhibiting ferroptosis in vascular endothelial cells[J].Burns,2024,50(9):107198.
Cui S, Liu X, Liu Y, et al. Autophagosomes Defeat Ferroptosis by Decreasing Generation and Increasing Discharge of Free Fe2+ in Skin Repair Cells to Accelerate Diabetic Wound Healing[J].Adv Sci (Weinh),2023,10(25):e2300414.
Chen J, Li X, Liu H, et al. Bone marrow stromal cell-derived exosomal circular RNA improves diabetic foot ulcer wound healing by activating the nuclear factor erythroid 2-related factor 2 pathway and inhibiting ferroptosis[J].Diabet Med,2023,40(7):e15031.
Downloads
How to Cite
Issue
Section
License
Copyright (c) 2025 吴民松; 晏和国, 袁菲琼
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
DATE
Accepted: 2025-10-30
Published: 2025-11-06
