_糖尿病足的诊治进展_糖尿病足的诊治进展

2017423201742diabeticfootDF、[1]。DF[2]。DF85％[3]。DF、、。DF。1DF、、、[4]1。DF、。、、、、400042【】15%~25%。、/、、。、。。。、。【】【】R587.1【】A【】2016-09-08ProgressintheassessmentandtreatmentfordiabeticfootYanZhenchengDepartmentofHypertensionandEndocrinologyCenterforHypertensionandMetabolicDiseasesChongqingInstituteofHypertensionInstituteofSurgeryResearchDapingHospitalThirdMilitaryMedicalUniversity【Abstract】DiabeticfootDFisacommonandseverecomplicationwithanincidenceof15%to25%indiabeticpopulation.AmongthesepatientswithDF50%areaccompaniedwithwoundinfection.TherearemultipleriskfactorswhichaffectDFprognosisinclud－ingperipheralarterialdiseaseproportionanddepthofulcerperipheralneuropathyandinfection.ThereforeDFisthemaincauseofamputationforclusteringriskfactors.MeanwhileDFmayalsoleadtoincreasingriskofcardiovasculareventsandall-causemortality.SopreventionandtreatmentofDFisvitalinimprovinglivingqualityandsurvivaltimeofdiabeticpatients.AlthoughprogresshavebeenmadeinDFtreatmentcurrenttherapiesarestillshortenedinresolvingclinicchallengesandexploringnewtreatmentforDFisurgentlyneeded.Forthepurposeadvanceindiagnosisassessmentandtherapyweresummarized.【Keywords】diabetesdiabeticfoot;diagnosistreatmentprogress。、。。SCI1010.59111。39732。9732013CB531104。——2017423201742、、。、、、、[5]。2、。、Wagner0~5。0~3A~D4ABCD[1]。、、。、。、、、。、、、、、、CT、。。3。。3.1。3.2789、anklebrachialindexABI、、4、、eGFR、、1AGE264——2017423201742[3]。62%[5]。。、。3.2.1。HBA1C6.2%[2]。。ADAperipheralarterialdiseasePAD、7.0％。3.2.2PAD2~4PAD。。10/5mmHg。PAD、angiotensin-convertingenzymeinhibitorsACEI、β。6ACEIPADABIACEI[5]4643ACEIangiotensinre－ceptorblockers0.76、0.71[6-7]。3.2.3diabeticfootulcerDFUPAD。、、、[8-9]。。[10]。3.2.4。25%[11]。ACC/AHAPADPAD。3.2.5。、、[12]。[13]。、、G-、。[14]。、①②③④⑤。3.3。。、、、。3.4。、。TASCA-CD。[15-18]。、。[19]C。TASCC、D4。1~275.5%~91.1%[20-21]。[22-23]。3~530%70%。、、、265——2017423201742。3.5。bone-marrowderivedmes－enchymalstemcellsMSCs。。、、[24]。4100%、ABI2[25]Hall[26]。、。3.6。β、、-、、、[27]。、。。2/1/[28]。111784.75%、98.31%36d68.97%、75.86%45d2[29]。、[30]。[31]。4。。。。、。。。[1]ChiuCCHuangCLWengSFetal.Amultidisciplinarydiabeticfootulcertreatmentprogrammesignificantlyimprovedtheoutcomeinpatientswithinfecteddiabeticfootulcers[J].JPlastReconstrAesthetSurg2011647867-872.[2]SchaperNCVanNettenJJApelqvistJetal.Preventionandman－agementoffootproblemsindiabetesaSummaryGuidanceforDailyPractice2015basedontheIWGDFGuidanceDocuments[J].DiabetesMetabResRev201632s17-15.[3]SunJHTsaiJSHuangCHetal.RiskfactorsforlowerextremityamputationindiabeticfootdiseasecategorizedbyWagnerclassification[J].DiabetesResClinPract2012953358-363.[4]AlaviASibbaldRGMayerDetal.DiabeticfootulcersPart.Management[J].JAmAcadDermatol201470121.e1-24;quiz45-46.[5]ZhangSSTangZYFangPetal.Nutritionalstatusdeterioratesastheseverityofdiabeticfootulcersincreasesandindependentlyassoci－ateswithprognosis[J].ExpTherMed201351215-222.[6]ShahinYBarnesRBarakatHetal.Meta-analysisofangiotensinconvertingenzymeinhibitorseffectonwalkingabilityandanklebrachialpressureindexinpatientswithintermittentclaudication[J].Atheroscle－rosis20132312283-290.[7]GasperWJRungeSJOwensCD.Managementofinfrapoplitealperipheralarterialocclusivedisease[J].CurrTreatOptionsCardiovascMed2012142136-148.266——2017423201742[8]ArmstrongEJChenDCSinghGDetal.Angiotensin-convertingenzymeinhibitororangiotensinreceptorblockeruseisassociatedwithreducedmajoradversecardiovasculareventsamongpatientswithcriti－callimbischemia[J].VascMed2015203237-244.[9]FranciaPAnichiniRDeBellisAetal.Diabeticfootpreventiontheroleofexercisetherapyinthetreatmentoflimitedjointmobilitymuscleweaknessandreducedgaitspeed[J].ItalJAnatEmbryol2015120121-32.[10]FoxJDBaquerizo-NoleKLFlorMacquhaeMDetal.Statinsmaybeassociatedwithsix-weekdiabeticfootulcerhealing[J].WoundRepairRegen2016242454-457.[11]RookeTWHirschATMisraSetal.2011ACCF/AHAfocusedupdateoftheguidelineforthemanagementofpatientswithperipheralarterydiseaseupdatingthe2005guideline[J].VascMed2011166452-476.[12]ShenQLinDZhuHetal.Clinicaldistributionandantimicro－bialresistanceanalysisof754pathogenicbacteriaindiabeticfootin－fection[J].ChineseMedicalJournal20149412889-894.[13]CharlesPGUckayIKressmannBetal.Theroleofanaerobesindiabeticfootinfections[J].Anaerobe2015348-13.[14]SmithKCollierATownsendEMetal.Onestepclosertoun－derstandingtheroleofbacteriaindiabeticfootulcerscharacterisingthemicrobiomeofulcers[J].BMCMicrobiol20161654.[15]ElgzyriTLarssonJNybergPetal.Earlyrevascularizationafteradmittancetoadiabeticfootcenteraffectsthehealingprobabilityofis－chemicfootulcerinpatientswithdiabetes[J].EurJVascEndovascSurg2014484440-446.[16]VenermoMBiancariFArvelaEetal.Theroleofchronickid－neydiseaseasapredictorofoutcomeafterrevascularisationoftheul－cerateddiabeticfoot[J].Diabetologia201154122971-2977.[17]PernèsJMAugusteMBorieHetal.Infrapoplitealarterialre－canalizationatrueadvanceforlimbsalvageindiabetics[J].DiagnIn－tervImaging2015965423-434.[18]JaffMRWhiteCJHiattWRetal.AnupdateonmethodsforrevascularizationandexpansionoftheTASClesionclassificationtoin－cludebelow-the-kneearteries