31例糖尿病足临床治疗体会

目的研究我院糖尿病足临床治疗效果,总结临床经验。方法回顾性分析2008年1月-2012年12月我院收治的31糖尿病足患者的临床资料,所有患者均行对症支持治疗、控制原发病和营养支持等常规等,并对足部创面行清创治疗和抗感染治疗。结果 31例糖尿病足患者治疗后血糖水平均得到良好控制;治疗总有效率93.5%,显效率达48.4%。结论对糖尿病足患者的临床治疗需要采取综合治疗,做好控制患者血糖、加强神经营养支持、做好创面清创、给予抗感染等措施,通过有效的综合治疗,提高糖尿病足的治愈率,降低致残率和致死率。同时应注意指导糖尿病患者注意预防糖尿病足等并发症的发生和复发。     

糖尿病足并感染46例细菌临床分析

糖尿病患者常因多种因素并发糖尿病足感染,占糖尿病住院病人的4%～5%,是糖尿病致残、致死的主要原因之一,糖尿病足已受到国内外学者的广泛重视[1].为了解糖尿病足(DF)感染菌种以选用敏感抗生素,我们总结了46例糖尿病足并感染的病例加以分析.     

干细胞对糖尿病足的治疗研究进展

糖尿病足患者大部分伴有下肢缺血,而缺血是导致糖尿病足溃疡不愈和截肢的最主要原因。传统的治疗方法并不能很好的降低其截肢率,糖尿病足溃疡已经成为世界范围内临床医学的难题。因此,深入研究糖尿病足的发病机制及下肢血管病变特点,探索新的治疗策略及推广应用,具有重要的社会意义。干细胞已经广泛应用于多个领域,其分泌细胞因子促进新生血管生成等机制为治疗糖尿病足提供了可能。本文就近年来干细胞治疗糖尿病足的研究进展作一综述。     

老年糖尿病56例临床分析

目的探讨老年糖尿病患者的发病特点,为规范化防治糖尿病提供参考。方法对我院2005年1月~2010年2月收治住院的56例老年糖尿病患者的资料进行回顾性分析。结果 56例老年糖尿病患者,以其他疾病为首诊治疗46例,合并高血压、高血脂、冠心病20例,糖尿病肾病12例,脑梗死10例,糖尿病足5例,糖尿病眼病4例,肺炎3例,肺结核2例。结论老年糖尿病症状隐匿,并发症多,病死率高,一旦确诊,应采取规范化综合治疗措施,并尽早使用胰岛素。     

细胞因子水平与糖尿病足的相关性研究

糖尿病足(Diabetic Foot,DF)是下肢远端神经异常和不同程度的周围血管病变相关的足部感染、溃疡和(或)深层组织破坏,是糖尿病常见而又严重的并发症之一。目前临床上提倡预防为主、防治结合方针。大量国内外研究已证实糖尿病足患者细胞因子水平存在明显变化,如胰岛素样生长因子、C反应蛋白、脂联素、抵抗素、白细胞介素-6、集落刺激因子等,且这些细胞因子的变化可作为DF发生的预防以及评估预后的监测指标。促红细胞生成素作为重要的集落刺激因子,具有抗凋亡、抗炎、抗氧化、促进血管生长等作用,目前已用于多种临床疾病的治疗,且对糖尿病并发症具有良好的疗效。本文通过对细胞因子水平与糖尿病足的相关性研究进展作一综述,旨在探索细胞因子用于糖尿病足治疗的可行性及有效性,为改善糖尿病足患者的生活质量提供新的治疗方案。     

全国妇产科微生态学学术研讨会征文通知

糖尿病患者常因多种因素并发糖尿病足感染,占糖尿病住院病人的4％～5％,是糖尿病致残、致死的主要原因之一．糖尿病足已受到国内外学者的广泛重视。为了解糖尿病足(DF)感染菌种以选用敏感抗生素,我们总结了46例糖尿病足并感染的病例加以分析。     

社区糖尿病足危险因素与健康教育需求的调查研究

目的:调查社区中糖尿病足高危人群在糖尿病患者中的比例以及糖尿病患者对糖尿病足防治相关知识掌握的情况.方法:对哈尔滨市5个社区中262例糖尿病患者进行糖尿病足防治相关知识调查及ABI测定和分析.结果:262例患者中ABI＜0.9者77例,占29.38％.糖尿病并发下肢动脉病变组与正常组比较,前者的年龄大、病程长、空腹血糖、餐后血糖、胆固醇、收缩压、吸烟率、合并冠心病率、合并脑血管病率明显增高.多元线性回归分析显示,年龄、病程、PBG2h、HbAlc是影响ABI的独立因素.近50％的病人对糖尿病足防治相关知识掌握明显不足.结论:在社区定期开展糖尿病足筛查,及时发现糖尿病危险足,积极开展糖尿病足的宣传教育活动,提高患者的自我防护意识,减少糖尿病足的发生率.     

40例糖尿病足细菌感染临床分析与护理对策

糖尿病足（DF）是糖尿病患者由于合并神经病变及各种不同程度末梢血管病变而导致下肢感染、溃疡形成和（或）深部组织的破坏。DF作为糖尿病的慢性并发症之一,具有很强的致残性和致死性,细菌感染是促使DF病情加重的一个重要诱因。因此,如何控制糖尿病足细菌感染已成为临床治疗与护理中急需共同解决的难题。笔者通过对糖尿病足细菌感染的临床分析,有的放矢进行诊治和护理,及时缓和和减轻病人痛苦,提高其治愈率。     

激素治疗大疱性疾病引起真菌感染回顾性分析

目的研究糖皮质激素治疗大疱性疾病患者发生医院真菌感染的病原菌分类、危险因素和防治对策。方法收集67例大疱性类天疱疮和38例天疱疮患者糖皮质激素治疗的临床资料,计算医院真菌感染率,分析相关危险因素。结果大疱性疾病患者糖皮质激素治疗出现医院真菌感染率达32.38%,口腔真菌感染率为27.61%,肺部真菌感染率为13.33%,主要病原菌分别为白念珠菌(69.77%),热带念珠菌(11.63%)和近平滑念珠菌(6.98%)。糖皮质激素剂量、免疫抑制剂、抗生素、住院日及糖尿病病史明显增加真菌感染危险,其中免疫抑制剂、抗生素和糖尿病病史为独立危险因素。结论糖皮质激素治疗大疱性疾病患者院内真菌感染发生率高,免疫抑制剂、抗生素和糖尿病病史是其主要危险因素。     

人工胰腺

据统计,我国1980年的糖尿病发病率仅为1％。今天已猛增到3．6％。最新资料表明,我国糖尿病患者已超过5000万,约占全球糖尿病患者的1／5。更为严重的是,专家预测,今后十年,糖尿病在我国的发病率将快速增长,有可能达到14％左右。糖尿病已成为继心血管病、脑血管病、癌症之后的第四号杀手。除了糖尿病本身疾病之外,其并发症也十分可怕,糖尿病足、视网膜病变导致失明、肾功能障碍、脑动脉硬化等,更使糖尿病人雪上加霜。     

脱细胞真皮基质治疗对糖尿病足综合征合并下肢动脉硬化闭塞患者神经病变和对足部功能的影响

目的:探究脱细胞真皮基质治疗对糖尿病足综合征合并下肢动脉硬化闭塞患者神经病变的缓解作用和对足部功能的影响。方法:选择本院2017.5-2020.5收治的80例糖尿病足综合征合并下肢动脉硬化闭塞患者平均分为观察组和对照组2组,其中对照组患者给与常规干预结合下肢动脉腔内治疗,观察组则在对照组的基础上实施脱细胞真皮基质治疗。分析两组患者治疗前后TCSS评分、神经传导速度、足部功能、治疗效果、创面感染发生率、治疗费用以及并发症发生率的差异。结果:治疗后观察组患者TCSS评分和足部功能评分均较对照组低,神经传导速度较对照组快,差异有统计学意义(P<0.05);观察组患者治疗总有效率、患者创面感染发生率和并发症发生率分别为100.00%、2.50%和2.50%,对照组患者则分别为80.00%、17.50%和55.00%,且对照组住院费用较观察组高,差异有统计学意义(P<0.05)。结论:脱细胞真皮基质治疗对糖尿病足综合征合并下肢动脉硬化闭塞患者神经病变具有确切的缓解作用,尤其对足部功能效果显著,值得临床广泛推广使用。     

How to make insulin-producing pancreatic β cells for diabetes treatment

Around 400 million people worldwide suffer from diabetes mellitus.The major pathological event for Type 1 diabetes and advanced Type 2 diabetes is loss or impairment of insulin-secreting β cells of the pancreas.For the past 100 years,daily insulin injection has served as a life-saving treatment for these patients.However,insulin injection often cannot achieve full glucose control,and over time poor glucose control leads to severe complications and mortality.As an alternative treatment,islet transplantation has been demonstrated to effectively maintain glucose homeostasis in diabetic patients,but its wide application is limited by the scarcity of donated islets.Therefore,it is important to define new strategies to obtain functional human β cells for transplantation therapies.Here,we summarize recent progress towards the production of β cells in vitro from pluripotent stem cells or somatic cell types including a cells,pancreatic exocrine cells,gastrointestinal stem cells,fibroblasts and hepatocytes.We also discuss novel methods for optimizing β cell transplantation and maintenance in vivo.From our perspective,the future of βcell replacement therapy is very promising although it is still challenging to control differentiation of β cells in vitro and to protect these cells from autoimmune attack in Type 1 diabetic patients.Overall,tremendous progress has been made in understanding βcell differentiation and producing functional β cells with different methods.In the coming years,we believe more clinical trials will be launched to move these technologies towards treatments to benefit diabetic patients.     

Foot care practices of diabetic patients in Saudi Arabia

Diabetic foot is a serious complication that causes lower extremity amputations. The aim of this study was to identify the patient’s awareness about risk factors for diabetic foot disease and to explore the knowledge and foot care practices among diabetic patients in a Saudi population. This cross-sectional study was conducted in King Khalid University Hospital (KKUH), King Abdulaziz University Hospital (KAUH), King Fahad Medical City, National Guard Hospital, Military Hospital, and Prince Salman Hospital capital city of Saudi Arabia. Patients were eligible if they had diabetes foot disease, signed the consent form, and completed the questionnaire. We selected 350 patients from different hospitals between November-2011 and April-2012. The majority of patients (68%) were selected from King Saud University hospitals. The mean age of patients was 50.87 ± 15.9 years with a range of 20–90 years. The majority of patients were male (64.3%) and had a family history of hypertension (55.4%), high total cholesterol (58.6%), and other diabetes (58.9%). A family history of smoking, a major risk factor for diabetic foot, was found in 20.3% of cases. Sixty percent of the patients were using oral medications, 27.1% were using insulin therapy, 10% were using both oral and insulin therapies, and 10% were on diet. In our study, 19.4% of participants were illiterate while 80.6% had a high school or university level education. Our findings also revealed that some patients had a lack of knowledge concerning diabetic foot disease and future complications. Patients are unaware of the risk factors for diabetes foot and practice poor foot care. Awareness programs should be mandatory in all hospitals and diabetes clinics to help compensate for the lack of awareness and lack of podiatric educational services. Such programs may decrease the risk of diabetes foot disease.     

Tool for Rapid & Easy Identification of High Risk Diabetic Foot: Validation & Clinical Pilot of the Simplified 60 Second Diabetic Foot Screening Tool

Background

Most diabetic foot amputations are caused by ulcers on the skin of the foot i.e. diabetic foot ulcers. Early identification of patients at high risk for diabetic foot ulcers is crucial. The ‘Simplified 60-Second Diabetic Foot Screening Tool’ has been designed to rapidly detect high risk diabetic feet, allowing for timely identification and referral of patients needing treatment. This study aimed to determine the clinical performance and inter-rater reliability of ‘Simplified 60 Second Diabetic Foot Screening Tool’ in order to evaluate its applicability for routine screening.

Methods and Findings

The tool was independently tested by n=12 assessors with n=18 Guyanese patients with diabetes. Inter-rater reliability was assessed by calculating Cronbach’s alpha for each of the assessment items. A minimum value of 0.60 was considered acceptable. Reliability scores of the screening tool assessment items were: ‘monofilament test’ 0.98; ‘active ulcer’ 0.97; ‘previous amputation’ 0.97; ‘previous ulcer’ 0.97; ‘fixed ankle’ 0.91; ‘deformity’ 0.87; ‘callus’ 0.87; ‘absent pulses’ 0.87; ‘fixed toe’ 0.80; ‘blisters’ 0.77; ‘ingrown nail’ 0.72; and ‘fissures’ 0.55. The item ‘stiffness in the toe or ankle’ was removed as it was observed in only 1.3% of patients. The item ‘fissures’ was also removed due to low inter-rater reliability. Clinical performance was assessed via a pilot study utilizing the screening tool on n=1,266 patients in an acute care setting in Georgetown, Guyana. In total, 48% of patients either had existing diabetic foot ulcers or were found to be at high risk for developing ulcers.

Conclusions

Clinicians in low and middle income countries such as Guyana can use the Simplified 60-Second Diabetic Screening Tool to facilitate early detection and appropriate treatment of diabetic foot ulcers. Implementation of this screening tool has the potential to decrease diabetes related disability and mortality.     

L’échographie doppler dans la prévention des amputations des membres inférieurs du diabétique en Côte d’Ivoire

ObjectiveThe aim of this study was to demonstrate the role of the Doppler ultrasound examination in the management of diabetic feet and particularly in the prevention of the diabetic's amputation.Patients and methodIt is about a retrospective study carried out over a 4-year period at Yopougon University Hospital (Abidjan, Côte d’Ivoire). It consisted in the analysis of the records of 78 patients hospitalized for diabetic foot and in whom was performed a Doppler ultrasound examination of the lower limbs vessels. The analysis of patients’ records helped to bring out the epidemiological, clinical, radiographic, biologic, therapeutic and evolutional elements.ResultsPatients’ mean age was 57.6 years. The sex ratio was 1.05. Adult diabetes accounted for 93.5% of cases and had been developing for 11.49 years on average. On the Doppler ultrasound scan of the lower limbs arterial anomalies of these limbs were found in 70 cases. They were associated with a venous anomaly in four cases. Arterial anomalies were represented by stenosis (34 cases), occlusions (10 cases), medialarterosclerosis (four cases), small arteries (six cases) and the associations of several elementary lesions (nine cases). In three cases, the arterial abnormality was not indicated. A medical treatment was instituted for all the patients. The outcome was favorable for 61 patients, 13 were amputated and four deaths were recorded.ConclusionColor Doppler ultrasound examination of lower limbs vessels helped to bring out a vascular anomaly in 89.7% of patients with diabetic foot whose treatment helped to keep the lower limb in 78.2%. We recommend the systematic request of this examination in the African diabetic with adult diabetes which has been developing for more than 10 years before the onset of diabetic foot.     

高压氧治疗糖尿病视网膜病变的研究进展

糖尿病视网膜病变是糖尿病最常见、最主要的微血管并发症之一,具有高发病率,高致盲率的特点,严重影响了人类的生存质量。控制高血糖和改善组织缺氧无疑是防治糖尿病微血管病变的有效方法。如果对糖尿病视网膜病变及时进行治疗,能延缓其发展并能提高病人的生活质量。近年来,随着对糖尿病发病机制的深入研究,很多方法用于防治糖尿病视网膜病人都取得了一定的疗效。而高压氧治疗是许多急慢性疾病的首选治疗方法。已有基础和临床研究证实,高压氧治疗对糖尿病视网膜病变安全有效。因此,作为一种新疗法,高压氧疗法可能会为糖尿病视网膜病变的治疗带来更广泛的应用前景。     

Study of Fatal Cases of Friedreich's Ataxia

A study of 82 fatal cases of Friedreich''s ataxia showed that over half the patients died of heart failure while nearly three-quarters had evidence of cardiac dysfunction during life. A high incidence of diabetes mellitus (23%) was another finding, and four patients developed diabetic ketosis terminally.     

外科新三联疗法治疗糖尿病足的临床观察

目的:观察外科新三联疗法(外科换药-威伐激光-成纤维细胞生长因子)治疗糖尿病足溃疡的临床疗效和安全性。方法:将57例糖尿病足溃疡患者随机分为2组。对照组28例,采用外科换药辅以成纤维细胞生长因子外敷治疗;治疗组29例,在对照组治疗的基础上配合威伐激光照射治疗。疗程为8周,观察两组患者的治疗有效率、愈合时间和不良反应的发生情况。结果:治疗组和对照组的有效率分别为86.21%、57.14%,治疗组显著高于对照组(P0.05);且治疗组溃疡的愈合时间(39.40±2.24天)较对照组(50.67±2.31天)明显缩短(P0.01)。此外,两组患者均无明显的不良反应发生。结论:外科新三联疗法(外科换药-威伐激光-成纤维细胞生长因子)是治疗糖尿病足溃疡的有效方法,且安全性好。     

The Incidence of End-Stage Renal Disease in the Diabetic (Compared to the Non-Diabetic) Population: A Systematic Review

End-stage renal disease (ESRD) in diabetes is a life threatening complication resulting in a poor prognosis for patients as well as high medical costs. The aims of this systematic review were (1) to evaluate the incidence of ESRD due to all causes and due to diabetic nephropathy in the diabetic population and differences between incidences of ESRD with respect to sex, ethnicity, age and regions, (2) to compare incidence rates in the diabetic and non-diabetic population, and (3) to investigate time trends. The systematic review was conducted according to the PRISMA group guidelines by performing systematic literature searches in the biomedical databases until January 3^rd 2015; thirty-two studies were included. Among patients with incident type 1 diabetes the 30-year cumulative incidence ranged from 3.3% to 7.8%. Among patients with prevalent diabetes, incidence rates of ESRD due to all causes ranged from 132.0 to 167.0 per 100,000 person-years, whereas incidence rates of ESRD due to diabetic nephropathy varied from 38.4 to 804.0 per 100,000 person-years. The incidence of ESRD in the diabetic population was higher compared to the non-diabetic population, and relative risks varied from 6.2 in the white population to 62.0 among Native Americans. The results regarding time trends were inconsistent. The review conducted demonstrates the considerable variation of incidences of ESRD among the diabetic population. Consistent findings included an excess risk when comparing the diabetic to the non-diabetic population and ethnic differences. We recommend that newly designed studies should use standardized methods for the determination of ESRD and population at risk.     

低血糖与2型糖尿病

糖尿病（DM）是一种慢性终身性疾病,目前已成为严重威胁人类健康的世界性公共卫生问题,2型糖尿病患者也逐渐增加。流行病学调查显示,目前全球大约有近2亿糖尿病患者,其中2型糖尿病占90%～95%。2型糖尿病发病机理是胰岛素分泌的相对或绝对不足伴有或不伴有胰岛素抵抗,持续的高血糖可严重抑制胰岛功能。严格的血糖控制能够延缓糖尿病慢性并发症的发生和发展,延长了患者的预期寿命。但是随着血糖控制达标,发生低血糖的危险性增加了,低血糖不仅严重阻碍了良好血糖控制,而且严重低血糖还是2型糖尿病致死、致残的重要原因。本文探讨2型糖尿病患者治疗中低血糖发生的原因、诱发因素以及可能的解决方案。