载抗生素骨水泥对中重度糖尿病足感染创面的临床疗效

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已出版: 2025-08-30
关键词:
载抗生素骨水泥, 致病菌, 诱导膜, 创面愈合

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蔡子欣
郑州大学人民医院河南省人民医院内分泌科，郑州 450003
周艳云
郑州大学人民医院河南省人民医院内分泌科，郑州450003
董承瑜
郑州大学人民医院河南省人民医院内分泌科，郑州450003
张会峰
郑州大学人民医院河南省人民医院内分泌科，郑州450003
李延焘
河南大学人民医院河南省人民医院内分泌科，郑州450003

摘要

探讨载抗生素骨水泥治疗中重度糖尿病足感染（diabetic foot infection，DFI）患者的临床疗效和相关机制。方法：采用前瞻性随机对照临床试验，选取2020年9月至2022年10月就诊于郑州大学人民医院内分泌科的167例中重度DFI患者作为研究对象。研究组104名患者给予载抗生素骨水泥治疗，对照组63名患者给予传统负压封闭引流治疗；研究组于术后第4周取创面诱导膜组织，行苏木素-伊红（HE）染色、免疫组织化学染色和蛋白质印迹（Western blot，WB）。收集患者的一般资料、创面病原菌培养结果、临床疗效指标、诱导膜的HE染色结果、免疫组化结果以及WB结果。比较两组患者的病原菌分布、不同感染程度组患者的病原菌分布以及治疗3个月后的创面愈合总有效率、愈合时间、总住院时间、总治疗费用、总清创次数、疼痛数字评价量表（NRS）评分、抑郁评定量表（PHQ-9）评分及焦虑筛查量表（GAD-7）评分；根据创面愈合程度的不同，将研究组患者分为治愈组和显效组，比较两组患者诱导膜中的MVD、血管内皮生长因子（VEGF）、表皮生长因子（EGF）、成纤维细胞生长因子-2（FGF-2）、转化生长因子-β1（TGF-β1）及Ⅰ型胶原蛋白的表达。结果：167名中重度DFI患者共培养出132株致病菌，包括72株革兰氏阴性菌、56株革兰氏阳性菌和4株真菌。研究组104名患者共培养出78株病原菌，对照组63名患者共培养出54株病原菌，两组培养出的病原菌主要是革兰氏阴性菌，不同感染程度的患者培养出的病原菌主要是革兰氏阴性菌。与对照组相比，研究组治疗的总有效率更高，治愈时间、总住院时间、总清创次数、总住院费用、NRS、PHQ-9和GAD-7评分更低，差异有统计学意义（P<0.05）。两组的溃疡复发率无明显差异（P>0.05）。研究组共收集了34例患者的诱导膜标本，其中21例（61.76%）患者创面治愈，13例（38.24%）患者创面显效，根据创面愈合程度的不同，分为治愈组和显效组。治愈组的MVD、VEGF、EGF、FGF-2、TGF-β1及I型胶原蛋白表达水平显著高于显效组，差异有统计学意义（P<0.05）。结论：相较于传统负压封闭引流治疗，应用载抗生素骨水泥治疗中重度DFI有助于控制感染，缩短住院时间，降低医疗费用，减轻患者负担，其促进创面愈合的机制可能与促进生长因子及I型胶原蛋白含量的表达有关。

Article Details

期
卷 1 编号 01 (2025): 临床与转化医学前沿
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原创研究
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本作品采用知识共享署名 4.0 国际许可协议授权。

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