Jude E B, Tentolouris N, Appleton I, Anderson S, Boulton A J
Manchester Royal Infirmary, and School of Biological Sciences, Manchester University, Manchester, United Kingdom.
Wound Repair Regen. 2001 Sep-Oct;9(5):353-9. doi: 10.1046/j.1524-475x.2001.00353.x.
Various factors are associated with foot ulceration, including delayed reporting of ulcers, poor glycemic control, and severity of neuropathy. Several studies have looked at the role of nitric oxide in wound healing. However, no studies have examined its role in the occurrence and recurrence of diabetic foot ulceration. In a cross-sectional study we examined the role of neuropathy, retinopathy, nephropathy, and plasma nitric oxide (estimated from plasma nitrite and nitrate) levels in diabetic patients with recurrent and non-recurrent neuropathic and neuroischemic foot ulcers. Patients with recurrent foot ulcers had higher vibration perception threshold values compared to patients with non-recurrent foot ulcers (47.4 +/- 5.7 volts versus 39.5 +/- 10.3 volts respectively, P < 0.05). In addition, subjects with recurrent foot ulcers had significantly higher plasma nitric oxide compared to subjects with non-recurrent foot ulcers (46.9 +/- 6.3 microm/L versus 30.2 +/- 2.4 microm/L respectively, P < 0.01). Multivariate logistic regression analysis adjusted for age, sex, hemoglobin A1c, presence of retinopathy and nephropathy, vibration perception threshold, plasma creatinine, and total nitric oxide, indicated that only vibration perception threshold was independently associated with the presence of an ulcer [odds ratio: 1.26 (1.10-1.46); P <0.001)] and the recurrence of foot ulcers [odds ratio: 1.13 (1.01-1.27); P =0.04)]. This study has shown that although plasma nitric oxide is higher in patients with recurrent neuropathic and neuroischemic foot ulcers, severity of neuropathy was the most important factor associated with the development and recurrence of foot ulcers in diabetic patients.
多种因素与足部溃疡相关，包括溃疡报告延迟、血糖控制不佳以及神经病变的严重程度。多项研究探讨了一氧化氮在伤口愈合中的作用。然而，尚无研究考察其在糖尿病足溃疡发生和复发中的作用。在一项横断面研究中，我们考察了神经病变、视网膜病变、肾病以及血浆一氧化氮（根据血浆亚硝酸盐和硝酸盐估算）水平在患有复发性和非复发性神经病变性及神经缺血性足部溃疡的糖尿病患者中的作用。与非复发性足部溃疡患者相比，复发性足部溃疡患者的振动觉阈值更高（分别为47.4±5.7伏和39.5±10.3伏，P<0.05）。此外，与非复发性足部溃疡患者相比，复发性足部溃疡患者的血浆一氧化氮水平显著更高（分别为46.9±6.3微摩尔/升和30.2±2.4微摩尔/升，P<0.01）。经年龄、性别、糖化血红蛋白、视网膜病变和肾病的存在情况、振动觉阈值、血浆肌酐以及总一氧化氮校正后的多因素逻辑回归分析表明，只有振动觉阈值与溃疡的存在[比值比：1.26（1.10 - 1.46）；P<0.001]和足部溃疡的复发[比值比：1.13（1.01 - 1.27）；P = 0.04]独立相关。这项研究表明，尽管复发性神经病变性和神经缺血性足部溃疡患者的血浆一氧化氮水平较高，但神经病变的严重程度是糖尿病患者足部溃疡发生和复发的最重要相关因素。
