Diabetes Research unit, Ipswich Hospital, East Suffolk and North Essex NHS Foundation Trust, Ipswich, UK.
Department of Internal Medicine and CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, Netherlands.
Diabetes Metab Res Rev. 2020 Mar;36 Suppl 1:e3244. doi: 10.1002/dmrr.3244. Epub 2019 Dec 16.
Chronic diabetic complications - both microvascular and macrovascular - have become serious health issues with their increasing prevalence paralleling the dramatic rise of the diabetic population worldwide. Of these complications, foot disease is a major cause of morbidity and mortality, consuming more health care resource than all other complications combined. Diabetic polyneuropathy and peripheral vascular disease constitute the two main risk factors, with trauma and foot infection being the most important initiating factors and contributors to delayed healing. Intracellular oxidative stress mediated by hyperglycaemia along with hypertension, dyslipidaemia and smoking constitute the main pathological processes in the aetiology of both macrovascular and microvascular disease. Whilst the former remains the major cause of overall mortality in diabetes, the role of microangiopathy in the pathogenesis of diabetes foot disease and its contribution to delayed wound healing in diabetes has yet to be fully understood and indeed continues to be debated. This article will review the key findings to date on structural and functional microvascular abnormalities in the diabetic foot skin and consider their contribution to impaired would healing.
慢性糖尿病并发症——微血管和大血管并发症——已成为严重的健康问题，其患病率的增加与全球糖尿病患者人数的急剧增加相平行。在这些并发症中，足部疾病是发病率和死亡率的主要原因，消耗的医疗保健资源超过其他所有并发症的总和。糖尿病多发性神经病变和外周血管疾病构成两个主要的危险因素，创伤和足部感染是导致愈合延迟的最重要的起始因素和促成因素。高血糖介导的细胞内氧化应激以及高血压、血脂异常和吸烟是大血管和微血管疾病发病机制中的主要病理过程。虽然前者仍然是糖尿病患者总体死亡率的主要原因，但微血管病变在糖尿病足病发病机制中的作用及其对糖尿病伤口愈合延迟的贡献尚未得到充分理解，实际上仍存在争议。本文将回顾目前关于糖尿病足皮肤结构和功能微血管异常的关键研究结果，并考虑其对伤口愈合受损的影响。
