Department of Dermatology, School of Medicine, University of California, Davis, California.
Dermatology Section, VA Northern California Health Care System, Mather, California.
Wound Repair Regen. 2020 May;28(3):282-292. doi: 10.1111/wrr.12800. Epub 2020 Mar 13.
Chronic wounds cause a significant burden on society financially, medically, and psychologically. Unfortunately, patients with nonhealing wounds often suffer from comorbidities that further compound their disability. Given the high rate of depressive symptoms experienced by patients with chronic wounds, further studies are needed to investigate the potentially linked pathophysiological changes in wounds and depression in order to improve patient care. The English literature on wound healing, inflammatory and microbial changes in chronic wounds and depression, and antiinflammatory and probiotic therapy was reviewed on PubMed. Chronic wound conditions and depression were demonstrated to share common pathologic features of dysregulated inflammation and altered microbiome, indicating a possible relationship. Furthermore, alternative treatment strategies such as immune-targeted and probiotic therapy showed promising potential by addressing both pathophysiological pathways. However, many existing studies are limited to a small study population, a cross-sectional design that does not establish temporality, or a wide range of confounding variables in the context of a highly complex and multifactorial disease process. Therefore, additional preclinical studies in suitable wound models, as well as larger clinical cohort studies and trials are necessary to elucidate the relationship between wound microbiome, healing, and depression, and ultimately guide the most effective therapeutic and management plan for chronic wound patients.
慢性伤口给社会带来了巨大的经济、医疗和心理负担。不幸的是，非愈合性伤口的患者常伴有合并症，这进一步加重了他们的残疾。鉴于慢性伤口患者经历的抑郁症状发生率较高，需要进一步研究以调查伤口和抑郁之间潜在的相关病理生理变化，从而改善患者的护理。在 PubMed 上对伤口愈合、慢性伤口中的炎症和微生物变化与抑郁、抗炎和益生菌治疗的英文文献进行了综述。慢性伤口状况和抑郁被证明具有共同的病理特征，即炎症失调和微生物组改变，表明两者之间可能存在关联。此外，免疫靶向和益生菌治疗等替代治疗策略通过针对两种病理生理途径显示出了有希望的潜力。然而，许多现有的研究仅限于小样本的研究人群、不能建立时间关系的横断面设计，或者在高度复杂和多因素疾病过程中存在广泛的混杂变量。因此，需要在合适的伤口模型中进行更多的临床前研究，以及更大的临床队列研究和试验，以阐明伤口微生物组、愈合和抑郁之间的关系，并最终为慢性伤口患者指导最有效的治疗和管理计划。
