糖尿病足溃疡和完整皮肤中糖化血红蛋白、维生素C与微生物群的关联：一项横断面研究。
Association between hemoglobin A1c, Vitamin C, and microbiome in diabetic foot ulcers and intact skin: A cross-sectional study.
作者信息
Tong Khanh Phuong S, Green Stefan J, Ortiz Jacquelyn, Wu Stephanie C
机构信息
Center for Lower Extremity Ambulatory Research (CLEAR), Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science North Chicago Illinois USA.
Department of Internal Medicine, Division of Infectious Diseases Rush University Medical Center Chicago Illinois USA.
出版信息
Health Sci Rep. 2022 Aug 3;5(5):e718. doi: 10.1002/hsr2.718. eCollection 2022 Sep.
BACKGROUND AND AIMS
Diabetic foot ulcers (DFUs) add billions of dollars to the direct annual costs associated with diabetes. Despite various treatments, many DFUs do not heal and become infected. Both skin-associated microbial communities and glycemic control are believed to be important in nonhealing DFUs. Recent studies have linked serum Vitamin C levels with glycemic control and DFUs. This cross-sectional study assessed skin microbiome in DFUs, intact diabetic skin, and nondiabetic skin to identify correlations between hemoglobin A1c (HbA1c), Vitamin C, and microbial community structure. Correlations between Vitamin C, HbA1c, wound size, and ulcer duration were also determined.
METHODS
Participants had their DFUs or intact skin culture swabbed. HbA1c was obtained via point-of-care fingerstick testing and serum Vitamin C was obtained via venipuncture. All participants completed a dietary questionnaire. Participants with ulcers were stratified into the controlled (≤8.0%) or uncontrolled (>8.0%) HbA1c group. Analysis of microbial communities was performed via 16S ribosomal RNA (rRNA) gene amplicon sequencing and bacterial load was measured by the domain-level quantitative polymerase chain reaction of the 16S rRNA gene.
RESULTS
Forty-two patients were recruited over 6 months. Bacteria from the genera and were present in all samples and often dominant, but a shift towards anaerobic pathogenic taxa was observed in ulcers. No global significant differences were observed for HbA1c and Vitamin C levels in the microbial community structure ( < 0.013/ > 0.375). Bacterial loads were 4-5 orders of magnitude higher in ulcers than in intact skin samples. Bacterial load was not significantly higher in the uncontrolled HbA1c group ( = 0.67). Larger wound sizes ( = 0.46) were observed in the uncontrolled HbA1c group compared to the control. Lower Vitamin C levels ( = 0.002) were observed in the uncontrolled HbA1c group compared to nondiabetic controls.
CONCLUSION
Understanding the link between Vitamin C and HbA1c and DFU microbiome may aid in new therapies.
背景与目的
糖尿病足溃疡（DFU）使每年与糖尿病相关的直接成本增加数十亿美元。尽管有各种治疗方法，但许多DFU无法愈合并发生感染。皮肤相关微生物群落和血糖控制被认为在不愈合的DFU中都很重要。最近的研究将血清维生素C水平与血糖控制和DFU联系起来。这项横断面研究评估了DFU、糖尿病患者完整皮肤和非糖尿病患者皮肤中的皮肤微生物群，以确定糖化血红蛋白（HbA1c）、维生素C和微生物群落结构之间的相关性。还确定了维生素C、HbA1c、伤口大小和溃疡持续时间之间的相关性。
方法
对参与者的DFU或完整皮肤进行培养拭子采样。通过即时护理指尖采血检测获得HbA1c，并通过静脉穿刺获得血清维生素C。所有参与者都完成了一份饮食问卷。患有溃疡的参与者被分为HbA1c控制组（≤8.0%）或未控制组（>8.0%）。通过16S核糖体RNA（rRNA）基因扩增子测序进行微生物群落分析，并通过16S rRNA基因的域级定量聚合酶链反应测量细菌载量。
结果
在6个月内招募了42名患者。所有样本中均存在来自属和属的细菌，且通常占主导地位，但在溃疡中观察到向厌氧致病类群的转变。在微生物群落结构中，HbA1c和维生素C水平未观察到全球显著差异（<0.013/>0.375）。溃疡中的细菌载量比完整皮肤样本高4-5个数量级。未控制的HbA1c组中的细菌载量没有显著更高（=0.67）。与对照组相比，未控制的HbA1c组中观察到更大的伤口大小（=0.46）。与非糖尿病对照组相比，未控制的HbA1c组中观察到更低的维生素C水平（=0.002）。
结论
了解维生素C与HbA1c和DFU微生物群之间的联系可能有助于开发新的治疗方法。
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