Sun Hao-Jie, Si Shan-Wen, Ma Ya-Mei, Liu Xue-Kui, Geng Hou-Fa, Liang Jun
Department of Endocrinology, Xuzhou Central Hospital, Xuzhou 221009, Jiangsu Province, China.
Department of Scientific Research, Fuyang Hospital of Anhui Medical University, Fuyang 236112, Anhui Province, China.
World J Diabetes. 2025 May 15;16(5):104350. doi: 10.4239/wjd.v16.i5.104350.
Negative pressure wound therapy (NPWT) is a potential treatment for diabetic foot ulcers (DFUs), although the mechanisms underlying its effectiveness remain unclear. This study posits that NPWT may improve wound healing by promoting angiogenesis and activating the nuclear factor erythroid 2-related factor 2 (Nrf2)/Kelch-like epichlorohydrin-associated protein 1 (Keap1) signaling pathway, which is crucial for the body's defense against oxidative stress. The hypothesis indicates that enhancing antioxidant defenses through NPWT may positively affect the healing process. There are still limited data on the roles of Nrf2, its downstream signaling molecules, and angiogenesis markers in patients undergoing NPWT.
To study the mechanism of NPWT in DFUs.
This study included a total of 40 hospitalized patients with DFUs from Xuzhou Central Hospital, who were divided into Control group ( = 21) and NPWT group ( = 19). The levels of Nrf2 and Keap1 were analyzed in the granulation tissue 7 days after treatment. The wound condition, erythrocyte sedimentation rate (ESR), procalcitonin (PCT), interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-α), vascular endothelial growth factor (VEGF), basic fibroblast growth factor (b-FGF), cluster of differentiation 31 (CD31), and levels of oxidative stress [malondialdehyde (MDA), superoxide dismutase (SOD), catalase (CAT), and total antioxidant capacity (T-AOC)] were analyzed before and 7 days after treatment by the Mann-Whitney test.
The NPWT group demonstrated significant improvements in wound healing compared to the control group after 7 days of treatment. The levels of ESR, PCT, IL-6, and TNF-α were significantly reduced in the NPWT group compared to the control group ( < 0.05), while the levels of CD31, VEGF, and b-FGF showed significant increases ( < 0.05). The NPWT group exhibited notable elevations in the levels of Nrf2 and its downstream targets (SOD, CAT, and T-AOC), accompanied by decreases in the levels of Keap1 and MDA ( < 0.05).
NPWT may contribute to the healing of DFUs by potentially reducing levels of oxidative stress. Its effects could possibly be enhanced through the action of Nrf2.
负压伤口治疗（NPWT）是糖尿病足溃疡（DFU）的一种潜在治疗方法，但其有效性的潜在机制仍不清楚。本研究认为，NPWT可能通过促进血管生成和激活核因子红细胞2相关因子2（Nrf2）/ Kelch样环氧氯丙烷相关蛋白1（Keap1）信号通路来改善伤口愈合，该信号通路对机体抵御氧化应激至关重要。该假说表明，通过NPWT增强抗氧化防御可能对愈合过程产生积极影响。关于Nrf2、其下游信号分子和血管生成标志物在接受NPWT治疗的患者中的作用的数据仍然有限。
研究NPWT治疗DFU的机制。
本研究共纳入徐州中心医院40例住院DFU患者，分为对照组（n = 21）和NPWT组（n = 19）。治疗7天后分析肉芽组织中Nrf2和Keap1的水平。采用Mann-Whitney U检验分析治疗前和治疗7天后的伤口状况、红细胞沉降率（ESR）、降钙素原（PCT）、白细胞介素6（IL-6）、肿瘤坏死因子α（TNF-α）、血管内皮生长因子（VEGF）、碱性成纤维细胞生长因子（b-FGF）、分化簇31（CD31）以及氧化应激水平[丙二醛（MDA）、超氧化物歧化酶（SOD）、过氧化氢酶（CAT）和总抗氧化能力（T-AOC）]。
治疗7天后，NPWT组与对照组相比，伤口愈合有显著改善。与对照组相比，NPWT组的ESR、PCT、IL-6和TNF-α水平显著降低（P < 0.05），而CD31、VEGF和b-FGF水平显著升高（P < 0.05）。NPWT组Nrf2及其下游靶点（SOD）、CAT和T-AOC）水平显著升高，同时Keap1和MDA水平降低（P < 0.05）。
NPWT可能通过潜在地降低氧化应激水平促进DFU愈合。其作用可能通过Nrf2的作用得到增强。
