Yang Jing, Ning Peng, Huang Jiali, Ouyang Hong, Zhang Jiaxing, Yang Fan, Cao Hongyi, Zhang Fan
Department of Endocrine and Metabolism, Chengdu Fifth People's Hospital (The Second Clinical Medical College, Affiliated Fifth People's Hospital of Chengdu University of Traditional Chinese Medicine), Geriatric Diseases Institute of Chengdu/Cancer Prevention and Treatment Institute of Chengdu, Chengdu, Sichuan, China.
Department of Endocrine and Metabolism, Guang'an People's Hospital (Sichuan University West China Hospital Guang'an Hospital), Guang'an, Sichuan, China.
PeerJ. 2025 Jun 16;13:e19571. doi: 10.7717/peerj.19571. eCollection 2025.
Diabetic foot ulcers (DFUs) pose significant clinical challenges, with gas therapy emerging as a promising intervention. However, the comparative efficacy of various gas therapy modalities remains unclear. This study evaluates the effectiveness of different gas therapies, particularly hyperbaric oxygen therapy (HBOT), in improving DFU outcomes.
We searched three major databases, PubMed, Embase, and the Cochrane Library, for randomized controlled trials (RCTs) published up to March 3, 2024, assessing the efficacy of different gas therapies in managing DFUs. Primary outcomes included ulcer healing and area reduction rates, while secondary outcomes encompassed healing time, amputation rate, and adverse events. A network meta-analysis was performed using R, with surface under the cumulative ranking curve (SUCRA) values calculated to rank therapies.
A total of 34 RCTs involving 2,268 DFUs were included in this analysis. HBOT ranked highest for the healing rate (SUCRA = 0.8 14) and area reduction rate (SUCRA = 0.730) but also had a higher amputation rate (SUCRA = 0.621). Except for carbon dioxide therapy, HBOT demonstrated significantly greater healing rates than standard of care (SOC) (mean difference (MD) = -2.71, 95% confidence interval (CI) [-4.85 to -1.34]) and topical oxygen therapy (MD = -2.03, 95% CI [-4.50 to -0.32]), while pairwise comparisons among other gaseous therapies were non-significant ( > 0.05). For wound area reduction, HBOT was superior to SOC (MD = 0.39, 95% CI [0.11-0.67]), whereas differences among other gaseous therapies remained non-significant ( > 0.05). There was substantial heterogeneity in the area reduction rate in net work analysis ( = 87%). Subgroup analyses revealed greater area reduction in DFUs treated with HBOT when the treatment duration exceeded six weeks.
HBOT improves ulcer healing and area reduction rates in DFU patients; however, its association with higher amputation rates warrants cautious use, considering resource availability. Given the limited number and quality of included studies, further high-quality research is needed to validate these findings.
糖尿病足溃疡（DFUs）带来了重大的临床挑战，气体疗法成为一种有前景的干预措施。然而，各种气体疗法的相对疗效仍不明确。本研究评估不同气体疗法，特别是高压氧疗法（HBOT），对改善糖尿病足溃疡结局的有效性。
我们检索了三个主要数据库，即PubMed、Embase和Cochrane图书馆，以查找截至2024年3月3日发表的随机对照试验（RCTs），评估不同气体疗法治疗糖尿病足溃疡的疗效。主要结局包括溃疡愈合和面积缩小率，次要结局包括愈合时间、截肢率和不良事件。使用R进行网络荟萃分析，并计算累积排名曲线下面积（SUCRA）值以对疗法进行排名。
本分析共纳入34项涉及2268例糖尿病足溃疡的随机对照试验。高压氧疗法在愈合率（SUCRA = 0.814）和面积缩小率（SUCRA = 0.730）方面排名最高，但截肢率也较高（SUCRA = 0.621）。除二氧化碳疗法外，高压氧疗法的愈合率显著高于标准治疗（SOC）（平均差（MD）= -2.71，95%置信区间（CI）[-4.85至-1.34]）和局部氧疗法（MD = - 2.03，95%CI[-4.50至-0.32]），而其他气体疗法之间的两两比较无显著性差异（P>0.05）。对于伤口面积缩小，高压氧疗法优于标准治疗（MD = 0.39，95%CI[0.11 - 0.67]），而其他气体疗法之间的差异仍无显著性（P>0.05）网络分析中面积缩小率存在很大异质性（I² = 87%）。亚组分析显示，当治疗持续时间超过六周时，接受高压氧疗法治疗的糖尿病足溃疡面积缩小更明显。
高压氧疗法可提高糖尿病足溃疡患者的溃疡愈合率和面积缩小率；然而，考虑到资源可用性，其与较高截肢率的关联值得谨慎使用。鉴于纳入研究的数量和质量有限，需要进一步的高质量研究来验证这些发现。
