Tang Guangjun, Wang Ying, Wu Junde, Zhu Ruizhen, Guo Hui, Zhang Yunhui, Chen Zhaojun
Beijing University of Chinese Medicine, Beijing, China.
Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China.
Medicine (Baltimore). 2025 Aug 22;104(34):e43637. doi: 10.1097/MD.0000000000043637.
Diabetic foot ulcers (DFUs) represent a significant complication affecting the lower extremities in individuals with diabetes. The development and progression of DFUs are primarily influenced by diabetic neuropathy (DN) and diabetic peripheral artery disease (DPAD). Recent studies indicate a novel link between the gut microbiota and these risk factors. However, it remains unclear whether a causal relationship exists between them. We obtained data on gut microbiota, derived from publicly available genome-wide association studies. Additionally, we included data on DN, diabetic polyneuropathy (DPN), and DPAD from the FinnGen consortium, considering these conditions as primary risk factors for the onset of DFUs. We employed the inverse variance weighting method for the primary effect analysis and conducted 3 sensitivity tests to ensure the robustness of the results. Our analysis revealed that 7 genera are associated with DN, 8 are associated with DPN, and 12 are associated with DPAD. Notably, the Lachnospiraceae emerged as a common risk factor for both DN [OR = 1.392, 95% CI (1.031, 1.880), P = .031] and DPAD [OR = 1.152, 95% CI (1.019, 1.303), P = .024]. Conversely, the Acidaminococcaceae was identified as a shared protective factor against both DPN [OR = 0.620, 95% CI (0.460, 0.837), P = .002] and DPAD [OR = 0.814, 95% CI (0.691, 0.959), P = .014]. The sensitivity analysis indicated minimal evidence of bias in this study. Our research findings suggest a potential causal relationship between gut microbiota and the key risk factors for developing DFUs. This suggests that early detection and prevention of this serious diabetic complication might be achievable through gut microbiota modulation.
糖尿病足溃疡（DFUs）是糖尿病患者下肢的一种严重并发症。DFUs的发生和发展主要受糖尿病神经病变（DN）和糖尿病外周动脉疾病（DPAD）影响。最近的研究表明肠道微生物群与这些风险因素之间存在新的联系。然而，它们之间是否存在因果关系仍不清楚。我们从公开的全基因组关联研究中获取了肠道微生物群的数据。此外，我们纳入了芬兰基因组联盟关于DN、糖尿病性多发性神经病变（DPN）和DPAD的数据，将这些疾病视为DFUs发病的主要风险因素。我们采用逆方差加权法进行主要效应分析，并进行了3项敏感性测试以确保结果的稳健性。我们的分析显示，7个菌属与DN相关，8个与DPN相关，12个与DPAD相关。值得注意的是，毛螺菌科是DN [比值比（OR）=1.392，95%置信区间（CI）（1.031，1.880），P = 0.031]和DPAD [OR = 1.152，95% CI（1.019，1.303），P = 0.024]的共同风险因素。相反，氨基酸球菌科被确定为针对DPN [OR = 0.620，95% CI（0.460，0.837），P = 0.002]和DPAD [OR = 0.814，95% CI（0.691，0.959），P = 0.014]的共同保护因素。敏感性分析表明本研究中偏差证据极少。我们的研究结果表明肠道微生物群与DFUs发生的关键风险因素之间可能存在因果关系。这表明通过调节肠道微生物群可能实现对这种严重糖尿病并发症的早期检测和预防。
