中药多信号通路治疗糖尿病足溃疡的研究进展  

A review on treating diabetic foot ulcer in TCM by multi-signal pathway

作　　者：张志勇 韦永明 黄丽梅 黄珍 林书华 梁益鸣 ZHANG Zhiyong

机构地区：[1]贵港市中医医院,广西贵港537000

出　　处：《中医临床研究》2024年第13期117-123,共7页Clinical Journal Of Chinese Medicine

基　　金：广西壮族自治区中医药管理局自筹课题(GXZYR20220583)。

摘　　要：糖尿病足溃疡是由长期严重的糖尿病导致的常见并发症,累及微血管、大血管、神经系统,如不及时控制则病变周围组织可感染、缺血坏死,最终导致截肢。目前医学界普遍认为,高血糖是血管病变的关键始发因素,发现糖尿病足溃疡的治疗靶点可以为临床治愈提供条件。近年来对糖尿病足溃疡延迟愈合原因的研究较多,主要有血管生成减少、肉芽组织生长缓慢、胶原蛋白合成不足、细胞凋亡增多、氧化应激水平升高、慢性炎症等,对糖尿病足溃疡创面愈合机制的研究较少。研究通过对国内外糖尿病足溃疡创面修复机制的研究进展进行总结,发现多个信号通路参与糖尿病足溃疡创面愈合的发病和发展,包括Wnt、核因子E2相关因子2(Nuclear Factor E2 Related Factor 2,Nrf2)/抗氧化反应元件(Antioxidant Response Element,ARE)、丝裂原活化蛋白激酶(Mitogen-Activated Protein Kinase,MAPK)、磷脂酰肌醇3激酶/蛋白激酶B(PI3K/Akt)、核因子κB(Nuclear Factor kappa B,NF-κB)、Notch、转化生长因子β(Transforming Growth Factorβ,TGF-β)/Smad、缺氧诱导因子-1α(Hypoxia Inducible Factor-1 Subunit Alpha,HIF-1α)/血管内皮生长因子(Vascular Endothelial Growth Factor,VEGF)信号通路,涉及促进细胞生长生殖代谢、减少细胞凋亡、促进创面血管生成、抑制氧化应激反应、参与炎症免疫反应等。另外,研究还发现中药治疗糖尿病足溃疡具有独特的优势,多种中药有效成分、中成药、中药方剂可通过多信号通路促进足部溃疡愈合,取得良好的临床疗效。文章将对中医药治疗糖尿病足溃疡愈合的信号通路进行分点论述,阐明当前治疗糖尿病足溃疡的核心靶点,梳理中药有效成分、中成药、中药方剂与各个信号通路的作用联系,同时为探究中医药治疗糖尿病足溃疡提供理论支撑。Diabetic foot ulcer(DFU)is a common complication caused by long-term severe diabetes,involving microvessels,macrovessels,and nervous system.If not controlled in time,the surrounding tissue can be infected,ischemic necrosis,and eventually lead to amputation.DFU is a common complication caused by long-term severe diabetes,involving microvessels,macrovessels,and nervous system.If not controlled in time,the surrounding tissue can be infected,ischemic necrosis,and eventually lead to amputation.At present,it is generally believed that hyperglycemia is the key initiating factor of vascular diseases,and the discovery of therapeutic targets for DFU can provide conditions for clinical cure.In recent years,there have been many studies on the causes of DFU delayed healing,mainly including reduced angiogenesis,slow growth of granulation tissue,insufficient collagen synthesis,increased apoptosis,increased oxidative stress level,chronic inflammation,etc..There are few studies on the mechanism of DFU wound healing.The author summarizes the research on DFU wound repair mechanism at home and abroad.Multiple signaling pathways were found to be involved in the pathogenesis and development of DFU wound healing,including Wnt,Nrf2/ARE,MAPK,PI3K/Akt,NF-κB,Notch,TGF-β/Smad,HIF-1α/VEGF signaling pathways.It is involved in promoting cell growth and reproductive metabolism,reducing cell apoptosis,promoting wound angiogenesis,inhibiting oxidative stress response,and participating in inflammatory immune response.In addition,studies have also found that TCM has unique advantages in the treatment of DFU.A variety of Chinese medicine active ingredients,Chinese patent medicine and Chinese medicine prescription can promote foot ulcer healing through multiple signaling pathways and achieve good clinical efficacy.This article will discuss the signal pathways of traditional Chinese medicine in the treatment of DFU healing,clarify the core targets of the current treatment of DFU,summarize the relationship between the active ingredients of tradition

关 键 词：糖尿病足溃疡 中医药 信号通路 综述 

分 类 号：R587.1[医药卫生—内分泌]