糖尿病足多学科综合治疗临床疗效观察
|
摘要
背景及目的
随着经济的发展、人民生活水平的提高以及人口的老龄化,2型糖尿病的发病率在全球范围内呈逐年增加趋势。糖尿病足是2型糖尿病并发症的一种,是中晚期2型糖尿病患者致残、致死的重要原因之一。Khanolkar等认为,与普通人群相比,糖尿病患者下肢截肢的机会要高出15～40倍,其中老年患者的危险性更高。在我国2型糖尿病患者中,有15%～18%的患者有足部并发症,截肢率高达20%～30%。较为严重糖尿病足发病和血管神经感染等多种因素有关,故治疗起来难度大,愈合由多重因素共同作用,主要包括控制感染、血运重建、治疗神经病变和清创换药等,这些因素可以影响和促进伤口愈合,任何一种单一治疗效果都不太理想。本研究通过多学科综合治疗糖尿病足并观察治疗效果,分析寻找促进糖尿病足患者伤口愈合的因素。
方法
选取2010年5月至2012年8月在我院内分泌科因糖尿病足住院患者120例,所有患者均符合1999年WHO糖尿病诊断标准,确诊为2型糖尿病,排除糖尿病足0级病变患者。120例入选患者单足或者双足均有溃疡,其中单足72例,双足48例,1-2级合并水泡(摩擦伤、自发性大泡、烧伤等)胼胝体、冻伤等表浅溃疡的67例,3级深达肌肉肌腱的30例。4级局部坏疽17例。5级全足坏疽6例。其中湿性坏疽34例,混合坏疽63例,干性坏疽23例。所有患者治疗前第一天抽取空腹血液测定空腹血糖(FBG)、餐后2小时血糖(2hBG)、糖化血红蛋白(HbAlc)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL-C)、高密度脂蛋白(HDL-C),测量收缩压(SBP)、舒张压(DBP)及踝肱指数(ABI),测量皮温,行四肢神经肌电图检查是否有糖尿病周围神经病变,行下肢动脉血管彩超检查是否有下肢血管病变,疗程完毕后再次复查上述指标。患者均行内科疗法治疗即降压、降脂、降糖、营养神经、改善循环以及抗感染清创换药等治疗,有选择的进行进一步检查,部分行介入治疗和负压吸引术,疗程为3月,可对比患者治疗前后一般情况及创面生长情况。
结果
经过3个月的多学科综合治疗后,120位患者中71人(59.17%)完全痊愈,而治疗无效患者2人(1.67%)。将治疗前后生化指标进行对比,可发现FPG、2hPG、HbAlc、SBP、LDL-C、皮温、缺血足的ABI在治疗前后有明显变化(P<0.05),由此可认为控制好血糖、SBP、LDL-C,提高ABI及改善皮温有利于糖尿病足溃疡的愈合。将治疗前后合并神经或血管病变的患者人数进行对比,二者无明显差异(P>0.05)。糖尿病足发病原因是血管神经病变为基础,感染为诱因的一种严重并发症,本研究通过抗感染,改善循环,营养神经,部分通过介入治疗,负压吸引技术,120例患者完全痊愈患者达到59.17%,明显好转患者达到23.33%,无效截肢患者1.67%。糖尿病足溃疡大部分合并感染,通过治疗感染大部分可以控制,多重耐药菌感染控制不好也可导致截肢,分泌物培养加药敏不能完全代表人体内对药物的敏感性,故不能作为抗生素应用的唯一标准,应根据临床症状体征经验用药加上参考药敏结果来选择适当的抗生素。
结论
本研究通过多学科综合疗法治疗糖尿病足切实有效值得临床推广。
Background and objective
With the development of economy, the improvement of people's living standard and the aging of the population, the morbidity of type2diabetes is increasing year by year in the global scope. Diabetic foot, one complication of type2diabetes, is one of the important reasons for the disability and death of the mid-term and advanced patients with type2diabetes. According to Khanolkar, diabetic patients have15～40times more chances of lower limb amputation than general population, of whom elderly diabetic patients have higher risk.15%～18%of Chinese patients with type2diabetes have foot complications, the amputation rate of whom reaches up to20%-30%. Diabetic foot is caused by many factors like the infection of the nerve of blood vessel, which adds to the difficulty of treatment. Healing in diabetic foot depends on many factors, including infection control, revascularization, treatment of neuropathy and debridement dressing and so on, all of which can influence and promote wound healing. This research focuses on multidisciplinary sequential therapy in the treatment of diabetic foot, the observation of its effect, and the analysis of the factors for promoting diabetic foot patients'wound healing as well as the search for them.
Method
120patients selected, who were being treated in our hospital because of diabetic foot from2010May to2012August, were in accordance with WHO diagnosis standard in1999, and diagnosed with type2diabetes, with patients with diabetic foot0lesions excluded.120patients selected had single or double foot ulcer, including72cases of single foot ulcer,48cases of double foot ulcer,67cases of superficial ulcer such as the blisters of grade1-2(friction injury, spontaneous bulla, burns, frostbite) callosum and cold injury,30cases of ulcer of grade3as deep as muscle tendon,17cases of the local gangrene of grade4,6cases of full foot gangrene of grade5, with34cases of the wet gangrene,63cases of mixed gangrene, and23cases of dry gangrene. During the first day after their hospitalization all of these patients underwent the fasting blood determination to mensurate their fasting blood glucose (FBG), postprandial blood glucose (2hBG)2hours after eating, glycosylated hemoglobin (HbAlc), total cholesterol (TC), triglyceride (TG), low density lipoprotein (LDL-C), high density lipoprotein (HDL-C), systolic blood pressure (SBP), diastolic blood pressure (DBP) and ankle brachial index (ABI), the measurement of their skin temperature, the nerve EMG check which helps to diagnose diabetic peripheral neuropathy, and the color Dopplar ultrasound check of lower extremity artery which helps to diagnose lower extremity vascular disease, all of which were checked again after treatment. Sequential therapy was used for three months to treat these patients, which includes bringing high blood pressure down, lowering blood fat and sugar, maintaining nerve nutrition, improving circulation and giving anti-infection debridement dressing treatment, selecting further examination, treating some patients by using interventional therapy and suction drainage, and comparing the general condition and wound growth before and after treatment.
Result
After3months of multidisciplinary treatment,71of120patients (59.17%) recovered completely, with the ineffective treatment of only2patients (1.67%).Comparing the biochemical indicators before and after treatment, I have found that FPG,2hPG, HbAlc, SBP, LDL-C, ABI, skin temperature all changed obviously before and after treatment (P＜0.05), which shows that the good control of blood glucose, SBP and LDL-C, together with increasing ABI and skin temperature is beneficial to the healing of diabetic foot ulcer. Comparing the numbers of patients with neurological or vascular lesions before and after treatment, I have found no significant difference between these two numbers (P＞0.05). Diabetic foot is a serious complication caused by infection and vascular neuropathy as the foundation. This research of treating by controlling the infection, improving circulation and maintaining the nerves, some with the further treatment of interventional therapy and suction drainage, led to the result that59.17%of120patients with diabetic feet fully recovered and23.33%improved obviously while only1.67%didn't recover. Diabetic foot ulcers are mostly concurrent infection, most of which can be controlled by treating infection, with the ineffective control of the infection by the anti medicine germs leading to cutting legs. Secretion culture and drug sensitivity test can not be fully representative of the drug sensitivity of human body, so it can not be used as the only standard of antibiotic application. The treatment should be based on the clinical experience of symptoms and signs, and the appropriate antibiotics should be selected with the reference of the results of drug sensitivity.
Conclusion
This research of treating diabetic foot by using multidisciplinary therapy is feasible and effective.
随着经济的发展、人民生活水平的提高以及人口的老龄化,2型糖尿病的发病率在全球范围内呈逐年增加趋势。糖尿病足是2型糖尿病并发症的一种,是中晚期2型糖尿病患者致残、致死的重要原因之一。Khanolkar等认为,与普通人群相比,糖尿病患者下肢截肢的机会要高出15～40倍,其中老年患者的危险性更高。在我国2型糖尿病患者中,有15%～18%的患者有足部并发症,截肢率高达20%～30%。较为严重糖尿病足发病和血管神经感染等多种因素有关,故治疗起来难度大,愈合由多重因素共同作用,主要包括控制感染、血运重建、治疗神经病变和清创换药等,这些因素可以影响和促进伤口愈合,任何一种单一治疗效果都不太理想。本研究通过多学科综合治疗糖尿病足并观察治疗效果,分析寻找促进糖尿病足患者伤口愈合的因素。
方法
选取2010年5月至2012年8月在我院内分泌科因糖尿病足住院患者120例,所有患者均符合1999年WHO糖尿病诊断标准,确诊为2型糖尿病,排除糖尿病足0级病变患者。120例入选患者单足或者双足均有溃疡,其中单足72例,双足48例,1-2级合并水泡(摩擦伤、自发性大泡、烧伤等)胼胝体、冻伤等表浅溃疡的67例,3级深达肌肉肌腱的30例。4级局部坏疽17例。5级全足坏疽6例。其中湿性坏疽34例,混合坏疽63例,干性坏疽23例。所有患者治疗前第一天抽取空腹血液测定空腹血糖(FBG)、餐后2小时血糖(2hBG)、糖化血红蛋白(HbAlc)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL-C)、高密度脂蛋白(HDL-C),测量收缩压(SBP)、舒张压(DBP)及踝肱指数(ABI),测量皮温,行四肢神经肌电图检查是否有糖尿病周围神经病变,行下肢动脉血管彩超检查是否有下肢血管病变,疗程完毕后再次复查上述指标。患者均行内科疗法治疗即降压、降脂、降糖、营养神经、改善循环以及抗感染清创换药等治疗,有选择的进行进一步检查,部分行介入治疗和负压吸引术,疗程为3月,可对比患者治疗前后一般情况及创面生长情况。
结果
经过3个月的多学科综合治疗后,120位患者中71人(59.17%)完全痊愈,而治疗无效患者2人(1.67%)。将治疗前后生化指标进行对比,可发现FPG、2hPG、HbAlc、SBP、LDL-C、皮温、缺血足的ABI在治疗前后有明显变化(P<0.05),由此可认为控制好血糖、SBP、LDL-C,提高ABI及改善皮温有利于糖尿病足溃疡的愈合。将治疗前后合并神经或血管病变的患者人数进行对比,二者无明显差异(P>0.05)。糖尿病足发病原因是血管神经病变为基础,感染为诱因的一种严重并发症,本研究通过抗感染,改善循环,营养神经,部分通过介入治疗,负压吸引技术,120例患者完全痊愈患者达到59.17%,明显好转患者达到23.33%,无效截肢患者1.67%。糖尿病足溃疡大部分合并感染,通过治疗感染大部分可以控制,多重耐药菌感染控制不好也可导致截肢,分泌物培养加药敏不能完全代表人体内对药物的敏感性,故不能作为抗生素应用的唯一标准,应根据临床症状体征经验用药加上参考药敏结果来选择适当的抗生素。
结论
本研究通过多学科综合疗法治疗糖尿病足切实有效值得临床推广。
Background and objective
With the development of economy, the improvement of people's living standard and the aging of the population, the morbidity of type2diabetes is increasing year by year in the global scope. Diabetic foot, one complication of type2diabetes, is one of the important reasons for the disability and death of the mid-term and advanced patients with type2diabetes. According to Khanolkar, diabetic patients have15～40times more chances of lower limb amputation than general population, of whom elderly diabetic patients have higher risk.15%～18%of Chinese patients with type2diabetes have foot complications, the amputation rate of whom reaches up to20%-30%. Diabetic foot is caused by many factors like the infection of the nerve of blood vessel, which adds to the difficulty of treatment. Healing in diabetic foot depends on many factors, including infection control, revascularization, treatment of neuropathy and debridement dressing and so on, all of which can influence and promote wound healing. This research focuses on multidisciplinary sequential therapy in the treatment of diabetic foot, the observation of its effect, and the analysis of the factors for promoting diabetic foot patients'wound healing as well as the search for them.
Method
120patients selected, who were being treated in our hospital because of diabetic foot from2010May to2012August, were in accordance with WHO diagnosis standard in1999, and diagnosed with type2diabetes, with patients with diabetic foot0lesions excluded.120patients selected had single or double foot ulcer, including72cases of single foot ulcer,48cases of double foot ulcer,67cases of superficial ulcer such as the blisters of grade1-2(friction injury, spontaneous bulla, burns, frostbite) callosum and cold injury,30cases of ulcer of grade3as deep as muscle tendon,17cases of the local gangrene of grade4,6cases of full foot gangrene of grade5, with34cases of the wet gangrene,63cases of mixed gangrene, and23cases of dry gangrene. During the first day after their hospitalization all of these patients underwent the fasting blood determination to mensurate their fasting blood glucose (FBG), postprandial blood glucose (2hBG)2hours after eating, glycosylated hemoglobin (HbAlc), total cholesterol (TC), triglyceride (TG), low density lipoprotein (LDL-C), high density lipoprotein (HDL-C), systolic blood pressure (SBP), diastolic blood pressure (DBP) and ankle brachial index (ABI), the measurement of their skin temperature, the nerve EMG check which helps to diagnose diabetic peripheral neuropathy, and the color Dopplar ultrasound check of lower extremity artery which helps to diagnose lower extremity vascular disease, all of which were checked again after treatment. Sequential therapy was used for three months to treat these patients, which includes bringing high blood pressure down, lowering blood fat and sugar, maintaining nerve nutrition, improving circulation and giving anti-infection debridement dressing treatment, selecting further examination, treating some patients by using interventional therapy and suction drainage, and comparing the general condition and wound growth before and after treatment.
Result
After3months of multidisciplinary treatment,71of120patients (59.17%) recovered completely, with the ineffective treatment of only2patients (1.67%).Comparing the biochemical indicators before and after treatment, I have found that FPG,2hPG, HbAlc, SBP, LDL-C, ABI, skin temperature all changed obviously before and after treatment (P＜0.05), which shows that the good control of blood glucose, SBP and LDL-C, together with increasing ABI and skin temperature is beneficial to the healing of diabetic foot ulcer. Comparing the numbers of patients with neurological or vascular lesions before and after treatment, I have found no significant difference between these two numbers (P＞0.05). Diabetic foot is a serious complication caused by infection and vascular neuropathy as the foundation. This research of treating by controlling the infection, improving circulation and maintaining the nerves, some with the further treatment of interventional therapy and suction drainage, led to the result that59.17%of120patients with diabetic feet fully recovered and23.33%improved obviously while only1.67%didn't recover. Diabetic foot ulcers are mostly concurrent infection, most of which can be controlled by treating infection, with the ineffective control of the infection by the anti medicine germs leading to cutting legs. Secretion culture and drug sensitivity test can not be fully representative of the drug sensitivity of human body, so it can not be used as the only standard of antibiotic application. The treatment should be based on the clinical experience of symptoms and signs, and the appropriate antibiotics should be selected with the reference of the results of drug sensitivity.
Conclusion
This research of treating diabetic foot by using multidisciplinary therapy is feasible and effective.
引文
[1]Yang W, Lu J, Weng J, et al. Prevalence of diabetes among men and women in China [J]. N Engl J Med,2010,362(12):1090-1101.
[2]Andrew Boulton. The dinbetic foot:epidemiology,risk factors and the status of care. Diabetes Voice,2005,50(special Issue):5-7
[3]Apelqvis J, Tennvall GR. Counting the costs of the diabetic foot. Diabetes Voice,2005,50 (Special Issue):8-10
[4]Khanolkar MP, Bain SC, Stephens JW. The diabetic foot[J]. QJM,2008,18(2):32-33.
[5]常宝成,潘从清,曾淑范.208例糖尿病足流行病学及临床特点分析.中华糖尿病杂志,2005,13(2)：129-130
[6]范丽凤,陆菊明,郑亚光,等.糖尿病足溃疡的危险因素分析.中国糖尿病杂志,2006,14：435-437
[7]王爱红,赵湜,李强,等.中国部分省市糖尿病足调查及医学经济学分析.中华内分泌代谢杂志,2005,21(6)-496-499
[8]王爱红,赵湜,李强,等.糖尿病足患者医疗费用分析.中华内科杂志,2007,46(6)：471-474
[9]李仕明主编.糖尿病足与相关并发症的诊治.人民卫生出版社,2003,52-54
[10]袁申元,武宝玉.微循环与糖尿病慢性并发症.中国微循环杂志,2000,4(2),73
[11]王爱红,许樟荣,许永杰,等,前列地尔E1脂微球载体制剂治疗糖尿病下肢动脉病变的临床观察.中华老年多器官疾病杂志,2005,4(1)：22-26
[12]赵通洲,曾龙,张国超,等.前列腺素E1治疗糖尿病足溃疡的初步观察.中华内分泌代谢杂志,2001；17：108
[13]刘丽,靖冬梅,王爱林,等.血管内超声消融治疗糖尿病足的疗效观察.中华糖尿病杂志,2004,12(5)：332-335
[14]Bommayya I, Edmonds M. The importance of infraingrinal angioplasty in salvage of diabetic feet. In:Neurodiab and DFSG of EASD Joint Meeting (Abstrcts Book) Hungary, 2002:P130
[15]谷涌泉,吴英峰,张建.糖尿病足的干细胞治疗近期及远期疗效.中国实用内科杂志,2007,27(7)：499-501
[16]王玉珍,李翔,许樟荣,等.沙格雷酯与阿司匹林治疗糖尿病下肢血管病变的随机对照临床研究.中华内分泌代谢杂志,2009,25(6)：595-597
[17]Factors in the development of diabetic neuropathy:Baseline analysis of neuropathy in the feasibility phase of the Diabetes Control and Complications Trisl(DCCT). The DCCT Research Group.Diabetes 1998;37:476-481.
[18]Dyck PJ,Kratz KM,Karnes JL,et al. The pprevalence by staged severity of various types of diabetic neyropathy,retinopathy,and nephropathy in a population-based cohort:the Rochester Diabetic Neuropathy Study,Neurology 1997;43:817-824.
[19]DCCT Research Group.Factors in development of diabetic neuropathy.Baseline analysis of neyropathy in feasibility phase of Diabetes Control and Complications Trial (DCCT). Diabetologia 1998;37:476-481.
[20]Porte D,Graf R,Halter J,et al. Diabetic neyropathy and plasma glucose control.AmJ Med 1999;70:195-200.
[21]Thomas P.Diabetic neuropathy:models,mechanisms and mayhem.Can J Netrol Sci 1999; 19:1-7.
[22]Boulton A,Knight G,Drury J,et al.The prevalence of symptomatic dinbetic neuropathy in an insulin treated population.Diabetes Care 1995;8:125-128.
[23]Pirart J.Diabetes mellitus and its degenerative complications:a prospective study of 4400 patients observed between 1947 and 1973.Diabetes Care 1978; 1:168.
[24]Harati Y.Frequently asked questions about diabetic peripheral neuropathies. Neurol Clin 1997;10:783-807
[25]Fernandez-Castaner M,Mendola QLevy J. The prevalence and clinical aspects of the cardiovascular autonomic neuropathy in diabetic patients (in Spanish)J.Med Clin[Barc] 1994;84:215
[26]YoungMJ,Veves A,Boulton AJM,Thediabetic foot:aetiopathogenesis and management. Diabetes Metab Rev 1998;9:109-127
[27]Brownlee M. Biochemistry and molecular cell biology of diabetic complications[J] Nature, 2001,414:813-820
[28]Packer L, Witt EH, Tritschler HJ. a-lipoic acid as a biological antioxidant [J] Free Radic Biol Med,1995,19:227-250.
[29]李仕明主编.糖尿病足与相关并发症的诊治.人民卫生出版社,2003,172
[30]主译潘长玉.Joslin糖尿病学第14版.人民卫生出版社,2007,1183
[31]National Heart, Lung, and Blood Institute. For safety, NHLBI changes intensive blood sugar treatment strategy in clinical trial of diabetes and cardiovascular disease.2008. htt://public.nhlbi.nih.gov/newsroom/home/GetPressRelease.aspx?id=2551.
[32]Reekers JA, Lammer J. Diabetic foot and PAD:the endovascular approach. Diabetes Metab Res Rev.2012;28(l):36-9.
[33]Pomposelli FB Jr,Jepsen SJ, Gibbons GW,et al. A flexible approach to infrapopliteal vein grafts in patients weth diabetes mellitus.Arch Surg 1999; 126:724-729.
[34]Pomposelli FB Jr,Jepsen SJ, Gibbons GW,et al. Efficacy of the dorsalis pedis pass for limb salvage in diabetic patients:short term observations. J Vasc surg 1997; 11:745-752.
[35]中国2型糖尿病防治指南.北京大学医学出版社,2010,44-45
[36]中国2型糖尿病防治指南.北京大学医学出版社,2010,31-32
[37]主译潘长玉Joslin糖尿病学第14版.人民卫生出版社,2007,870-881
[38]Stehouwer CD, Gall MA, Hougaard P, et al. Plasma homocysteine concentration predicts mortality in non-insulin-dependent diabetic patients with and without albuminuria[J]. Kidney Int,1999,55(1):308-314
[39]洪天配,糖尿病诊断与防治工作最新进展[J],中国实用内科杂志,2007,27(13)：1052-1053。
[40]Bowling FL, Jude EB,Boulton AJ,MRSA and diabetic foot wounds;contaminating or infecting organisms? Curr Diab Rep,2009,9:440-444.
[41]Citron DM, Goldstein EJ, Merriam CV,et al.Bacterioloy of moderate to severe diabetic foot infections and in vitro actibity of antimicrobial agents.J Clin Microbiol, 2007,45:2819-2828.
[42]Gadepalli R,Dhawan B, Sreenivas V A clinic-microbiological study of diabetic foot ulcers in an Indian tertiary care hospital.Diabetes Care,2006,8:1727-1732.
[43]Hanna BC,Delap TG,Scott K, et al. Surgical debridement of craniocervical necrotizing fasciitis; the window of opportunity.J Laryngol Otol,2006,120:702-704.
[44]Joseph WS,Lipsky BA.Medical therapy of diabetic foot infections,J Vasc Surg,2010, 52:67-71.
[45]姜彭,许樟荣.糖尿病足溃疡合并感染的抗生素治疗进展,中华糖尿病杂志2012,4(2)123-125.
[46]肖正华,廖军等.血浆免疫指标变化与糖尿病足部溃疡[J].广州医学院院报,2002,30(1)：35-37.
[47]Dang CN, Praserd YD, Boulton AJ, et al. Methicillirr resistant staphylococcus aureus in the diabetic foot clinic:a worsening problem [J]. Diabet Med,2003,20(2):159-161.
[48]Stiegler H.Diabetic foot syndrome [J]. Herz 2004,29(1):104-115.
[49]肖正华,周倩等.细菌感染对糖尿病足治疗及预后的影响,实用全科医学,20064(1)37-39.
[50]万明,冯会芳等.糖尿病足感染分泌物病原菌及药敏分析.华西医学,2010,25：1718-1719.
[51]杨彩哲,关小宏等.糖尿病足患者病原菌分布及抗菌药物的选择.北京学,2010,32：383-386.
[52]Feiring AJ, Wesolowski AA,Ladl S. Primary stentsupported angiop lasty for treatment of below-knee critical limb ischemia and severe claudication:early and one-year outcomes [J]. JAm Coll Cardiol,2004,44(12):2307-2314
[53]王建波,赵俊功等.膝下动脉经皮腔内血管成形术治疗糖尿病下肢缺血,介入放射学杂志,2008,17(5)：319.
[54]管金平,李强等.精辟腔内成形术血运重建治疗糖尿病严重肢体缺血[J].中国介入影像与治疗学,2008,5(6)：467-470.
[55]张记蔚.糖尿病下肢动脉缺血的介入治疗[J].国外医学：内分泌学分册,2004,24(5)：320-321.
[56]王志强,李涛等.经皮腔内血管成形术在糖尿病足治疗的临床应用,当代医学201016(5)：16-17.
[57]张秀军,郭志.糖尿病足介入治疗现状,武警后勤学院学报(医学版)201221(5)： 388-390.
[58]Mousa A, Rhee JY, Trocciola SM,et al. Percutaneous endovascular trertment for chronic limb ischemia[J]. Ann Vase Surg,2005,19:186-191.
[59]Rand T, Basile A, Cejna M, et al. PTA versus carbofilm-coated stents in infrapopliteal arteries:pilot study [J]. Cardiovasc Intervent Radiol,2006,29:29-38.
[60]Fleischmann W, Streeker W, Bombelli M. Vacuum serling as treatment of soft damage in open fractures[J]. Unfallchirurg,1993,96(9):488-492.
[61]刘飞,罗晴瑜,梁志.封闭式负压吸引技术的原理与创面修复[J].中华损伤与修复杂志,2008,3(4)：49-51.
[62]林秀丽,杨浩瑾等.真空负压封闭技术在糖尿病足治疗中的应用.实用医学杂志,2010,26(7)：1243-1244.
[1]S.R. McGee, E.J. Boyko, Physical examination and chronic lower-extremity ischemia:a critical review. Arch. Intern. Med.1998,158(12),1357.
[2]N.C. Schaper, G Andros, J. Apelqvist, K. Bakker, J. Lammer, M. Lepantalo, J. L.Mills, J. Reekers, C.P. Shearman, R.E. Zierler, R.J. Hinchliffe, Specific guidelines for the diagnosis and treatment of peripheral arterial disease in a patient with diabetes and ulceration of the foot. Diabetes Me tab. Res. Rev.2012,28(1),236-237.
[3]M. Lundin, J.P. Wiksten, T. Pera kyla O. Lindfors, H. Savolainen, J. Skytta et al, Distal pulse palpation:is it reliable? World J. Surg.1999,23,252-255.
[4]Jude, D. Mauricio et al, and Prediction of outcome in individuals with diabetic foot ulcers: focus on the differences between individuals with and without peripheral arterial disease. The EURODIALE study. Dialectologies 2008,51(5),747-755.
[5]L. Prompers, M. Huijberts, J. Apelqvist, E. Jude, A. Piaggesi, K.Bakker, M. Edmonds, P. Holstein, A. Jirkovska, D. Mauricio, G Ragnarson Tennvall, H. Reike, M. Spraul, L. Uccioli, V. Urbancic, K. Van Acker, J. van Baal, F. van Merode, High prevalence of ischaemia, infection and serious co morbidity in patients with diabetic foot disease in Europe. Baseline results from the Eurodiale study. Diabetologia2007,50,18-25.
[6]J. Apelqvist, J. Larsson, What is the most effective way to reduce incidence of amputation in the diabetic foot? Diabetes Me tab. Res. Rev.2000,16 (11), S75-S83.
[7]S. Krishnan, F. Nash, N. Baker, D. Fowler, G Rayman, Reduction in diabetic amputations over 11 years in a defined U.K. population:Benefits of multidisciplinary team work and continuous prospective audit. Diabetes Care2008,31,99-101.
[8]F. Pomposelli, Arterial imaging in patients with lower extremity ischemia and diabetes mellitus. J. Vasc. Surg.2010,52(3),81S-91S.
[9]李彦豪.实用介入诊疗技术图解[M].北京：科学出版社,2002：357-359.
[10]J. Apelqvist, K. Bakker, W.H. van Houtum, International Working Group on the Diabetic Foot (IWGDF) Editorial Board, Practical guidelines on the management and prevention of the diabetic foot:based upon the International Consensus on the Diabetic Foot (2007) prepared by the International Working Group on the Diabetic Foot. Diabetes Me tab.
[11]王威舒血宁配伍制剂局部换药治疗糖尿病足部溃疡临床观察[J].哈尔滨医科大学学报,2007,41(2)：18.
[12]高华,胡建国,张卓,等.维生素C保护糖尿病大鼠主动脉的作用机制[J].天津医药,2007,35(2)： 121-123.
[13]Brownlee M. Biochemistry and molecular cell biology of diabetic complications [J].Nature, 2001,414:813-820.
[14]L. Prompers, M. Huijberts, J. Apelqvist, E. Jude, A. Piaggesi, K.Bakker, M. Edmonds, P. Holstein, A. Jirkovska, D. Mauricio, G. Ragnarson Tennvall, H. Reike, M. Spraul, L. Uccioli, V. Urbancic, K. Van Acker, J. van Baal, F. van Merode, High prevalence of ischaemia, infection and serious co morbidity in patients with diabetic foot disease in Europe. Baseline results from the Eurodiale study. Dialectologies 2007,50,18-25.
[15]M. Eneroth, J. Larsson, J. Apelqvist, Foot infections in diabetes mellitus entity with different characteristics, treatment and prognosis. J. Diabetes Complicat.1999,13(5-6), 254-263.
[16]L.A. Lavery, D. Armstrong, R. Wunderlich, M. Mohler, C. Wendel, B. Lipsky, Risk factors for foot infections in individuals with diabetes. Diabetes Care 2006,29,1288-1293.
[17]C.E. Attinger, K.K. Evans, E. Bulan, P. Blume, P. Cooper, Angiosomes of the foot and ankle and clinical implications for limb salvage:reconstruction, incisions, and revascularization. Plast. Reconstr. Surg.2006,117(7),261S-293S.
[18]B.A. Lipsky, Y.P. Tabak, R.S. Johannes et al. Skin and soft tissue infections in hospitalized patients with diabetes:culture isolates and risk factors associated with mortality, length of stay and cost. Dialectologies 2010,53,914-923.
[19]B.A. Lipsky, A.R. Berendt, J. Embil, F. de Lalla, Diagnosing and treating diabetic foot infections. Diabetes Me tab. Res. Rev.2004,20(1), S56-S64.
[20]M. Eneroth, J. Larsson, J. Apelqvist, Foot infections in diabetes mellitus-entity with different characteristics, treatment and prognosis. J. Diabetes Complicat.1999,13(5-6), 254-263.
[21]L.A. Lavery, D. Armstrong, R. Wunderlich, M. Mohler, C. Wendel, B. Lipsky, Risk factors for foot infections in individuals with diabetes. Diabetes Care 2006,29,1288-1293.
[22]A.R. Berendt, E.J. Peters, K. Bakker, J.M. Embil, M. Eneroth, R.J. Hinchliffe, W.J. Jeffcoate, B.A. Lipsky, E. Senneville, J. Teh, GD. Valk, Diabetic foot osteomyelitis:a progress report on diagnosis and a systematic review of treatment. Diabetes Me tab. Res.Rev.2008,24(1),S145-S161.
[23]Asahara T, Masuda H, Takahashi T, et al. Bone manowori gin of endothelial progenitor cells responsible for postnatal vascuiogenesis in physiological and pathological revascularization. Circ Res.1999,85(3):221-228.
[24]谷涌泉,郭连瑞,张建,等.自体骨髓干细胞移植治疗严重下肢缺血1例[J].中国实用外科杂志,2003,23：670.
[25]Shintani S, Murohara T, Ikeda H, et al. Mbbilization of endothelial progenitor cells in patients with acute myocardial infarction. Circulation,2001; 103(23):2776-2779.
[26]R. van Deursen, Footwear for the neuropathic patient:offloading and stability. Diabetes Me tab. Res. Rev.2008,24(1), S96-S100.
[27]S.A. Bus, G.D.Valk, R.W. van Deursen, D.G. Armstrong, C. Caravaggi, P. Hlava'cek et al. The effectiveness of footwear and off loading interventions to prevent and heal foot ulcers and reduce plantar pressure in diabetes:a systematic review. Diabetes Metab. Res. Rev. 2008,24 (1),S162-S180.
[28]Petre M, Tokar P,Kostar D, el al.Revisiting the total contact cast:maximizing off-loading by wound isolation[J].Diabetes Care,2005,28:929-930.
[29]L. Norgren, W.R. Hiatt, J.A. Donnandy, on behalf of the TASC II Working Group, Inter-society consensus for the management of peripheral arterial disease (TASC II). J. Vasc.2007,45, S5-S67.
[30]Management of peripheral arterial disease (PAD), Transatlantic inter-society consensus (TASC). Eur. J. Vasc. Endovasc,2000,19(A), S1-S250.
[31]International Working Group on the Diabetic Foot, International consensus on the diabetic foot and practical guidelines on the management and the prevention of the diabetic foot. Amsterdam,2000, the Netherlands.
[32]J. Apelqvist, J. Larsson, What is the most effective way to reduce incidence of amputation in the diabetic foot? Diabetes Me tab. Res. Rev.2000,16(1), S75-S83.
[33]L. Prompers, M. Huijberts, J. Apelqvist, E. Jude, A. Piaggesi, K. Bakker, M. Edmonds, P. Holstein, A. Jirkovska, D. Mauricio, G Ragnarson Tennvall, H. Reike, M. Spraul, L. Uccioli, V. Ur bancic, K. Van Acker, J. van Baal, F. van Merode, High prevalence of ischaemia, infection and serious co morbidity in patients with diabetic foot disease in Europe. Baseline results from the Eurodiale study. Diabetologia2007,50,18-25.
[34]M.A. Gershater, M. Lo ndahl, P. Nyberg, J. Larsson, J. Thorne,M. Eneroth, J. Apelqvist, Complexity of factors related to outcome of neuropathic and neuroischaemic/ischaemic diabetic foot ulcers:a cohort study. Diabetologia 2009,52(3),398-407.
[35]M. Luther, I. Kantonen, M. Lepantalo, FINNVASC Study Group, Arterial intervention and reduction in amputation for chronic critical leg ischaemia. Br. J. Surg.2000,87,454-458.
[36]赵苏苏,张东生,卢勤.血管内药物涂层支架制备及应用的研究进展[J].中国介入影像与治疗学,2007,26(5)：378-381.
[37]李景庆,高印生,杨迎国.球囊扩张成形术治疗糖尿病足部急性缺血性病变1例[J].中国介入影像与治疗学,2008,5(1)：74.
[38]J. Edwards, S. Stapley, Debridement of diabetic foot ulcers. Cochrane Database Syst. Rev. (1),2010, CD003556.
[39]F. Game, The advantages and disadvantages of non-surgical management of the diabetic foot. Diabetes Me tab. Res. Rev.2008,24(1), S72-S75.
[40]M.S. Ruiter, J.M. van Golde, N.C. Schaper, C.D. Stehouwer, M.S. Huijberts, Diabetes impairs arteriogenesis in the peripheral circulation:review of molecular mechanisms. Clin. Science,2010,119(6),225-238.
[41]C. Gazzaruso, A. Coppola, M. Montalcini, E. Baffero, A. Garzaniti, G.G Pelissero, S. Collaviti, A. Grugnetti, P. Gallotti, A. Pujia, S.B. Solerte, A. Giustina, Lipoprotein(a) and homocys teine as genetic risk factors for vascular and neuropathic diabetic foot in type 2 diabetes mellitus. Endocrine2012,41,89-95.
[42]R. Sibbald, K. Woo, The biology of chronic foot ulcers in persons with diabetes. Diabetes Metab.2008,24(1), S25.S30.
[2]Andrew Boulton. The dinbetic foot:epidemiology,risk factors and the status of care. Diabetes Voice,2005,50(special Issue):5-7
[3]Apelqvis J, Tennvall GR. Counting the costs of the diabetic foot. Diabetes Voice,2005,50 (Special Issue):8-10
[4]Khanolkar MP, Bain SC, Stephens JW. The diabetic foot[J]. QJM,2008,18(2):32-33.
[5]常宝成,潘从清,曾淑范.208例糖尿病足流行病学及临床特点分析.中华糖尿病杂志,2005,13(2)：129-130
[6]范丽凤,陆菊明,郑亚光,等.糖尿病足溃疡的危险因素分析.中国糖尿病杂志,2006,14：435-437
[7]王爱红,赵湜,李强,等.中国部分省市糖尿病足调查及医学经济学分析.中华内分泌代谢杂志,2005,21(6)-496-499
[8]王爱红,赵湜,李强,等.糖尿病足患者医疗费用分析.中华内科杂志,2007,46(6)：471-474
[9]李仕明主编.糖尿病足与相关并发症的诊治.人民卫生出版社,2003,52-54
[10]袁申元,武宝玉.微循环与糖尿病慢性并发症.中国微循环杂志,2000,4(2),73
[11]王爱红,许樟荣,许永杰,等,前列地尔E1脂微球载体制剂治疗糖尿病下肢动脉病变的临床观察.中华老年多器官疾病杂志,2005,4(1)：22-26
[12]赵通洲,曾龙,张国超,等.前列腺素E1治疗糖尿病足溃疡的初步观察.中华内分泌代谢杂志,2001；17：108
[13]刘丽,靖冬梅,王爱林,等.血管内超声消融治疗糖尿病足的疗效观察.中华糖尿病杂志,2004,12(5)：332-335
[14]Bommayya I, Edmonds M. The importance of infraingrinal angioplasty in salvage of diabetic feet. In:Neurodiab and DFSG of EASD Joint Meeting (Abstrcts Book) Hungary, 2002:P130
[15]谷涌泉,吴英峰,张建.糖尿病足的干细胞治疗近期及远期疗效.中国实用内科杂志,2007,27(7)：499-501
[16]王玉珍,李翔,许樟荣,等.沙格雷酯与阿司匹林治疗糖尿病下肢血管病变的随机对照临床研究.中华内分泌代谢杂志,2009,25(6)：595-597
[17]Factors in the development of diabetic neuropathy:Baseline analysis of neuropathy in the feasibility phase of the Diabetes Control and Complications Trisl(DCCT). The DCCT Research Group.Diabetes 1998;37:476-481.
[18]Dyck PJ,Kratz KM,Karnes JL,et al. The pprevalence by staged severity of various types of diabetic neyropathy,retinopathy,and nephropathy in a population-based cohort:the Rochester Diabetic Neuropathy Study,Neurology 1997;43:817-824.
[19]DCCT Research Group.Factors in development of diabetic neuropathy.Baseline analysis of neyropathy in feasibility phase of Diabetes Control and Complications Trial (DCCT). Diabetologia 1998;37:476-481.
[20]Porte D,Graf R,Halter J,et al. Diabetic neyropathy and plasma glucose control.AmJ Med 1999;70:195-200.
[21]Thomas P.Diabetic neuropathy:models,mechanisms and mayhem.Can J Netrol Sci 1999; 19:1-7.
[22]Boulton A,Knight G,Drury J,et al.The prevalence of symptomatic dinbetic neuropathy in an insulin treated population.Diabetes Care 1995;8:125-128.
[23]Pirart J.Diabetes mellitus and its degenerative complications:a prospective study of 4400 patients observed between 1947 and 1973.Diabetes Care 1978; 1:168.
[24]Harati Y.Frequently asked questions about diabetic peripheral neuropathies. Neurol Clin 1997;10:783-807
[25]Fernandez-Castaner M,Mendola QLevy J. The prevalence and clinical aspects of the cardiovascular autonomic neuropathy in diabetic patients (in Spanish)J.Med Clin[Barc] 1994;84:215
[26]YoungMJ,Veves A,Boulton AJM,Thediabetic foot:aetiopathogenesis and management. Diabetes Metab Rev 1998;9:109-127
[27]Brownlee M. Biochemistry and molecular cell biology of diabetic complications[J] Nature, 2001,414:813-820
[28]Packer L, Witt EH, Tritschler HJ. a-lipoic acid as a biological antioxidant [J] Free Radic Biol Med,1995,19:227-250.
[29]李仕明主编.糖尿病足与相关并发症的诊治.人民卫生出版社,2003,172
[30]主译潘长玉.Joslin糖尿病学第14版.人民卫生出版社,2007,1183
[31]National Heart, Lung, and Blood Institute. For safety, NHLBI changes intensive blood sugar treatment strategy in clinical trial of diabetes and cardiovascular disease.2008. htt://public.nhlbi.nih.gov/newsroom/home/GetPressRelease.aspx?id=2551.
[32]Reekers JA, Lammer J. Diabetic foot and PAD:the endovascular approach. Diabetes Metab Res Rev.2012;28(l):36-9.
[33]Pomposelli FB Jr,Jepsen SJ, Gibbons GW,et al. A flexible approach to infrapopliteal vein grafts in patients weth diabetes mellitus.Arch Surg 1999; 126:724-729.
[34]Pomposelli FB Jr,Jepsen SJ, Gibbons GW,et al. Efficacy of the dorsalis pedis pass for limb salvage in diabetic patients:short term observations. J Vasc surg 1997; 11:745-752.
[35]中国2型糖尿病防治指南.北京大学医学出版社,2010,44-45
[36]中国2型糖尿病防治指南.北京大学医学出版社,2010,31-32
[37]主译潘长玉Joslin糖尿病学第14版.人民卫生出版社,2007,870-881
[38]Stehouwer CD, Gall MA, Hougaard P, et al. Plasma homocysteine concentration predicts mortality in non-insulin-dependent diabetic patients with and without albuminuria[J]. Kidney Int,1999,55(1):308-314
[39]洪天配,糖尿病诊断与防治工作最新进展[J],中国实用内科杂志,2007,27(13)：1052-1053。
[40]Bowling FL, Jude EB,Boulton AJ,MRSA and diabetic foot wounds;contaminating or infecting organisms? Curr Diab Rep,2009,9:440-444.
[41]Citron DM, Goldstein EJ, Merriam CV,et al.Bacterioloy of moderate to severe diabetic foot infections and in vitro actibity of antimicrobial agents.J Clin Microbiol, 2007,45:2819-2828.
[42]Gadepalli R,Dhawan B, Sreenivas V A clinic-microbiological study of diabetic foot ulcers in an Indian tertiary care hospital.Diabetes Care,2006,8:1727-1732.
[43]Hanna BC,Delap TG,Scott K, et al. Surgical debridement of craniocervical necrotizing fasciitis; the window of opportunity.J Laryngol Otol,2006,120:702-704.
[44]Joseph WS,Lipsky BA.Medical therapy of diabetic foot infections,J Vasc Surg,2010, 52:67-71.
[45]姜彭,许樟荣.糖尿病足溃疡合并感染的抗生素治疗进展,中华糖尿病杂志2012,4(2)123-125.
[46]肖正华,廖军等.血浆免疫指标变化与糖尿病足部溃疡[J].广州医学院院报,2002,30(1)：35-37.
[47]Dang CN, Praserd YD, Boulton AJ, et al. Methicillirr resistant staphylococcus aureus in the diabetic foot clinic:a worsening problem [J]. Diabet Med,2003,20(2):159-161.
[48]Stiegler H.Diabetic foot syndrome [J]. Herz 2004,29(1):104-115.
[49]肖正华,周倩等.细菌感染对糖尿病足治疗及预后的影响,实用全科医学,20064(1)37-39.
[50]万明,冯会芳等.糖尿病足感染分泌物病原菌及药敏分析.华西医学,2010,25：1718-1719.
[51]杨彩哲,关小宏等.糖尿病足患者病原菌分布及抗菌药物的选择.北京学,2010,32：383-386.
[52]Feiring AJ, Wesolowski AA,Ladl S. Primary stentsupported angiop lasty for treatment of below-knee critical limb ischemia and severe claudication:early and one-year outcomes [J]. JAm Coll Cardiol,2004,44(12):2307-2314
[53]王建波,赵俊功等.膝下动脉经皮腔内血管成形术治疗糖尿病下肢缺血,介入放射学杂志,2008,17(5)：319.
[54]管金平,李强等.精辟腔内成形术血运重建治疗糖尿病严重肢体缺血[J].中国介入影像与治疗学,2008,5(6)：467-470.
[55]张记蔚.糖尿病下肢动脉缺血的介入治疗[J].国外医学：内分泌学分册,2004,24(5)：320-321.
[56]王志强,李涛等.经皮腔内血管成形术在糖尿病足治疗的临床应用,当代医学201016(5)：16-17.
[57]张秀军,郭志.糖尿病足介入治疗现状,武警后勤学院学报(医学版)201221(5)： 388-390.
[58]Mousa A, Rhee JY, Trocciola SM,et al. Percutaneous endovascular trertment for chronic limb ischemia[J]. Ann Vase Surg,2005,19:186-191.
[59]Rand T, Basile A, Cejna M, et al. PTA versus carbofilm-coated stents in infrapopliteal arteries:pilot study [J]. Cardiovasc Intervent Radiol,2006,29:29-38.
[60]Fleischmann W, Streeker W, Bombelli M. Vacuum serling as treatment of soft damage in open fractures[J]. Unfallchirurg,1993,96(9):488-492.
[61]刘飞,罗晴瑜,梁志.封闭式负压吸引技术的原理与创面修复[J].中华损伤与修复杂志,2008,3(4)：49-51.
[62]林秀丽,杨浩瑾等.真空负压封闭技术在糖尿病足治疗中的应用.实用医学杂志,2010,26(7)：1243-1244.
[1]S.R. McGee, E.J. Boyko, Physical examination and chronic lower-extremity ischemia:a critical review. Arch. Intern. Med.1998,158(12),1357.
[2]N.C. Schaper, G Andros, J. Apelqvist, K. Bakker, J. Lammer, M. Lepantalo, J. L.Mills, J. Reekers, C.P. Shearman, R.E. Zierler, R.J. Hinchliffe, Specific guidelines for the diagnosis and treatment of peripheral arterial disease in a patient with diabetes and ulceration of the foot. Diabetes Me tab. Res. Rev.2012,28(1),236-237.
[3]M. Lundin, J.P. Wiksten, T. Pera kyla O. Lindfors, H. Savolainen, J. Skytta et al, Distal pulse palpation:is it reliable? World J. Surg.1999,23,252-255.
[4]Jude, D. Mauricio et al, and Prediction of outcome in individuals with diabetic foot ulcers: focus on the differences between individuals with and without peripheral arterial disease. The EURODIALE study. Dialectologies 2008,51(5),747-755.
[5]L. Prompers, M. Huijberts, J. Apelqvist, E. Jude, A. Piaggesi, K.Bakker, M. Edmonds, P. Holstein, A. Jirkovska, D. Mauricio, G Ragnarson Tennvall, H. Reike, M. Spraul, L. Uccioli, V. Urbancic, K. Van Acker, J. van Baal, F. van Merode, High prevalence of ischaemia, infection and serious co morbidity in patients with diabetic foot disease in Europe. Baseline results from the Eurodiale study. Diabetologia2007,50,18-25.
[6]J. Apelqvist, J. Larsson, What is the most effective way to reduce incidence of amputation in the diabetic foot? Diabetes Me tab. Res. Rev.2000,16 (11), S75-S83.
[7]S. Krishnan, F. Nash, N. Baker, D. Fowler, G Rayman, Reduction in diabetic amputations over 11 years in a defined U.K. population:Benefits of multidisciplinary team work and continuous prospective audit. Diabetes Care2008,31,99-101.
[8]F. Pomposelli, Arterial imaging in patients with lower extremity ischemia and diabetes mellitus. J. Vasc. Surg.2010,52(3),81S-91S.
[9]李彦豪.实用介入诊疗技术图解[M].北京：科学出版社,2002：357-359.
[10]J. Apelqvist, K. Bakker, W.H. van Houtum, International Working Group on the Diabetic Foot (IWGDF) Editorial Board, Practical guidelines on the management and prevention of the diabetic foot:based upon the International Consensus on the Diabetic Foot (2007) prepared by the International Working Group on the Diabetic Foot. Diabetes Me tab.
[11]王威舒血宁配伍制剂局部换药治疗糖尿病足部溃疡临床观察[J].哈尔滨医科大学学报,2007,41(2)：18.
[12]高华,胡建国,张卓,等.维生素C保护糖尿病大鼠主动脉的作用机制[J].天津医药,2007,35(2)： 121-123.
[13]Brownlee M. Biochemistry and molecular cell biology of diabetic complications [J].Nature, 2001,414:813-820.
[14]L. Prompers, M. Huijberts, J. Apelqvist, E. Jude, A. Piaggesi, K.Bakker, M. Edmonds, P. Holstein, A. Jirkovska, D. Mauricio, G. Ragnarson Tennvall, H. Reike, M. Spraul, L. Uccioli, V. Urbancic, K. Van Acker, J. van Baal, F. van Merode, High prevalence of ischaemia, infection and serious co morbidity in patients with diabetic foot disease in Europe. Baseline results from the Eurodiale study. Dialectologies 2007,50,18-25.
[15]M. Eneroth, J. Larsson, J. Apelqvist, Foot infections in diabetes mellitus entity with different characteristics, treatment and prognosis. J. Diabetes Complicat.1999,13(5-6), 254-263.
[16]L.A. Lavery, D. Armstrong, R. Wunderlich, M. Mohler, C. Wendel, B. Lipsky, Risk factors for foot infections in individuals with diabetes. Diabetes Care 2006,29,1288-1293.
[17]C.E. Attinger, K.K. Evans, E. Bulan, P. Blume, P. Cooper, Angiosomes of the foot and ankle and clinical implications for limb salvage:reconstruction, incisions, and revascularization. Plast. Reconstr. Surg.2006,117(7),261S-293S.
[18]B.A. Lipsky, Y.P. Tabak, R.S. Johannes et al. Skin and soft tissue infections in hospitalized patients with diabetes:culture isolates and risk factors associated with mortality, length of stay and cost. Dialectologies 2010,53,914-923.
[19]B.A. Lipsky, A.R. Berendt, J. Embil, F. de Lalla, Diagnosing and treating diabetic foot infections. Diabetes Me tab. Res. Rev.2004,20(1), S56-S64.
[20]M. Eneroth, J. Larsson, J. Apelqvist, Foot infections in diabetes mellitus-entity with different characteristics, treatment and prognosis. J. Diabetes Complicat.1999,13(5-6), 254-263.
[21]L.A. Lavery, D. Armstrong, R. Wunderlich, M. Mohler, C. Wendel, B. Lipsky, Risk factors for foot infections in individuals with diabetes. Diabetes Care 2006,29,1288-1293.
[22]A.R. Berendt, E.J. Peters, K. Bakker, J.M. Embil, M. Eneroth, R.J. Hinchliffe, W.J. Jeffcoate, B.A. Lipsky, E. Senneville, J. Teh, GD. Valk, Diabetic foot osteomyelitis:a progress report on diagnosis and a systematic review of treatment. Diabetes Me tab. Res.Rev.2008,24(1),S145-S161.
[23]Asahara T, Masuda H, Takahashi T, et al. Bone manowori gin of endothelial progenitor cells responsible for postnatal vascuiogenesis in physiological and pathological revascularization. Circ Res.1999,85(3):221-228.
[24]谷涌泉,郭连瑞,张建,等.自体骨髓干细胞移植治疗严重下肢缺血1例[J].中国实用外科杂志,2003,23：670.
[25]Shintani S, Murohara T, Ikeda H, et al. Mbbilization of endothelial progenitor cells in patients with acute myocardial infarction. Circulation,2001; 103(23):2776-2779.
[26]R. van Deursen, Footwear for the neuropathic patient:offloading and stability. Diabetes Me tab. Res. Rev.2008,24(1), S96-S100.
[27]S.A. Bus, G.D.Valk, R.W. van Deursen, D.G. Armstrong, C. Caravaggi, P. Hlava'cek et al. The effectiveness of footwear and off loading interventions to prevent and heal foot ulcers and reduce plantar pressure in diabetes:a systematic review. Diabetes Metab. Res. Rev. 2008,24 (1),S162-S180.
[28]Petre M, Tokar P,Kostar D, el al.Revisiting the total contact cast:maximizing off-loading by wound isolation[J].Diabetes Care,2005,28:929-930.
[29]L. Norgren, W.R. Hiatt, J.A. Donnandy, on behalf of the TASC II Working Group, Inter-society consensus for the management of peripheral arterial disease (TASC II). J. Vasc.2007,45, S5-S67.
[30]Management of peripheral arterial disease (PAD), Transatlantic inter-society consensus (TASC). Eur. J. Vasc. Endovasc,2000,19(A), S1-S250.
[31]International Working Group on the Diabetic Foot, International consensus on the diabetic foot and practical guidelines on the management and the prevention of the diabetic foot. Amsterdam,2000, the Netherlands.
[32]J. Apelqvist, J. Larsson, What is the most effective way to reduce incidence of amputation in the diabetic foot? Diabetes Me tab. Res. Rev.2000,16(1), S75-S83.
[33]L. Prompers, M. Huijberts, J. Apelqvist, E. Jude, A. Piaggesi, K. Bakker, M. Edmonds, P. Holstein, A. Jirkovska, D. Mauricio, G Ragnarson Tennvall, H. Reike, M. Spraul, L. Uccioli, V. Ur bancic, K. Van Acker, J. van Baal, F. van Merode, High prevalence of ischaemia, infection and serious co morbidity in patients with diabetic foot disease in Europe. Baseline results from the Eurodiale study. Diabetologia2007,50,18-25.
[34]M.A. Gershater, M. Lo ndahl, P. Nyberg, J. Larsson, J. Thorne,M. Eneroth, J. Apelqvist, Complexity of factors related to outcome of neuropathic and neuroischaemic/ischaemic diabetic foot ulcers:a cohort study. Diabetologia 2009,52(3),398-407.
[35]M. Luther, I. Kantonen, M. Lepantalo, FINNVASC Study Group, Arterial intervention and reduction in amputation for chronic critical leg ischaemia. Br. J. Surg.2000,87,454-458.
[36]赵苏苏,张东生,卢勤.血管内药物涂层支架制备及应用的研究进展[J].中国介入影像与治疗学,2007,26(5)：378-381.
[37]李景庆,高印生,杨迎国.球囊扩张成形术治疗糖尿病足部急性缺血性病变1例[J].中国介入影像与治疗学,2008,5(1)：74.
[38]J. Edwards, S. Stapley, Debridement of diabetic foot ulcers. Cochrane Database Syst. Rev. (1),2010, CD003556.
[39]F. Game, The advantages and disadvantages of non-surgical management of the diabetic foot. Diabetes Me tab. Res. Rev.2008,24(1), S72-S75.
[40]M.S. Ruiter, J.M. van Golde, N.C. Schaper, C.D. Stehouwer, M.S. Huijberts, Diabetes impairs arteriogenesis in the peripheral circulation:review of molecular mechanisms. Clin. Science,2010,119(6),225-238.
[41]C. Gazzaruso, A. Coppola, M. Montalcini, E. Baffero, A. Garzaniti, G.G Pelissero, S. Collaviti, A. Grugnetti, P. Gallotti, A. Pujia, S.B. Solerte, A. Giustina, Lipoprotein(a) and homocys teine as genetic risk factors for vascular and neuropathic diabetic foot in type 2 diabetes mellitus. Endocrine2012,41,89-95.
[42]R. Sibbald, K. Woo, The biology of chronic foot ulcers in persons with diabetes. Diabetes Metab.2008,24(1), S25.S30.