endosergЭндокринная хирургияEndocrine Surgery2306-35132310-3965Типография «Печатных дел Мастер»10.14341/2306-3513-2007-1-38-42endoserg-3981Research ArticleСтатьиArticlesОсобенности хронических ран у больных сахарным диабетом и пути их коррекцииOsobennosti khronicheskikh ran u bol'nykh sakharnym diabetom i puti ikh korrektsiiTokmakovaA Yu-StrakhovaG Yu-ArbuzovaM I-20071503200711№1 (2007)3842Copyright © Tokmakova A.Y., Strakhova G.Y., Arbuzova M.I., 20072007Tokmakova A.Y., Strakhova G.Y., Arbuzova M.I.Tokmakova A.Y., Strakhova G.Y., Arbuzova M.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.surg-endojournals.ru/jour/article/view/3981

Хронические раневые дефекты (трофические язвы) стоп часто встречающееся и специфичное для диабета поражение. Их определяют как эрозию кожи, распространяющуюся не только на эпидермис и дерму, но и проникающую в более глубоко расположенные ткани и характеризующуюся замедленной эпителизацией [13]. Распространенность хронических раневых дефектов нижних конечностей у пациентов с сахарным диабетом, по мнению различных авторов, составляет от 4 до 15% [16]. Локализация поражений на стопе зависит в основном от этиологических факторов. По данным эпидемиологических исследований у больных сахарным диабетом наиболее часто диагностируются раневые дефекты тыльной и подошвенной поверхностей пальцев, подошвенной поверхности в зоне проекции плюснефаланговых суставов и костей предплюсны. Последние характеризуются наиболее тяжелым течением и худшим клиническим прогнозом [14]. Большинство исследователей считает нейропатию, связанные с ней изменения периферической чувствительности и специфические изменения костных структур стопы наиболее значимым фактором в развитии хронических раневых дефектов мягких тканей нижних конечностей. Для того чтобы правильно выбрать тактику лечения хронических раневых дефектов у больных сахарным диабетом, необходимо учитывать особенности течения раневого процесса у данной категории пациентов.

ReferencesAgren M.S., Steenfos H.H., Dabelsteen S., Hansen J.B., Dabelsteen E. Proliferation and mitogenic response to PDGF-BB of fibroblasts isolated from chronic leg ulcers is ulcer-dependent.// J Invest Dermatol. 1999. v. 112. p. 463-469.Agren M.S., Steenfos H.H., Dabelsteen S., Hansen J.B., Dabelsteen E. Proliferation and mitogenic response to PDGF-BB of fibroblasts isolated from chronic leg ulcers is ulcer-dependent.// J Invest Dermatol. 1999. v. 112. p. 463-469.Arkell J., Jackson CJ. Constitutive secretion of MMP-9 by early-passage cultured human endotelial cells. // Cell Biochem Funct. 2003. v. 21, №4. -p. 381-386.Arkell J., Jackson CJ. Constitutive secretion of MMP-9 by early-passage cultured human endotelial cells. // Cell Biochem Funct. 2003. v. 21, №4. -p. 381-386.Baker E.A., Leaper DJ. Profiles of matrix metalloproteinase and their tissue inhibitors in intraperitoneal drainage fluid: relationship to healing. // Wound Rep Reg. 2003. v. 11, №4. p. 268-274.Baker E.A., Leaper DJ. Profiles of matrix metalloproteinase and their tissue inhibitors in intraperitoneal drainage fluid: relationship to healing. // Wound Rep Reg. 2003. v. 11, №4. p. 268-274.Barrick B., Campbell E.J., Owen C.A. Leukocyte proteinases in wound healing: roles in physiologic and pathologic processes. //Wound Rep Reg. -1999. v. 7. p. 410-422.Barrick B., Campbell E.J., Owen C.A. Leukocyte proteinases in wound healing: roles in physiologic and pathologic processes. //Wound Rep Reg. -1999. v. 7. p. 410-422.Bullen E.C., Longaker M.T., Updike D.L., Benton R. Et al. Tissue inhibitor of metalloproteinases-1 is decreased and activated gelatinases are increased in chronic wounds. //J Invest Dermatol. 1995. v. 104. -p. 236-240.Bullen E.C., Longaker M.T., Updike D.L., Benton R. Et al. Tissue inhibitor of metalloproteinases-1 is decreased and activated gelatinases are increased in chronic wounds. //J Invest Dermatol. 1995. v. 104. -p. 236-240.Clark R.A.F. Wound repair: overview and general considerations. / In: Clark R.A.F., editor. The molecular biology of wound repair (2-nd ed.). New York: Plenum Press. 1996. p. 3-51.Clark R.A.F. Wound repair: overview and general considerations. / In: Clark R.A.F., editor. The molecular biology of wound repair (2-nd ed.). New York: Plenum Press. 1996. p. 3-51.Cullen B., Smith R., Macculloch E., Silcock D., Morrison L. Mechanism of action of PROMOGRAN, a protease modulating matrix, for the treatment of diabetic foot ulcers. // Wound Rep Reg. 2002. v. 10, № 1. p. 16-25.Cullen B., Smith R., Macculloch E., Silcock D., Morrison L. Mechanism of action of PROMOGRAN, a protease modulating matrix, for the treatment of diabetic foot ulcers. // Wound Rep Reg. 2002. v. 10, № 1. p. 16-25.Fedele D., Comi G., Coscelli C., Cuccinota D. et al. Italian diabetic neuropathy Commetec. A multicentre study on the prevalence of diabetic neuropathy in Italy. // Diabetes Care. 1997. v. 620. p. 836-843.Fedele D., Comi G., Coscelli C., Cuccinota D. et al. Italian diabetic neuropathy Commetec. A multicentre study on the prevalence of diabetic neuropathy in Italy. // Diabetes Care. 1997. v. 620. p. 836-843.Essler A., Boyle C., Cullen B. Extracellular matrix regulation and the role of proteases. // Wound Rep Reg. 2006. v. 14, № 2. A59.Essler A., Boyle C., Cullen B. Extracellular matrix regulation and the role of proteases. // Wound Rep Reg. 2006. v. 14, № 2. A59.Gillard J., Reed M.W.R., Buttle D., Cross S.S. et al. Matrix metalloproteinase activity and immunuhistichemical profile of matrix metal-loproteinase-2 and -9 and tissue inhibitor of metalloproteinase-1 during human dermal wound healing.// Wound Rep Reg. 2004. v. 12, № 3. p. 295-304.Gillard J., Reed M.W.R., Buttle D., Cross S.S. et al. Matrix metalloproteinase activity and immunuhistichemical profile of matrix metal-loproteinase-2 and -9 and tissue inhibitor of metalloproteinase-1 during human dermal wound healing.// Wound Rep Reg. 2004. v. 12, № 3. p. 295-304.Murphy G. Matrix metalloproteinase and their inhibitors. // Acta Orthop Scand Suppl. 1995. v. 266. p. 55-60.Murphy G. Matrix metalloproteinase and their inhibitors. // Acta Orthop Scand Suppl. 1995. v. 266. p. 55-60.Parks W.C. Matrix metalloproteinases in repair. // Woun Rep Reg. -1999. v. 7. p. 423-432.Parks W.C. Matrix metalloproteinases in repair. // Woun Rep Reg. -1999. v. 7. p. 423-432.Reiber G.E. Epidemiology of foot ulcers and amputations in the diabetic foot. / In: Levin and O'Neal's The Diabetic Foot (6-th ed.). Mosby. 2001. p.13-32.Reiber G.E. Epidemiology of foot ulcers and amputations in the diabetic foot. / In: Levin and O'Neal's The Diabetic Foot (6-th ed.). Mosby. 2001. p.13-32.Reiber G., Lipsky B., Gibbons G. The burden of diabetic foot ulcers. // Am J Surg. 1998. v. 176. 5s-10s.Reiber G., Lipsky B., Gibbons G. The burden of diabetic foot ulcers. // Am J Surg. 1998. v. 176. 5s-10s.Revanti L., Kahari V-M., Matrix mettaloproteinases in wound repair (review). // Int J Mol Med. 2000. v. 6. p. 391-407.Revanti L., Kahari V-M., Matrix mettaloproteinases in wound repair (review). // Int J Mol Med. 2000. v. 6. p. 391-407.Ross R.T. How to examine the nervous system, 3-th ed. Stamford: CT, Appleton&Lange. 1999. 64 p.,Ross R.T. How to examine the nervous system, 3-th ed. Stamford: CT, Appleton&Lange. 1999. 64 p.,Schultz G.S., Sibbald R.G., Falanga V., Ayello E.A. et al. Wound bed preparation: a systemic approach to wound management. // Wound Rep Reg. 2003. v. 11, suppl 2. 1s-28s.Schultz G.S., Sibbald R.G., Falanga V., Ayello E.A. et al. Wound bed preparation: a systemic approach to wound management. // Wound Rep Reg. 2003. v. 11, suppl 2. 1s-28s.Singer A.J., Clark R.A. Mechanisms of disease: cutaneous wound healing. // N Eng J Med. 1999. v. 341. p. 738-746.Singer A.J., Clark R.A. Mechanisms of disease: cutaneous wound healing. // N Eng J Med. 1999. v. 341. p. 738-746.Soo C., Shaw W., Zhang X., Longaker M.T. et al. Differential expression of matrix metalloproteinases and tissue-derived inhibitors in cutateous wound repair.// Plast Reconstr Surg. 2000. v. 105. p. 638-647.Soo C., Shaw W., Zhang X., Longaker M.T. et al. Differential expression of matrix metalloproteinases and tissue-derived inhibitors in cutateous wound repair.// Plast Reconstr Surg. 2000. v. 105. p. 638-647.Sytze Van Dam P., Sweder Van Asbeck B., Willem Erkelens D. et al. The role of oxidative stress in neuropathy and other diabetic complications. // DiabetesMetabolism Reviews. 1995. v. 11, №3. p. 181-192.Sytze Van Dam P., Sweder Van Asbeck B., Willem Erkelens D. et al. The role of oxidative stress in neuropathy and other diabetic complications. // DiabetesMetabolism Reviews. 1995. v. 11, №3. p. 181-192.Trengove N.J., Stacey M.C., MacAuley S., Bennett N et al. Analysis of acute and chronic wound environments: the role of proteases and their inhibitors. // Wound Rep Reg. 1999. v. 7. p. 442-457.Trengove N.J., Stacey M.C., MacAuley S., Bennett N et al. Analysis of acute and chronic wound environments: the role of proteases and their inhibitors. // Wound Rep Reg. 1999. v. 7. p. 442-457.

The authors declare that there are no conflicts of interest present.