The Influence Of Blood Glucose On Diabetic Wound Healing And The Influencing Factors Of Diabetic Foot Prognosis

Part 1: The influence of blood glucose on diabetic wound healingObjective: Through the establishment of diabetic wound model in rats,to observe the effect of blood glucose control on the inflammatory response,microvascular formation,fibrocyte formation and wound healing rate in rats,to explore the effect of blood glucose on diabetic wound healing.Methods: 60 rats were divided into control group(20 rats),model group(40 rats),control group were normal rats and have normal diet.(1)The rats in the model group were fed with high-fat diet for 4 weeks after one week of adaptive feeding,intraperitoneal injection of streptozotocin(STZ)45 mg/kg,with fasting blood glucose ?16.7mmol/L and typical symptoms of diabetes as a successful model for diabetes.(2)One week after the successful establishment of the diabetic rat model,the rats were anesthetized by intraperitoneal injection of raldehyde hydrate,then prepared skin in the model area,disinfected with Iodophor,and established a full-thickness skin resection model with a diameter of about 2.5cm×2.5cm on the back,the wound depth required to reach the fascia.(3)Then 40 model group rats were randomly divided into two groups: blood glucose control group and blood glucose uncontrolled group.Among them,the blood glucose control group was given insulin subcutaneously every day according to the blood glucose situation to control the blood glucose,the blood glucose control target was less than 16.7mmol/L,while in the blood glucose uncontrolled group the blood glucose was not strictly controlled.(4)After the model was made successfully,the wound healing rate of rats in each group was measured and calculated,and the wound tissues were collected at 5 time points on the first day,the fifth day,the 11 th day,the 18 th day and the 25 th day.The collected tissue samples were observed by routine pathological techniques.The pathological sections of the collected tissue samples were used to observe the morphological structure of the wound and the number of inflammatory cells,fibroblasts and microvessels.Results:(1)Wound healing: in the control group,the wound healing was the best and the healing time was the shortest;in the model group,the wound healing in the blood glucose control group was better than that in the blood glucose uncontrolled group.The wound healing rate of each group increased gradually with the increase of each phase point.On the 5th day and 11 th day,the wound healing rate was in the control group> blood glucose control group > blood glucose uncontrolled group.The difference was statistically significant(P<0.05).On the 18 th day and the 25 th day,the wound healing rate was control group> model group,the difference was statistically significant(P<0.05),but there was no significant difference between the two groups in the model group(P>0.05).(2)Wound pathological changes: 1.Number of microvessels: There was a statistically significant difference in the number of microvessels in each group of the 3 groups(P <0.05),except for the difference in the number of microvessels between the 2 groups in the model group on day 5(P>0.05),the contrast of the number of microvessels in the remaining groups was control group> blood glucose control group> blood glucose uncontrolled group,the difference was statistically significant(P <0.05).With the increase of treatment time in each group,the number of microvessels showed an increasing trend(P <0.05).2.The number of inflammatory cells: There was a statistically significant difference in the number of inflammatory cells in each group of the 3 groups(P <0.05).The number of inflammatory cells in each group was the blood glucose uncontrolled group> blood glucose control group> control group,the difference was statistically significant(P <0.05).With the increase of treatment time in each group,the number of inflammatory cells showed a downward trend(P <0.05).3.There was a statistically significant difference in the number of fibroblasts in each group of the 3 groups(P <0.05).The comparison of the number of fibroblasts at each time in each group was the control group> the blood glucose control group> blood glucose uncontrolled group,the difference was statistically significant(P <0.05).With the increase of treatment time in each group,the number of fibroblasts showed an upward trend until the 11 th day,and then gradually decreased(P <0.05).Conclusion: Hyperglycemia can significantly affect wound healing and delay the time of wound healing,which may be related to the increase of wound inflammation,inhibition of microvascular and fibrocyte formation and other fact.Part 2: The influence of blood pressure and metabolism of glucose,lipid and protein on the prognosis of diabetic footObjective: To observe the influence of blood pressure,blood glucose,lipid and protein metabolism on the severity and prognosis of diabetic foot.Methods: Selected the clinical data of 162 patients with diabetic foot at the Department of Endocrinology of Youjiang Medical University for Nationalities from January 2015 to June 2019.The patients in the group were divided into the light and severe group according to the Wagner grading.The data between the two groups were analyzed by single factor analysis and Logistic regression analysis,and the subgroup analysis was conducted according to the metabolic index to explore the relationship of incidence and prognosis between the metabolic level and diabetic foot.Results: The blood pressure,fasting blood glucose and glycosylated hemoglobin in the severe group were higher than the light group(P < 0.05),while albumin was lower than the light group(P < 0.05).Regression analysis showed that high glycosylated hemoglobin and low albumin were independent risk factors for the severity of diabetic foot.Subgroup analysis showed that high glycosylated hemoglobin and low albumin could affect the severity of diabetic foot and improve the amputation rate of diabetic foot(P < 0.05).Conclusion: Blood pressure,blood glucose and protein metabolism are closely related to the occurrence and development of diabetic foot,which may be used as an index for prevention,treatment and prognosis of diabetic foot.