Discussion: Biology and Biomarkers for Wound Healing.
Discussion: Biology and Biomarkers for Wound Healing.
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讨论：伤口愈合的生物学和生物标志物。
DOI：
10.1097/prs.0000000000002698
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发表时间：
2016
影响因子：
3.6
通讯作者：
Veves,Aristidis
中科院分区：
文献类型：
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作者：
Veves,Aristidis
慢性伤口是一个严重的问题，影响了相当多的受试者，并带来了沉重的经济成本。传统上，慢性伤口的管理是护士工作的一部分，但在过去的50年里，有相当多的基础和临床研究，导致了新疗法的发展，需要包括医生，护士和其他医疗保健提供者在内的大型团队的合作。新的治疗方法，主要是生长因子和生物工程皮肤的可用性，提高了治疗团队在无法愈合伤口的患者中实现完全伤口愈合的能力，但这伴随着管理成本的显著增加。此外，并非所有患者都对这种密集且昂贵的治疗有反应：在这些新疗法的关键临床试验中，很大一部分参与者（有时超过一半）未能产生反应并实现伤口完全愈合。鉴于慢性伤口重症监护的巨大成本，能够识别出对常规护理无效的患者的技术可能至关重要。第一种技术是基于在大型关键临床试验中在一定时间内减少溃疡面积，非常成功，至今仍在使用。因此，在静脉性溃疡中，大的长期溃疡在3周的最佳治疗后未能实现40%的尺寸减小是不太可能愈合的。1此外，糖尿病足溃疡患者在4周内未能愈合53%，限制了在12周内实现伤口完全愈合的机会。2目前正在开发的其他技术包括超光谱成像3和近红外光谱。4
Chronic wounds are a serious problem that affects a considerable number of subjects and carries a heavy economic cost. Traditionally, the management of chronic wounds was part of nurses’ job, but during the last 5 decades, there has been considerable research, both basic and clinical, that has resulted in the development of new treatments and requires the collaboration of a large team that includes medical doctors, nurses, and other healthcare providers. The availability of new treatments, mainly growth factors and bioengineered skin, has increased the ability of the treating team to achieve complete wound healing in patients who would fail to heal their wounds, but this is accompanied by a significant increase of the management cost. Furthermore, not all patients respond to such intensive and expensive treatment: in the pivotal clinical trials of these new treatments, a large portion of the participants, sometimes more than half of them, failed to respond and achieve complete wound healing.Given the great cost of the intensive care for chronic wounds, techniques that can identify patients who are going to fail to respond to regular care can be of paramount importance. The first techniques, which were based on the reduction of ulcer area over a certain period of time in large pivotal clinical trials, were quite successful and are still being used today. Thus, in venous ulcers, large, long-standing ulcers that fail to achieve 40% reduction in size after 3 weeks of optimal therapy are unlikely to heal. 1 In addition, patients with diabetic foot ulcers who fail to heal by 53% over a 4-week period have limited the chances to achieve complete wound healing over a 12-week period. 2 Additional techniques that are currently under development include hyperspectral imaging 3 and near infrared spectroscopy. 4