Effect of oral nutritional supplementation on wound healing in diabetic foot ulcers: a prospective randomized controlled trial.
Effect of oral nutritional supplementation on wound healing in diabetic foot ulcers: a prospective randomized controlled trial.
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DOI：
10.1111/dme.12509
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发表时间：
2014-09
期刊：
影响因子：
--
通讯作者：
Diabetic Foot Nutrition Study Group
中科院分区：
文献类型：
--
作者：
Armstrong DG;Hanft JR;Driver VR;Smith AP;Lazaro-Martinez JL;Reyzelman AM;Furst GJ;Vayser DJ;Cervantes HL;Snyder RJ;Moore MF;May PE;Nelson JL;Baggs GE;Voss AC;Diabetic Foot Nutrition Study Group
在糖尿病患者中，10-25% 的人会出现足部溃疡。研究表明，补充精氨酸、谷氨酰胺和β-羟基-β-甲基丁酸可以改善伤口修复。这项研究测试了这种补充剂是否可以改善糖尿病患者足部溃疡的愈合。除标准护理外，270 名受试者以双盲方式（每天两次）接受精氨酸、谷氨酰胺和 β-羟基-β-甲基丁酸盐或对照饮料，为期 16 周。评估了伤口完全闭合的受试者比例和完全愈合的时间。在事后分析中，研究了血清白蛋白或肢体灌注（通过踝臂指数测量）与补充剂对愈合的相互作用。总体而言，第 16 周时伤口闭合或伤口愈合时间没有组间差异。然而，在白蛋白水平 ≤ 40 g/l 和/或踝臂指数 < 1.0 的受试者中，与对照组受试者相比，精氨酸、谷氨酰胺和 β-羟基-β-甲基丁酸盐组中在第 16 周愈合的受试者比例显着更高（分别为 P = 0.03 和 0.008）。补充组中白蛋白低或肢体灌注减少的患者治愈的可能性分别高出 1.70 (95% CI 1.04–2.79) 和 1.66 (95% CI 1.15–2.38) 倍。虽然在非缺血性患者或白蛋白正常的患者中补充补充剂对愈合没有差异，但添加精氨酸、谷氨酰胺和 β-羟基-β-甲基丁酸盐作为标准护理的辅助手段可能会改善具有肢体灌注不良和/或白蛋白水平低风险的患者糖尿病足溃疡的愈合。对这些高风险亚组中精氨酸、谷氨酰胺和 β-羟基-β-甲基丁酸的进一步研究可能具有临床价值。
Among people with diabetes, 10–25% will experience a foot ulcer. Research has shown that supplementation with arginine, glutamine and β-hydroxy-β-methylbutyrate may improve wound repair. This study tested whether such supplementation would improve healing of foot ulcers in persons with diabetes. Along with standard of care, 270 subjects received, in a double-blinded fashion, (twice per day) either arginine, glutamine and β-hydroxy-β-methylbutyrate or a control drink for 16 weeks. The proportion of subjects with total wound closure and time to complete healing was assessed. In a post-hoc analysis, the interaction of serum albumin or limb perfusion, as measured by ankle–brachial index, and supplementation on healing was investigated. Overall, there were no group differences in wound closure or time to wound healing at week 16. However, in subjects with an albumin level of ≤ 40 g/l and/or an ankle–brachial index of < 1.0, a significantly greater proportion of subjects in the arginine, glutamine and β-hydroxy-β-methylbutyrate group healed at week 16 compared with control subjects (P = 0.03 and 0.008, respectively). Those with low albumin or decreased limb perfusion in the supplementation group were 1.70 (95% CI 1.04–2.79) and 1.66 (95% CI 1.15–2.38) times more likely to heal. While no differences in healing were identified with supplementation in non-ischaemic patients or those with normal albumin, addition of arginine, glutamine and β-hydroxy-β-methylbutyrate as an adjunct to standard of care may improve healing of diabetic foot ulcers in patients with risk of poor limb perfusion and/or low albumin levels. Further investigation involving arginine, glutamine and β-hydroxy-β-methylbutyrate in these high-risk subgroups might prove clinically valuable.
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