二肽基肽酶4抑制剂对糖尿病足溃疡愈合影响的研究进展

Research progress of dipeptidyl peptidase 4 inhibitors on healing of chronic diabetic foot ulcers

目的综述二肽基肽酶4(dipeptidyl peptidase 4,DPP-4)抑制剂对糖尿病足溃疡愈合的影响及其机制研究进展。方法查阅近年来关于DPP-4抑制剂治疗糖尿病足溃疡的相关文献,并进行总结分析。结果 DPP-4抑制剂能促进溃疡创面愈合,其可能作用机制包括:抑制创面基质金属蛋白酶的表达,恢复创面基质金属蛋白酶及其抑制剂的平衡;促进内皮祖细胞的募集以及血管新生;调节由于慢性创面所致的免疫反应及优化细胞外基质构建。目前,临床研究结果显示,DPP-4抑制剂可作为一种促进糖尿病足溃疡愈合的辅助治疗手段。结论 DPP-4抑制剂具有促进糖尿病足溃疡愈合的作用,但仍需大样本、多中心随机对照试验以及长期随访进一步验证其疗效及安全性。

Objective To review the effect of dipeptidyl peptidase 4（DPP-4） inhibitors on the wound healing and its mechanisms in chronic diabetic foot ulcers. Methods The latest literature concerning DPP-4 inhibitors for chronic diabetic foot ulcers was extensively reviewed, as well as the potential benefit and mechanism of DPP-4 inhibitors on wound healing of diabetic foot ulcers was analyzed thoroughly. Results DPP-4 inhibitors can accelerated the ulcer healing. The mechanisms probably include inhibiting the expression of the matrix metalloproteinase（MMP） and restoring the balance of the wound MMP and the tissue inhibitors of MMP; promoting recruitment of endothelial progenitor cells and augmenting angiogenesis; optimizing extracellular matrix construction and the immune response to persistent hypoxia in chronic diabetes wounds, and so on. At present, clinical researches show that DPP-4 inhibitors may be considered as an adjuvant treatment for chronic diabetic foot ulcers. Conclusion DPP-4 inhibitors show promise in the local wound healing of chronic diabetic foot ulcers. However, more strictly designed, adequately powered, long-term follow-up, and high-quality randomized control trials are needed to further verify their efficacy and safety for chronic diabetic foot ulcers.