黄芪有效成分治疗糖尿病足溃疡的药理作用研究进展
Research Progress on the Pharmacological Effects of Astragalus Active Ingredients in Treating Diabetic Foot Ulcers
DOI: 10.12677/acm.2026.1682817, PDF,   
作者: 李欣怡*：黑龙江中医药大学研究生院，黑龙江 哈尔滨；孙 秋#：黑龙江中医药大学附属第一医院周围血管病一科，黑龙江 哈尔滨
关键词: 黄芪；糖尿病足溃疡；降糖；炎症因子；血管生成；氧化应激；周围神经；Astragalus； Diabetic Foot Ulcer； Blood Sugar Reduction； Inflammatory Factors； Angiogenesis； Oxidative Stress； Peripheral Nerves
摘要: 糖尿病足溃疡(DFU)作为糖尿病最严重的并发症之一，以皮肤溃烂、感染、神经或血管损伤等为主要临床表现，其复杂的发病机制给临床治疗带来了巨大挑战。传统中药黄芪的多种有效成分如黄芪多糖(APS)、黄芪甲苷(AS-IV)、黄酮类化合物等，在降糖与改善胰岛素抵抗、抑制炎症因子释放、促进血管生成、抗氧化应激以及保护周围神经与抗感染等途径对糖尿病足溃疡愈合有显著疗效。本文总结了黄芪治疗糖尿病足溃疡的药理作用研究进展，为黄芪治疗糖尿病足溃疡的临床应用提供支持。
Abstract: Diabetic foot ulcer (DFU), as one of the most severe complications of diabetes, primarily manifests clinically as skin ulcers, infections, and nerve or vascular damage. Its complex pathogenesis poses significant challenges for clinical treatment. Various active components in the traditional Chinese medicine Astragalus, such as Astragalus polysaccharides (APS), Astragaloside IV (AS-IV), and flavonoids, have shown significant efficacy in promoting the healing of diabetic foot ulcers through mechanisms such as lowering blood sugar and improving insulin resistance, inhibiting the release of inflammatory factors, promoting angiogenesis, combating oxidative stress, and protecting peripheral nerves and fighting infection. This paper summarizes the research progress on the pharmacological effects of Astragalus in treating diabetic foot ulcers, providing support for its clinical application.
文章引用：李欣怡, 孙秋. 黄芪有效成分治疗糖尿病足溃疡的药理作用研究进展[J]. 临床医学进展, 2026, 16(8): 475-481. https://doi.org/10.12677/acm.2026.1682817

参考文献

[1] McDermott, K., Fang, M., Boulton, A.J.M., Selvin, E. and Hicks, C.W. (2023) Etiology, Epidemiology, and Disparities in the Burden of Diabetic Foot Ulcers. Diabetes Care, 46, 209-221.
https://doi.org/10.2337/dci22-0043
[2] Deng, H., Li, B., Shen, Q., Zhang, C., Kuang, L., Chen, R., et al. (2023) Mechanisms of Diabetic Foot Ulceration: A Review. Journal of Diabetes, 15, 299-312.
https://doi.org/10.1111/1753-0407.13372
[3] Everett, E. and Mathioudakis, N. (2018) Update on Management of Diabetic Foot Ulcers. Annals of the New York Academy of Sciences, 1411, 153-165.
https://doi.org/10.1111/nyas.13569
[4] 陈伯勋, 丁皓, 毛宏, 等. 黄芪及其有效成分促进糖尿病足溃疡愈合机制的研究进展[J]. 中国医药导报, 2024, 21(30): 41-44.
[5] Li, C.X., Liu, Y., Zhang, Y.Z., Li, J. and Lai, J. (2022) Astragalus Polysaccharide: A Review of Its Immunomodulatory Effect. Archives of Pharmacal Research, 45, 367-389.
https://doi.org/10.1007/s12272-022-01393-3
[6] Dong, M., Li, J., Yang, D., Li, M. and Wei, J. (2023) Biosynthesis and Pharmacological Activities of Flavonoids, Triterpene Saponins and Polysaccharides Derived from Astragalus membranaceus. Molecules, 28, Article No. 5018.
https://doi.org/10.3390/molecules28135018
[7] Li, L., Zhang, Y., Luo, Y., Meng, X., Pan, G., Zhang, H., et al. (2023) The Molecular Basis of the Anti-Inflammatory Property of Astragaloside IV for the Treatment of Diabetes and Its Complications. Drug Design, Development and Therapy, 17, 771-790.
https://doi.org/10.2147/dddt.s399423
[8] Khalid, M., Petroianu, G. and Adem, A. (2022) Advanced Glycation End Products and Diabetes Mellitus: Mechanisms and Perspectives. Biomolecules, 12, Article No. 542.
https://doi.org/10.3390/biom12040542
[9] Ke, B., Ke, X., Wan, X., et al. (2017) Astragalus Polysaccharides Attenuates TNF-α-Induced Insulin Resistance via Suppression of miR-721 and Activation of PPAR-γ and PI3K/AKT in 3T3-L1 Adipocytes. American Journal of Translational Research, 9, 2195-2206.
[10] Zhang, J., Wu, C., Gao, L., et al. (2020) Astragaloside IV Derived from Astragalus membranaceus: A Research Review on the Pharmacological Effects. Advances in Pharmacology, 87, 89-112.
[11] Yuan, H., Xu, G., Liu, J., Yan, Y., Zhao, S., Cai, F., et al. (2025) Astragalus mongholicus Polysaccharides Alleviate Insulin Resistance through Modulation of PI3K/AKT, TLR4/NF-κB Signaling Pathway and Microbiota in Rats with Type 2 Diabetes Mellitus. Journal of Traditional and Complementary Medicine, 15, 274-285.
https://doi.org/10.1016/j.jtcme.2024.05.007
[12] Zhao, R., Liang, H., Clarke, E., Jackson, C. and Xue, M. (2016) Inflammation in Chronic Wounds. International Journal of Molecular Sciences, 17, Article No. 2085.
https://doi.org/10.3390/ijms17122085
[13] Wang, Z., Li, W., Gou, L., Zhou, Y., Peng, G., Zhang, J., et al. (2022) Biodegradable and Antioxidant DNA Hydrogel as a Cytokine Delivery System for Diabetic Wound Healing. Advanced Healthcare Materials, 11, e2200782.
https://doi.org/10.1002/adhm.202200782
[14] 朱信霖, 廖万清, 张超, 等. 糖尿病足溃疡发病机制及治疗[J]. 中国皮肤性病学杂志, 2023, 37(4): 367-372.
[15] Barnabei, L., Laplantine, E., Mbongo, W., Rieux-Laucat, F. and Weil, R. (2021) NF-κB: At the Borders of Autoimmunity and Inflammation. Frontiers in Immunology, 12, Article ID: 716469.
https://doi.org/10.3389/fimmu.2021.716469
[16] Kim, S.Y. and Nair, M.G. (2019) Macrophages in Wound Healing: Activation and Plasticity. Immunology & Cell Biology, 97, 258-267.
https://doi.org/10.1111/imcb.12236
[17] Zhen, Z., Wei, S., Yunfei, W., Jie, X., Jienan, X., Yiting, S., et al. (2024) Astragalus Polysaccharide Improves Diabetic Ulcers by Promoting M2-Polarization of Macrophages to Reduce Excessive Inflammation via the β-Catenin/NF-κB Axis at the Late Phase of Wound-Healing. Heliyon, 10, e24644.
https://doi.org/10.1016/j.heliyon.2024.e24644
[18] 鲍亚玲, 雷慧, 马君, 等. 黄芪阳和汤调控PI3K/AKT/NF-κB信号通路促进糖尿病足溃疡大鼠创面愈合[J]. 天津医药, 2024, 52(3): 266-272.
[19] Wang, B.S., Ma, X.F., Zhang, C.Y., et al. (2021) Astragaloside IV Improves Angiogenesis and Promotes Wound Healing in Diabetic Rats via the Activation of the SUMOylation Pathway. Biomedical and Environmental Sciences, 34, 124-129.
[20] Basiri, R., Spicer, M., Levenson, C., Ledermann, T., Akhavan, N. and Arjmandi, B. (2022) Improving Dietary Intake of Essential Nutrients Can Ameliorate Inflammation in Patients with Diabetic Foot Ulcers. Nutrients, 14, Article No. 2393.
https://doi.org/10.3390/nu14122393
[21] Zhao, K., Jiang, Y., Zhang, J., Shi, J., Zheng, P., Yang, C., et al. (2022) Celastrol Inhibits Pathologic Neovascularization in Oxygen-Induced Retinopathy by Targeting the miR-17-5p/HIF-1α/VEGF Pathway. Cell Cycle, 21, 2091-2108.
https://doi.org/10.1080/15384101.2022.2087277
[22] Wang, J., Yang, L., Liang, F., Chen, Y. and Yang, G. (2019) Integrin Alpha X Stimulates Cancer Angiogenesis through PI3K/Akt Signaling-Mediated VEGFR2/VEGF‐A Overexpression in Blood Vessel Endothelial Cells. Journal of Cellular Biochemistry, 120, 1807-1818.
https://doi.org/10.1002/jcb.27480
[23] 刘东波, 李卫, 何藻鹏, 等. 黄芪甲苷调节PI3K/AKT/eNOS信号通路对糖尿病大鼠皮肤缺损的影响[J]. 中医药导报, 2022, 28(7): 20-26.
[24] Liu, X., Guo, C., Yang, W., Wang, W., Diao, N., Cao, M., et al. (2024) Composite Microneedles Loaded with Astragalus membranaceus Polysaccharide Nanoparticles Promote Wound Healing by Curbing the ROS/NF-κB Pathway to Regulate Macrophage Polarization. Carbohydrate Polymers, 345, Article ID: 122574.
https://doi.org/10.1016/j.carbpol.2024.122574
[25] Cham, E.D., Peng, T.I. and Jou, M.J. (2024) Pathological Role of High Sugar in Mitochondrial Respiratory Chain Defect-Augmented Mitochondrial Stress. Biology, 13, Article No. 639.
https://doi.org/10.3390/biology13080639
[26] Mohsin, F., Javaid, S., Tariq, M. and Mustafa, M. (2024) Molecular Immunological Mechanisms of Impaired Wound Healing in Diabetic Foot Ulcers (DFU), Current Therapeutic Strategies and Future Directions. International Immunopharmacology, 139, Article ID: 112713.
https://doi.org/10.1016/j.intimp.2024.112713
[27] Ambrozova, N., Ulrichova, J. and Galandakova, A. (2017) Models for the Study of Skin Wound Healing. The Role of Nrf2 and NF-κB. Biomedical Papers, 161, 1-13.
https://doi.org/10.5507/bp.2016.063
[28] Ma, Q. (2013) Role of Nrf2 in Oxidative Stress and Toxicity. Annual Review of Pharmacology and Toxicology, 53, 401-426.
https://doi.org/10.1146/annurev-pharmtox-011112-140320
[29] Zhao, C., Xiao, C., Feng, S. and Bai, J. (2023) Artemisitene Alters LPS-Induced Oxidative Stress, Inflammation and Ferroptosis in Liver through Nrf2/HO-1 and NF-κB Pathway. Frontiers in Pharmacology, 14, Article ID: 1177542.
https://doi.org/10.3389/fphar.2023.1177542
[30] Yu, T., Ding, C., Peng, J., Liang, G., Tang, Y., Zhao, J., et al. (2025) SIRT7-Mediated NRF2 Deacetylation Promotes Antioxidant Response and Protects against Chemodrug-Induced Liver Injury. Cell Death & Disease, 16, Article No. 232.
https://doi.org/10.1038/s41419-025-07549-5
[31] Jiang, X.Y., Guo, Q.Q., Wang, S.S., Guo, R., Zou, Y., Liu, J., et al. (2025) DNA Damage Response Pathway Regulates Nrf2 in Response to Oxidative Stress. Science Advances, 11, eadu9555.
https://doi.org/10.1126/sciadv.adu9555
[32] Long, M., Rojo de la Vega, M., Wen, Q., Bharara, M., Jiang, T., Zhang, R., et al. (2016) An Essential Role of NRF2 in Diabetic Wound Healing. Diabetes, 65, 780-793.
https://doi.org/10.2337/db15-0564
[33] Luo, X., Huang, P., Yuan, B., Liu, T., Lan, F., Lu, X., et al. (2016) Astragaloside IV Enhances Diabetic Wound Healing Involving Upregulation of Alternatively Activated Macrophages. International Immunopharmacology, 35, 22-28.
https://doi.org/10.1016/j.intimp.2016.03.020
[34] Cai, F., Chen, W., Zhao, R. and Liu, Y. (2023) Mechanisms of Nrf2 and NF-κB Pathways in Diabetic Wound and Potential Treatment Strategies. Molecular Biology Reports, 50, 5355-5367.
https://doi.org/10.1007/s11033-023-08392-7
[35] Wilkinson, H.N. and Hardman, M.J. (2020) Wound Healing: Cellular Mechanisms and Pathological Outcomes. Open Biology, 10, Article ID: 200223.
https://doi.org/10.1098/rsob.200223
[36] Yan, L., Wang, Y., Feng, J., Ni, Y., Zhang, T., Cao, Y., et al. (2024) Mechanism and Application of Fibrous Proteins in Diabetic Wound Healing: A Literature Review. Frontiers in Endocrinology (Lausanne), 15, Article ID: 1430543.
https://doi.org/10.3389/fendo.2024.1430543
[37] Hosty, L., Heatherington, T., Quondamatteo, F. and Browne, S. (2024) Extracellular Matrix-Inspired Biomaterials for Wound Healing. Molecular Biology Reports, 51, Article No. 830.
https://doi.org/10.1007/s11033-024-09750-9
[38] Zhang, W.Q., Tang, W., Hu, S.Q., Fu, X., Wu, H., Shen, W., et al. (2023) Effect of Matrix Metalloproteinases on the Healing of Diabetic Foot Ulcer: A Systematic Review. Journal of Tissue Viability, 32, 51-58.
https://doi.org/10.1016/j.jtv.2022.12.001
[39] Bansode, S.B. and Gacche, R.N. (2019) Glycation-Induced Modification of Tissue-Specific ECM Proteins: A Pathophysiological Mechanism in Degenerative Diseases. Biochimica et Biophysica Acta (BBA)—General Subjects, 1863, Article ID: 129411.
https://doi.org/10.1016/j.bbagen.2019.08.004
[40] Huang, Y. and Kyriakides, T.R. (2020) The Role of Extracellular Matrix in the Pathophysiology of Diabetic Wounds. Matrix Biology Plus, 6, Article ID: 100037.
https://doi.org/10.1016/j.mbplus.2020.100037
[41] Qu, C., Tan, X., Hu, Q., Tang, J., Wang, Y., He, C., et al. (2024) A Systematic Review of Astragaloside IV Effects on Animal Models of Diabetes Mellitus and Its Complications. Heliyon, 10, e26863.
https://doi.org/10.1016/j.heliyon.2024.e26863
[42] Ben, Y., Hao, J., Zhang, Z., Xiong, Y., Zhang, C., Chang, Y., et al. (2021) Astragaloside IV Inhibits Mitochondrial-Dependent Apoptosis of the Dorsal Root Ganglion in Diabetic Peripheral Neuropathy Rats through Modulation of the SIRT1/p53 Signaling Pathway. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 14, 1647-1661.
https://doi.org/10.2147/dmso.s301068
[43] Lin, C., Liu, H., Dong, S., Yang, L., Kong, L., Guan, Y., et al. (2025) Beyond Traditional Use: The Scientific Evidence for the Role of Astragali Radix in Organ Protection via Modulating Oxidative Stress, Cell Death, and Immune Responses. Pharmaceuticals, 18, Article No. 1448.
https://doi.org/10.3390/ph18101448
[44] Liang, H., Tao, S., Wang, Y., Zhao, J., Yan, C., Wu, Y., et al. (2024) Astragalus Polysaccharide: Implication for Intestinal Barrier, Anti-Inflammation, and Animal Production. Frontiers in Nutrition, 11, Article ID: 1364739.
https://doi.org/10.3389/fnut.2024.1364739

为你推荐