糖尿病足中医药干预的多维度机制与临床转化研究进展

Multidimensional Mechanisms and Clinical Translation Research Progress of Traditional Chinese Medicine Intervention in Diabetic Foot

摘要: 糖尿病足是糖尿病最严重的慢性并发症之一，具有高发病率、高致残率和高死亡率的特点，其创面愈合障碍涉及慢性炎症、免疫微环境失衡、血管生成障碍及感染等多因素交互作用。中医药基于“脱疽”“筋疽”理论，提出“虚、瘀、毒”核心病机，通过益气化瘀、扶正托毒等治法在糖尿病足治疗中展现出独特优势。本文系统检索近年来国内外相关文献，从免疫重塑(巨噬细胞M1/M2极化调控)、血管神经修复(血管生成与神经再生偶联)、微生态调节(肠道菌群–皮肤轴)三个维度综述中医药干预糖尿病足的核心机制，并总结中医内治法、外治法及新型递药系统的临床应用进展。研究表明，中医药通过多靶点、多通路协同调节NF-κB、PI3K/AKT、Nrf2等信号通路，在改善创面微循环、调控炎症反应、促进组织修复方面具有显著作用。然而，当前研究仍面临中医病机理论不统一、复方机制研究深度不足、临床疗效评价缺乏标准化等挑战。未来应整合系统生物学与人工智能技术，构建动态“证候–病理–分子网络”模型，推动中医药防治糖尿病足的精准化与国际化发展。

Abstract: Diabetic foot is one of the most severe chronic complications of diabetes mellitus, characterized by high incidence, high disability rate, and high mortality. The impairment of wound healing involves multiple interacting factors including chronic inflammation, immune microenvironment imbalance, angiogenesis disorder, and infection. Traditional Chinese medicine (TCM), based on the theories of “digital gangrene” and “sinew abscess”, proposes the core pathogenesis of “deficiency, stasis, and toxicity”. Through therapeutic methods such as invigorating qi to resolve stasis and supporting healthy qi to expel toxins, TCM demonstrates unique advantages in the treatment of diabetic foot. This article systematically reviews relevant domestic and international literature in recent years, summarizing the core mechanisms of TCM intervention in diabetic foot from three dimensions: immune remodeling (regulation of macrophage M1/M2 polarization), vascular and neural repair (coupling of angiogenesis and nerve regeneration), and microecological regulation (gut-skin axis). The clinical application progress of TCM internal therapies, external therapies, and novel drug delivery systems is also reviewed. Research indicates that TCM exerts significant effects in improving wound microcirculation, regulating inflammatory responses, and promoting tissue repair through multi-target and multi-pathway synergistic regulation of signaling pathways such as NF-κB, PI3K/AKT, and Nrf2. However, current research still faces challenges including inconsistency in TCM pathogenesis theories, insufficient depth in compound mechanism studies, and lack of standardized clinical efficacy evaluation. Future research should integrate systems biology and artificial intelligence technologies to construct a dynamic “syndrome, pathology, molecular network” model, promoting the precision and internationalization of TCM development in diabetic foot prevention and treatment.