ssmuБюллетень сибирской медициныBulletin of Siberian Medicine1682-03631819-3684Siberian State Medical University, the Ministry of Healthcare of the Russian Federation10.20538/1682-0363-2022-3-166-180ssmu-4919Research ArticleОБЗОРЫ И ЛЕКЦИИREVIEW AND LECTURESПатоген-специфическая молекулярная визуализация и методы молекулярного тестирования в прогнозе осложненного течения синдрома диабетической стопы, риска ампутаций и выживаемости пациентовPathogen-specific molecular imaging and molecular testing methods in the prognosis of the complicated course of diabetic foot syndrome, the risk of amputation, and patient survivalhttps://orcid.org/0000-0003-0025-2147ЗоркальцевМ. А.ZorkaltsevM. A.

Зоркальцев Максим Александрович – доктор медицинских наук, доцент, кафедра лучевой диагностики и лучевой терапии, СибГМУ.

634050, Томск, Московский тракт, 2

2, Moscow Trakt, 634050 Tomsk

Zorkaltsev@mail.ruhttps://orcid.org/0000-0001-6231-7650ЗавадовскаяВ. Д.ZavadovskayaV. D.

Завадовская Вера Дмитриевна – доктор медицинских наук, профессор, и.о. заведующий кафедрой лучевой диагностики и лучевой терапии, СибГМУ.

634050, Томск, Московский тракт, 2

2, Moscow Trakt, 634050 Tomsk

Wdzav@mail.ruhttps://orcid.org/0000-0001-9011-8720СапринаТ. В.SaprinaT. V.

Саприна Татьяна Владимировна – доктор медицинских наук, профессор, кафедра факультетской терапии с курсом клинической фармакологии, СибГМУ, зав. эндокринологической клиникой СибГМУ.

634050, Томск, Московский тракт, 2

2, Moscow Trakt, 634050 Tomsk

Tanja.v.saprina@mail.ruhttps://orcid.org/0000-0001-7582-3843ЗамышевскаяМ. А.ZamyshevskayaM. A.

Замышевская Мария Александровна – кандидат медицинских наук, ассистент, кафедра лучевой диагностики и лучевой терапии, СибГМУ.

634050, Томск, Московский тракт, 2

2, Moscow Trakt, 634050 Tomsk

Zamyshevskayamari@mail.ruhttps://orcid.org/0000-0002-1321-7861УдодовВ. Д.UdodovV. D.

Удодов Владимир Дмитриевич – кандидат медицинских наук, ассистент, кафедра лучевой диагностики и лучевой терапии, СибГМУ.

634050, Томск, Московский тракт, 2

2, Moscow Trakt, 634050 Tomsk

Udodov.vd@ssmu.ruhttps://orcid.org/0000-0001-9648-8255ШестаковА. В.ShestakovA. V.

Шестаков Александр Владимирович – аспирант, кафедра факультетской терапии с курсом клинической фармакологии, СибГМУ.

634050, Томск, Московский тракт, 2

2, Moscow Trakt, 634050 Tomsk

Shestakov1808@gmail.comhttps://orcid.org/0000-0001-6066-3525МихайловаА. А.MikhailovaA. A.

Михайлова Арина Алексеевна – студент 6-го курса, лечебный факультет, СибГМУ.

634050, Томск, Московский тракт, 2

2, Moscow Trakt, 634050 Tomsk

Armikhaylova@yandex.ruhttps://orcid.org/0000-0002-1889-4554ЛойкоЮ. Н.LoykoYu. N.

Лойко Юлия Николаевна – ординатор, кафедра лучевой диагностики и лучевой терапии, СибГМУ.

634050, Томск, Московский тракт, 2

2, Moscow Trakt, 634050 Tomsk

Loikojulian@gmail.comhttps://orcid.org/0000-0001-7148-6739МусинаН. Н.MusinaN. N.

Мусина Надежда Нурлановна – аспирант, кафедра факультетской терапии с курсом клинической фармакологии, СибГМУ.

634050, Томск, Московский тракт, 2

2, Moscow Trakt, 634050 Tomsk

Nadiezhda-musina@mail.ruСибирский государственный медицинский университет (СибГМУ)РоссияSiberian State Medical UniversityRussian Federation202215102022213166180Copyright © Зоркальцев М.А., Завадовская В.Д., Саприна Т.В., Замышевская М.А., Удодов В.Д., Шестаков А.В., Михайлова А.А., Лойко Ю.Н., Мусина Н.Н., 20222022Зоркальцев М.А., Завадовская В.Д., Саприна Т.В., Замышевская М.А., Удодов В.Д., Шестаков А.В., Михайлова А.А., Лойко Ю.Н., Мусина Н.Н.Zorkaltsev M.A., Zavadovskaya V.D., Saprina T.V., Zamyshevskaya M.A., Udodov V.D., Shestakov A.V., Mikhailova A.A., Loyko Y.N., Musina N.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://bulletin.ssmu.ru/jour/article/view/4919

Цель настоящего обзора – расширение информации об актуальных направлениях в диагностике осложненного течения синдрома диабетической стопы (СДС), частого и тяжелого осложнения сахарного диабета, включая высокотехнологические методы медицинской визуализации и инструментально-лабораторные предикторы осложненного течения и риска ампутаций при СДС.

Представлен аналитический обзор современных публикаций за последние 5 лет по диагностическим и терапевтическим направлениям; систематизированы и обобщены, а также подвергнуты аналитической оценке пилотные данные, касающиеся использования высокотехнологических методов медицинской визуализации, оценки микробиоты кожи и язвенных дефектов при СДС, методов молекулярного тестирования с точки зрения прогноза риска ампутаций и выживаемости пациентов с СДС и эффективности применения систем биосенсирования.

Дана экспертная оценка возможностей патоген-специфической молекулярной визуализации с использованием современных технологий позитронно-эмиссионной томографии (ПЭТ) и однофотонной эмиссионной компьютерной томографии (ОФЭКТ) и высокоэнергетических радионуклидов при бактериальной инфекции для понимания ее патогенеза, минимизации диагностических проблем, улучшения антимикробного лечения и для решения фундаментальных и прикладных аспектов СДС. Систематизированы литературные данные об оценке перфузии стоп у больных сахарным диабетом с различной степенью ишемии конечностей методами гибридных технологий (ОФЭКТ/КТ и ПЭТ/КТ) и новых модальностей магнитно-резонансной томографии, что способствует новому пониманию ответной реакции на реваскуляризацию, хирургическое шунтирование и стимулирование ангиогенеза в пределах ишемизированной ткани, а также потенциально – и для заживления язвы стопы.

Статья направлена на обоснование мультидисциплинарного подхода при СДС, а также выбор, развитие и внедрение инновационных стратегий диагностических модальностей в установлении патологических процессов при СДС, выбор адекватного метода лечения и мониторирования результатов терапии в рамках развития персонифицированной медицины.

The aim of this review was to provide extended information on current trends in the diagnosis of complicated diabetic foot syndrome (DFS), the most frequent and severe complication of diabetes mellitus, including hightech medical imaging methods and instrumental and laboratory predictors of the complicated course and risk of amputation in DFS.

The article provides an analytical review of modern publications over the past 5 years on diagnosis and therapy. Pilot data on the use of high-tech medical imaging methods, assessment of skin microbiota and ulcers in DFS, molecular testing methods in terms of predicting the amputation risk and survival of patients with DFS, as well as the effectiveness of biosensing systems have been systematized, summarized, and subjected to analytical evaluation.

The review provides an expert assessment of the capabilities of pathogen-specific molecular imaging using modern positron emission tomography (PET), single-photon emission computed tomography (SPECT), and highenergy radionuclides in bacterial infection to understand its pathogenesis, minimize diagnostic problems, improve antimicrobial treatment, and address fundamental and applied aspects of DFS. Literature data on the assessment of foot perfusion in diabetic patients with varying degrees of limb ischemia by hybrid technologies (SPECT / CT and PET / CT) and new modalities of magnetic resonance imaging (MRI) are also systematized, which contributes to new understanding of the response to revascularization, surgical shunting, and stimulation of angiogenesis within ischemic tissue, as well as potentially to healing of foot ulcers.

The review is aimed at substantiating a multidisciplinary approach in DFS, selection, development, and implementation of innovative strategies for diagnostic modalities to identify diabetic foot pathologies, and choice of an adequate method for treating and monitoring the results of therapy in the context of personalized medicine.

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The authors declare that there are no conflicts of interest present.