含碘敷料在糖尿病足溃疡中应用的研究进展

doi:10.3969/j.issn.1674-8115.2026.10.012

摘要/Abstract

摘要：

糖尿病足溃疡（diabetic foot ulcer，DFU）是糖尿病致残与致死的严重并发症。感染及由生物膜介导的持续微生物负荷，是驱动创面停滞、深部组织受累并急剧增加截肢风险的关键枢纽。局部抗菌敷料在DFU综合治疗中定位为阶段性、指征驱动的辅助工具，旨在迅速压降微生物负荷并促进创面微环境转归。涵盖分子碘与高分子载碘体系的含碘敷料，通过多靶点氧化与卤代反应实施广谱杀菌，不仅获得性耐药风险极低，且展现出卓越的抗生物膜潜能。现有循证医学证据表明，在代谢与营养支持、充分清创及有效减压等标准基础治疗充分落实的前提下，含碘敷料总体具备非劣效性。其核心临床增益精准聚焦于感染高危、中重度渗出或疑似生物膜相关创面停滞的特定亚型，主要表现为高效控菌收敛、加速创面准备及降低护理负担。同时，前沿材料学与递送技术的融合正推动含碘体系向“控释释碘与微环境响应”的多功能平台跃升。然而，其临床应用仍需恪守“短程试用、动态复评”原则，并高度关注碘过敏及甲状腺功能异常等潜在安全风险。该文综述国内外含碘敷料在DFU领域的作用机制、循证医学证据及前沿材料学进展，系统梳理其在创面综合管理中的临床定位与实践策略，以期为国内DFU局部抗菌干预的规范化、高质量开展提供理论参考，推动糖尿病足创面管理向循证化与精准化持续演进。

关键词: 糖尿病足溃疡, 含碘敷料, 聚维酮碘, 卡地姆碘, 生物膜, 局部抗菌治疗

Abstract:

Diabetic foot ulcer (DFU) is a severe complication of diabetes that can lead to disability and death. Infection and biofilm-mediated persistent microbial burden are key factors driving wound stalling, deep tissue involvement, and a sharply increased risk of amputation. In comprehensive DFU management, topical antimicrobial dressings serve as stage-specific, indication-driven adjuncts to rapidly suppress microbial load and promote improvements in the wound microenvironment. Iodine-containing dressings, including molecular iodine and polymeric iodine-containing systems, exert broad-spectrum bactericidal effects via multi-target oxidation and halogenation, with an extremely low risk of acquired resistance and potent antibiofilm potential. Current evidence indicates that, provided that standard treatments, including metabolic and nutritional support, adequate debridement, and effective offloading, are fully implemented, iodine-containing dressings are generally non-inferior in terms of healing outcomes. Their core clinical benefits are specifically focused on certain wound subtypes characterized by high infection risk, moderate-to-heavy exudate, or suspected biofilm-associated wound stalling, and are mainly reflected in effective and sustained bioburden control, accelerated wound bed preparation, and reduced nursing burden.Meanwhile, the integration of advanced materials science and drug delivery technologies is driving iodine-containing systems toward multifunctional platforms featuring controlled iodine release and microenvironment responsiveness. However, their clinical application should adhere to the principle of "short-term trial use and dynamic reassessment," with close attention to potential safety risks, including iodine hypersensitivity and thyroid dysfunction. This article reviews the mechanisms of action, clinical evidence, and advances in materials science relating to iodine-containing dressings in DFU management. It systematically summarizes their clinical positioning and practical strategies to provide a theoretical reference for the standardized and high-quality implementation of topical antimicrobial interventions for DFU in China and promoting the continued development of evidence-based and precision-oriented diabetic foot wound management.

Key words: diabetic foot ulcer (DFU), iodine-containing dressing, povidone-iodine, cadexomer iodine, biofilm, topical antimicrobial therapy

中图分类号:

R587.2

魏璐, 高艳虹. 含碘敷料在糖尿病足溃疡中应用的研究进展[J]. 上海交通大学学报（医学版）, 2026, 46(10): 1420-1427.

Wei Lu, Gao Yanhong. Research progress in the application of iodine-containing dressings in diabetic foot ulcers[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2026,(10): 1420-1427.

图/表 1

参考文献 47

[1]	Armstrong D G, Tan T W, Boulton A J M, et al. Diabetic foot ulcers: a review[J]. JAMA, 2023, 330(1): 62-75.
[2]	Chen L H, Sun S Y, Gao Y Y, et al. Global mortality of diabetic foot ulcer: a systematic review and meta-analysis of observational studies[J]. Diabetes Obes Metab, 2023, 25(1): 36-45.
[3]	中华医学会内分泌学分会, 中国内分泌代谢病专科联盟. 糖尿病足溃疡创面治疗专家共识(2024)[J]. 中华内分泌代谢杂志, 2024, 40(7): 565-569.
	Chinese Society of Endocrinology, China Endocrinology and Metabolism Specialist Alliance. Expert consensus on wound treatment of diabetic foot ulcer(2024)[J]. Chinese Journal of Endocrinology and Metabolism, 2024, 40(7): 565-569.
[4]	Sen C K, Roy S, Mathew-Steiner S S, et al. Biofilm management in wound care[J]. Plast Reconstr Surg, 2021, 148(2): 275e-288e.
[5]	Schaper N C, van Netten J J, Apelqvist J, et al. Practical guidelines on the prevention and management of diabetes-related foot disease (IWGDF 2023 update)[J]. Diabetes Metab Res Rev, 2024, 40(3): e3657.
[6]	Chen P, Vilorio N C, Dhatariya K, et al. Guidelines on interventions to enhance healing of foot ulcers in people with diabetes (IWGDF 2023 update)[J]. Diabetes/metabolism Res Rev, 2024, 40(3): e3644.
[7]	Wu L H, Norman G, Dumville J C, et al. Dressings for treating foot ulcers in people with diabetes: an overview of systematic reviews[J]. Cochrane Database Syst Rev, 2015, 2015(7): CD010471.
[8]	Bigliardi P L, Alsagoff S A L, El-Kafrawi H Y, et al. Povidone iodine in wound healing: a review of current concepts and practices[J]. Int J Surg, 2017, 44: 260-268.
[9]	Vermeulen H, Westerbos S J, Ubbink D T. Benefit and harm of iodine in wound care: a systematic review[J]. J Hosp Infect, 2010, 76(3): 191-199.
[10]	Zeng J J, Wang Z X, Wu F G. Iodine-containing materials for biomedical applications[J]. J Mater Chem B, 2025, 13(29): 8583-8597.
[11]	聂真, 褚万立, 聂伟志, 等. 含碘敷料的研究进展与应用现状[J]. 材料导报, 2023, 37(2): 219-225.
	Nie Z, Chu W L, Nie W Z, et al. Application status and research progress of iodine dressing[J]. Materials Reports, 2023, 37(2): 219-225.
[12]	van Netten J J, Bus S A, Apelqvist J, et al. Definitions and criteria for diabetes-related foot disease (IWGDF 2023 update)[J]. Diabetes Metab Res Rev, 2024, 40(3): e3654.
[13]	Yuan Z M, Jiang C J, Lao G J, et al. Effectiveness of Global Leadership Initiative on Malnutrition and Subjective Global Assessment for diagnosing malnutrition and predicting wound healing in patients with diabetic foot ulcers[J]. Br J Nutr, 2024, 132(1): 21-30.
[14]	Senneville É, Lille U F, Albalawi Z, et al. IWGDF/IDSA guidelines on the diagnosis and treatment of diabetes-related foot infections (IWGDF/IDSA 2023)[J]. Diabetes Metab Res Rev, 2024, 40(3): e3687.
[15]	International Wound Infection Institute (IWII). Wound infection in clinical practice: principles of best practice [EB/OL]. (2022-03-02)[2026-03-14]. https://woundsinternational.com/consensus-documents/wound-infection-in-clinical-practice-principles-of-best-practice.
[16]	Metcalf D G, Bowler P G. Biofilm delays wound healing: a review of the evidence[J]. Burns Trauma, 2013, 1(1): 5-12.
[17]	Dawi J, Tumanyan K, Tomas K, et al. Diabetic foot ulcers: pathophysiology, immune dysregulation, and emerging therapeutic strategies[J]. Biomedicines, 2025, 13(5): 1076.
[18]	Fu K, Zheng X Y, Chen Y H, et al. Role of matrix metalloproteinases in diabetic foot ulcers: potential therapeutic targets[J]. Front Pharmacol, 2022, 13: 1050630.
[19]	MacDonald K E, Boeckh S, Stacey H J, et al. The microbiology of diabetic foot infections: a meta-analysis[J]. BMC Infect Dis, 2021, 21(1): 770.
[20]	Chang J J, Zhao G, Zhao X Y, et al. New promises from an old friend: iodine-rich compounds as prospective energetic biocidal agents[J]. Acc Chem Res, 2021, 54(2): 332-343.
[21]	Woo K, Dowsett C, Costa B, et al. Efficacy of topical cadexomer iodine treatment in chronic wounds: systematic review and meta-analysis of comparative clinical trials[J]. Int Wound J, 2021, 18(5): 586-597.
[22]	Hoekstra M J, Westgate S J, Mueller S. Povidone-iodine ointment demonstrates in vitro efficacy against biofilm formation[J]. Int Wound J, 2017, 14(1): 172-179.
[23]	Malone M, Schwarzer S, Radzieta M, et al. Effect on total microbial load and community composition with two vs six-week topical Cadexomer Iodine for treating chronic biofilm infections in diabetic foot ulcers[J]. Int Wound J, 2019, 16(6): 1477-1486.
[24]	张雅玲. 聚维酮碘软膏治疗糖尿病足的观察与护理[J]. 吉林医学, 2010, 31(8): 1106-1107.
	Zhang Y L. Observation and nursing care of diabetic foot treated with povidone iodine ointment[J]. Jilin Medical Journal, 2010, 31(8): 1106-1107.
[25]	Woo K Y. Management of non-healable or maintenance wounds with topical povidone iodine[J]. Int Wound J, 2014, 11(6): 622-626.
[26]	赵选忠, 高占峰. 碘仿在糖尿病足溃疡中的应用价值[J]. 血管与腔内血管外科杂志, 2024, 10(4): 502-504.
	Zhao X Z, Gao Z F. Application value of iodoform in diabetic foot ulcer[J]. Journal of Vascular and Endovascular Surgery, 2024, 10(4): 502-504.
[27]	Jeffcoate W J, Price P E, Phillips C J, et al. Randomised controlled trial of the use of three dressing preparations in the management of chronic ulceration of the foot in diabetes[J]. Health Technol Assess, 2009, 13(54): 1-86, iii-iv.
[28]	Gwak H C, Han S H, Lee J, et al. Efficacy of a povidone-iodine foam dressing (Betafoam) on diabetic foot ulcer[J]. Int Wound J, 2020, 17(1): 91-99.
[29]	Apelqvist J, Ragnarson Tennvall G. Cavity foot ulcers in diabetic patients: a comparative study of cadexomer iodine ointment and standard treatment. An economic analysis alongside a clinical trial[J]. Acta Derm Venereol, 1996, 76(3): 231-235.
[30]	Gupta S, Shinde R K, Shinde S. Comparison of the outcomes of cadexomer iodine and povidone-iodine ointments in wound management[J]. Cureus, 2022, 14(5): e24667.
[31]	Pecová J, Rohlíková V, Šmoldasová M, et al. Clinical efficacy of hyaluronic acid with iodine in hard-to-heal wounds[J]. Pharmaceutics, 2023, 15(9): 2268.
[32]	Vogt P M, Hauser J, Mueller S, et al. Efficacy of conventional and liposomal povidone-iodine in infected mesh skin grafts: an exploratory study[J]. Infect Dis Ther, 2017, 6(4): 545-555.
[33]	Lee H M, Lee H H, Na Y C. Effects on thyroid function of topical liposomal hydrogel with 3% povidone-iodine dressing[J]. J Wound Manag Res, 2024, 20(3): 234-240.
[34]	Song Q, Xiao Z H, Liu T, et al. Antibacterial iodine-releasing coatings of cross-linked poly(N-vinylpyrrolidone) synthesized by solvent-free initiated chemical vapor deposition[J]. ACS Macro Lett, 2024, 13(8): 1056-1064.
[35]	You Y L, Zhu Y X, Jiang J J, et al. Iodinene nanosheet-to-iodine molecule allotropic transformation for antibiosis[J]. J Am Chem Soc, 2023, 145(24): 13249-13260.
[36]	Sun W, Wang Z X, Guo Y X, et al. Iodine/soluble starch cryogel: an iodine-based antiseptic with instant water-solubility, improved stability, and potent bactericidal activity[J]. Carbohydr Polym, 2024, 340: 122217.
[37]	Miao Z H, Sun Y B, Tao Z C, et al. Thermochromic polyvinyl alcohol-iodine hydrogels with safe threshold temperature for infectious wound healing[J]. Adv Healthc Mater, 2021, 10(18): e2100722.
[38]	Khan N U, Chengfeng X, Jiang M Q, et al. Obstructed vein delivery of ceftriaxone via poly(vinyl-pyrrolidone)-iodine-chitosan nanofibers for the management of diabetic foot infections and burn wounds[J]. Int J Biol Macromol, 2024, 277(Pt 2): 134166.
[39]	Puri D, Mishra A, Singh A P, et al. Formulation development of topical preparation containing nanoparticles of povidone-iodine for wound healing[J]. Assay Drug Dev Technol, 2021, 19(2): 115-123.
[40]	Han X, Boix G, Balcerzak M, et al. Antibacterial films based on MOF composites that release iodine passively or upon triggering by near-infrared light[J]. Adv Funct Mater, 2022, 32(19): 2112902.
[41]	Alves P J, Barreto R T, Barrois B M, et al. Update on the role of antiseptics in the management of chronic wounds with critical colonisation and/or biofilm[J]. Int Wound J, 2021, 18(3): 342-358.
[42]	Jiang Y, Zhang Q J, Wang H J, et al. Effectiveness of silver and iodine dressings on wound healing: a systematic review and meta-analysis[J]. BMJ Open, 2024, 14(8): e077902.
[43]	Koujalagi R S, Uppin V M, Shah S, et al. One year randomized controlled trial to compare the effectiveness of honey dressing versus povidone iodine dressing for diabetic foot ulcer at Dr. Prabhakar Kore Hospital and MRC, Belagavi[J]. Int Surg J, 2020, 7(2): 506-513.
[44]	Ps K, Ramlakshmi V, Kr S, et al. Comparative study on metrogyl dressing versus povidone iodine dressing among patients presenting with diabetic foot ulcers in tertiary care hospitals[J]. Cureus, 2025, 17(8): e89475.
[45]	Nobukuni K, Hayakawa N, Namba R, et al. The influence of long-term treatment with povidone-iodine on thyroid function[J]. Dermatology, 1997, 195(Suppl 2): 69-72.
[46]	Honda Keith Y, Yamauchi I, Yamane S, et al. Hypothyroidism associated with povidone-iodine sugar ointment for chronic cutaneous ulcers[J]. Eur J Dermatol, 2022, 32(5): 638-640.
[47]	Fujita N, Ono Y, Kobayashi T, et al. Iodine-containing ointment-induced hypothyroidism in a patient with anorexia nervosa and sacral decubitus ulcer: a case report with literature review[J]. Endocr J, 2022, 69(12): 1423-1429.

Dressing type	Antimicrobial activity	Main advantage	Best suited for	Limitation
Iodine-containing dressings	Broad-spectrum activity; multi-target oxidative action	Anti biofilm activity; exudate and odor control; low risk of acquired resistance	Stalled wounds, suspected biofilm, moderate-to-heavy exudation, and cavity wounds	Caution in patients with thyroid disorders and during pregnancy; prolonged or extensive use may require thyroid monitoring
Silver-containing dressings	Broad-spectrum activity;disruption of microbial enzymes and membranes	Sustained antimicrobial activity; multiple formulations	Wounds requiring broad antimicrobial coverage or less frequent dressing changes	Variable evidence for improved healing; relatively high cost
Honey-based dressings	Osmotic activity and peroxide-mediated antimicrobial effects	Support for autolytic debridement and odor control	Wounds with slough or devitalized tissue	May increase exudation or cause discomfort; not routinely recommended to promote DFU healing
Topical metronidazole	Primarily active against anaerobes	Particularly useful for controlling malodor and local anaerobic bioburden; relatively inexpensive	Malodorous wounds with suspected anaerobic involvement	Narrow spectrum; limited high-level evidence; does not replace systemic antibiotics

Dressing type	Antimicrobial activity	Main advantage	Best suited for	Limitation
Iodine-containing dressings	Broad-spectrum activity; multi-target oxidative action	Anti biofilm activity; exudate and odor control; low risk of acquired resistance	Stalled wounds, suspected biofilm, moderate-to-heavy exudation, and cavity wounds	Caution in patients with thyroid disorders and during pregnancy; prolonged or extensive use may require thyroid monitoring
Silver-containing dressings	Broad-spectrum activity;disruption of microbial enzymes and membranes	Sustained antimicrobial activity; multiple formulations	Wounds requiring broad antimicrobial coverage or less frequent dressing changes	Variable evidence for improved healing; relatively high cost
Honey-based dressings	Osmotic activity and peroxide-mediated antimicrobial effects	Support for autolytic debridement and odor control	Wounds with slough or devitalized tissue	May increase exudation or cause discomfort; not routinely recommended to promote DFU healing
Topical metronidazole	Primarily active against anaerobes	Particularly useful for controlling malodor and local anaerobic bioburden; relatively inexpensive	Malodorous wounds with suspected anaerobic involvement	Narrow spectrum; limited high-level evidence; does not replace systemic antibiotics