The role of proinflammatory cytokines in the comprehensive treatment of patients with diabetic foot syndrome complicated by osteomyelitis

Background. Diabetic foot syndrome (DFS) complicated by osteomyelitis is a severe consequence of diabetes mellitus, often leading to amputations. Chronic inflammation and cytokine imbalance (interleukin – IL-1β, 6, tumor necrosis factor – TNF-α) play a key role in pathogenesis, making the search for immunomodulatory therapies, such as ozone therapy (OT), highly relevant.

Aim. To study the role of proinflammatory cytokines in the complex treatment of patients with DFS complicated by osteomyelitis.

Materials and methods. The study included 62 patients with DFS complicated by osteomyelitis, divided into two groups: the main group (n = 31) received standard treatment supplemented with OT (intravenous infusions of ozonated saline) and ultrasonic cavitation (USC) of osteomyelitic lesions, while the control group (n = 31) received only standard treatment. Levels of IL-1β, TNF-α, and IL-6 were measured using Enzyme-Linked Immunosorbent Assay before treatment and on days 14–15.

Results. In the main group, levels of IL-1β, TNF-α and IL-6 decreased by 4.4, 10.24 and 3.2 times respectively (p < 0.001). The frequency of postoperative complications (phlegmons) was lower in the main group (9.7% vs 22.6%; p = 0.04). The average hospitalization duration decreased from 20.3 ± 4.84 to 14.9 ± 2.08 days.

Conclusion. OT and USC demonstrated significant immunomodulatory effects, reducing pro-inflammatory cytokine levels and improving clinical outcomes. The inclusion of OT and USC in the comprehensive treatment of diabetic foot syndrome complicated by osteomyelitis is advisable to reduce healing time and complications.