糖尿病创面愈合过程的动态组织学特征

Dynamic histological characteristics during diabetic wound healing

目的:动态观察糖尿病创面愈合过程及其组织学的特征,探讨糖尿病创面难愈可能的机制。方法:2001-06/2003-06广西医科大学第一附属医院烧伤整形康复中心采用15例糖尿病足部溃疡手术患者的供皮区共45个创面为实验组,以瘢痕整形手术患者供皮区为对照组,分别对术后第3,7,14天创面的上皮葡行情况、肉芽组织成熟程度、创面组织学特征进行动态观察,并取材。免疫组化方法检测皮肤创面局部糖基化终末产物(advancedglycationendproducts,AGEs)。结果:糖尿病创面上皮葡行以及肉芽成熟程度在早期与非糖尿病创面愈合过程无明显差异(P>0.05),但在愈合过程的中晚期明显滞后于非糖尿病创面愈合,术后14d时,术后创面残余面积实验组(0.92±0.09)cm2,对照组(0.78±0.10)cm2,肉芽组织成熟程度实验组“10例,“3例,对照组“3例,“5例,7“例(t=4.0303,P<0.05,或χ2=6.6516,6.7081,P<0.01)。组织学显示,糖尿病创面新生胶原稀疏、细小,极性差;新生的基底膜细小;已上皮化的创面仍可见较多的炎性细胞。糖尿病皮肤组织局部AGEs明显蓄积,而上皮化创面AGEs蓄积则不明显。结论:在糖尿病创面愈合过程中胶原形成不良、上皮迁移延迟以及炎症反应异常可能是糖尿病创面难愈的组织学基础,而糖尿病皮肤局部AGEs的过多蓄积可能是糖尿病创面组织学?

AIM: To observe the diabetic wound healing and its histological characteristics dynamically,and probe into the possible mechanism of impaired diabetic wound healing. METHODS:From June 2001 to June 2003,15 patients with diabetic foot ulcer were selected from Rehabilitation Center for Burns and Plastic Surgery,First Affiliated Hospital of Guangxi Medical University and 45 wound sites among their donor sites were served as experiment group,meanwhile another 45 donor sites in 15 patients undertaken scar plastic surgery were as control group.The epithelial growth,maturity degree of granulation tissues and histological characteristics in the wound sites were both observed on the 3rd,7th,and 14th days post operation respectively.Advanced Glycation End Products(AGEs) in local wound sites were also detected by immunohistochemical method. RESULTS:It was shown that a significant delay could be observed in diabetes in the later stage though there were no significant differences in the early stage between the two groups in the epithelial growth and the granulation tissue in the wound sites(P >0.05).At 14 days after operation,the remained area of wound sites was (0.92±0.09) cm2 in the experiment group and (0.78±0.10) cm2 in the control group;The maturity degree of granulation tissue was found in 10 cases and in 3 cases in the experiment group,and in 3 case,in 5 cases and in 7 cases in the control group(t=4.030 3,P< 0.05,or χ2=6.651 6,6.708 1,P< 0.01).By comparison,the histological observation of the wounds in experiment group showed that the regeneration collagens were sparse,small and arranged disorderly,and the regeneration basement membranes were thinner,meanwhile,there were still more inflammatory cells when the tissue epithelized.Excessive accumulation of AGEs was detected in diabetic skin,but there was no obvious accumulation of AGEs in the epithelized tissues. CONCLUSION:The abnormal collagen formation,delayed epithelization and abnormal inflammatory reaction may be the histological bases of impaired wound healing in diabetes.The excessive accumulation of AGEs in the diabetic skin may be one of the reasons for histological abnormality in impaired diabetic wounds.