NPWT联合银离子敷料治疗老年男性糖尿病足趾骨髓炎术后组织缺损的临床疗效及对MMP2、TMP1、VEGF的影响

Clinical efficacy of NPWT combined with silver ion dressing in elderly male diabetic toe os⁃teomyelitis and its effect on MMP 2,TMP 1 and VEGF

目的分析NPWT联合银离子敷料治疗老年男性DFO术后缺损的临床疗效及对MMP2、TMP1、VEGF水平的影响。方法选取2021年5月至2022年7月武汉市第三医院内分泌科收治的30例老年男性DFO术后缺损患者,随机分为对照组15例(银离子敷料治疗)和联合组15例(NPWT联合银离子敷料治疗)。比较两组治疗创面感染情况、CRP、创面容积变化、创面愈合率、创面愈合时间、截趾率和创面组织中MMP2、TMP1、VEGF水平变化,随访3~6月观察两组复发和截趾情况。结果治疗7天、14天,联合组创面感染率均低于对照组,差异有统计学意义(P<0.05)。治疗14天,联合组CRP值、创面容积值低于对照组,差异有统计学意义(P<0.05)。联合组创面愈合率高于对照组,截趾率、创面愈合时间均低于对照组,差异有统计学意义(P<0.05)。两组MMP2、TMP1时间效应、组间效应和交互效应比较差异有统计学意义(P<0.05)。随着治疗时间延长,联合组VEGF和TMP1表达升高,MMP2表达降低(P<0.05)。联合组3个月复发率及复发截趾率、6个月截趾率均低于对照组,差异有统计学意义(P<0.05);但两组6个月复发率比较差异无统计学意义(P>0.05)。结论应用NPWT联合银离子敷料治疗DFO临床疗效佳,可降低3个月后DFO复发率及截趾率,其分子机制可能与减少创面组织MMP2表达,增加TMP1、VEGF表达相关。

Objective To analyze the clinical efficacy of NPWT combined with silver ion dress⁃ing in the treatment of postoperative defects of DFO in elderly men and its effects on the levels of MMP2,TMP1 and VEGF.Methods Thirty elderly male patients with DFO postoperative defects admitted to the De⁃partment of Endocrinology,Wuhan Third Hospital from May 2021 to July 2022 were prospectively selected and randomly divided into control group(15 cases,silver ion dressing treatment)and combined group(15 cases,NPWT combined with silver ion dressing treatment).The wound infection,CRP,wound volume change,wound healing rate,wound healing time,toe amputation rate and the levels of MMP2,TMP1 and VEGF in wound tissue were compared between the two groups after 14 days of treatment.The recurrence and toe amputation of the two groups were observed after 3⁃6 months of follow⁃up.Results After 7 days and 14 days of treatment,the wound infection rate of the combined group was lower than that of the control group,and the difference was statistically significant(P<0.05).After 14 days of treatment,the CRP value and wound volume value of the combined group were lower than those of the control group,and the difference was statisti⁃cally significant(P<0.05).The wound healing rate in the combined group was 86.67%,which was higher than 40.00%in the control group.2;the cutting rate of 6.67%and the wound healing time of 65.53 days were lower than the control group,significant(P<0.05).There were significant differences in the time effect,inter⁃group effect and interaction effect of MMP2 and TMP1 between the two groups(P<0.05).With the prolonga⁃tion of treatment time,the expression of VEGF and TMP1 in the combined group increased,and the expres⁃sion of MMP2 decreased(P<0.05).The 3⁃month recurrence rate,recurrence toe amputation rate and 6⁃month toe amputation rate in the combined group were lower than those in the control group(P<0.05).However,there was no significant difference in the recurrence rate at 6 months(P>0.05).Conclusion The combination of NPWT and silver ion dressing in DFO can reduce the rate of DFO recurrence and amputation after 3 months.The molecular mechanism may be associated with the reduction of MMP 2 and increasing the expression of TMP 1 and VEGF.