VEGF以明胶海绵为载体可提高糖尿病的大鼠缺血皮瓣成活能力

Spongia gelatinosa with VEGF can enhance the survival of the diabetic rats'ischemic skin flap more effectively

目的:观察皮瓣下放置携带有血管内皮生长因子(VEGF)的明胶海绵对糖尿病大鼠缺血皮瓣存活能力的影响。方法:60只SD大鼠。15只为对照组(A组),其余45只尾静脉注射STZ,糖尿病大鼠模型,并随机分为3组,每组各15只。均于背部作6cm×1.5cm蒂位于双侧髂棘连线上的全层缺血皮瓣。B组在皮瓣下注射生理盐水,C组皮瓣下注射VEGF生理盐水溶液,D组皮瓣下放置含VEGF生理盐水溶液明胶海绵,原位缝合皮瓣。术后3,7,14d观察缺血皮瓣的成活面积,并进行组织学观察;CD31测定皮下组织中微血管密度(MVD)及CDK4阳性细胞的灰度值。结果:14天时,D组皮瓣的成活面积率明显高于其余组,微血管记数密度D组高于A、C组,A、C组间无差异并高于B组,且于7天时表达量最高。CDK4的灰度值B组明显低于其余组,而C组又低于D组。结论:VEGF的局部应用,可以加速皮瓣内血管再生,从而改善了糖尿病大鼠缺血皮瓣远端的血供状态,尤其采用明胶海绵携带VEGF皮瓣下放置的方法,更能明显地增强糖尿病大鼠缺血皮瓣的成活能力。

Objective To explore the influence of Spongia gelatinosa with vascular endothelial cell growth factor(VEGF)on the survival of the diabetic rats' ischemic skin flap.Methods 45 SD rats,15 was normal control group(group A).Diabetes was induced by vena caudalisinjection of streptozotoc in45 SD rats,which were randomized into three groups and 15 rats in each group.a 6×1.5cm full thickness dorsal ischemic skin flap with the pedicle remaining attached at the ambi-spina iliace line was elevated and received the following treatment.groupB:subdermal normal saline were injected into the flap;group C:subdermal VEGF 1ml injected into the flap;group D:spongia gelatinosa with VEGF was spreaded under the flap,and then sutured the flap orthotopely.The area of flap survival was measured and distal-flaps(5centimeter section)were dissected in 3,7and 14 days respectively.The survive situation of vascular endothelial cell was observed by microvessel density(MDV)and cell gray scale values were determined through HE staining and IHC staining both CD31 and CDK4.Results On the 14th day after operation,The rate of flap survival in the group D was significantly higher than the other groups,MDV in the group D(per cm2)was higher than group A and group C at each time point,group A and group C are the same levle,and got its peak in the 7th day.cell gray scale valuation of CDK4 in group A was the lowest than the others,while group C is lower than group C.Conclusions Local application of VEGF can ameliorate the microcirculation and accelerate vascularization of the flap,which changes the condition of blood supply in the distal flap and to help the flap survival and also improve the survival rate of the ischemic flap.Spongia gelatinosa with VEGF under the flap would lengthen the action time of VEGF and enhance the survival rate of the diabetic rats'ischemic flap more effectively.