糖尿病足溃疡渗出液中IL-1β动态变化及黄芪提取液外敷治疗

Dynamics of IL-1β Level in Diabetic Ulcer Oozes and Possible Mechanisms Underlying Topical Use of Astragalus Extract

目的：观测糖尿病足部溃疡渗出液中白介素1β（IL-1β）动态变化,探讨用黄芪提取液外敷促进溃疡愈合的可能机理。方法：收集急慢性糖尿病伤口渗出液,用ELISA法检测IL-1β的变化,用酶标仪测定不同剂量IL-1β的变化对成纤维细胞（Fb）增殖能力的影响,观测外敷黄芪提取液治疗过程中IL-1β量的改变,同时观测足部溃疡肉芽开始出现时间（GT）、溃疡愈合时间（HT）、截肢率、病死率的差异。结果：糖尿病足溃疡病人创面渗出液中IL-1β含量为（89.16±38.14）ng/mL,糖尿病急性损伤病人创面渗出液中IL-1β含量为（8.84±7.06）ng/mL,其差异有统计学意义（P〈0.01）;IL-1β在0.5~5 ng/mL浓度范围可明显促进Fb增殖,随着其浓度增加,这种作用逐渐减弱,当IL-1β为50 ng/mL对Fb增殖没有影响,IL-1β再继续增加时对Fb增殖表现为抑制作用;黄芪外敷组与生理盐水外敷组在治疗前伤口渗出液中IL-1β的浓度在两组间无显著性差异（P〉0.05）,第1周末黄芪组IL-1β量低于生理盐水组,但两组间仍无显著性差异（P〉0.05）,自第2周末开始黄芪治疗组伤口渗出液中的IL-1β量均显著低于生理盐水治疗组（P〈0.05）,并且黄芪治疗组GT和HT亦显著短于生理盐水组（P均〈0.01）。黄芪治疗组患者溃疡愈合过程中的GT、HT均与伤口渗出液中IL-1β浓度有显著正相关（P分别为0.7123,0.6866,P均〈0.01）。结论：糖尿病足部溃疡难以治愈的原因与伤口渗出液中IL-1β量过高,成纤维细胞增殖能力明显受抑有关,黄芪多糖外敷可以降低伤口渗出液中IL-1β浓度,显著缩短溃疡GT和HT,降低截肢率。

Objective：To explore the dynamics of IL-113 level in diabetic ulcer oozes and possible mechanisms underlying topical use of Astragalus extract （Astragalus Polysaccharides, APs） to promote healing. Methods： We determined the level of IL-1β in oozes from acute trauma and chronic diabetic ulcers and the effects of IL-1β on fibroblast proliferation. Dynamics of IL-1β level during topical use of APs were obsecved. Time to growth of granulation tissue （GT） and healing （ HT）, rate of amputation and mortality were also compared between groups with and without AP treatment. Results：①There was a significant difference in IL-1β between oozes from acute traumatic lesion （8.84±7.06） ng/mL and from unhealed diabetic foot ulcer （89.16±38.14） ng/mL （P 〈0.001 ）,②Over the range from 0.5 ng/ml, to 5 ng/mL, IL-1β significantly promoted fibroblast proliferation, but the action gradually declined with increase of IL-1β, and the fibroblast proliferation was inhibited when the level of IL-1β exceeded 50ng/mL.③The level of IL-1β in oozes from wounds was comparable between the group using APs for and the group using normal saline for external application before treatment（ P 〉 0.05 ） and by the end of first week （ P 〉 0. 05 ）, but was significantly lower in the AP group since the cud of second week （ P 〈 0.05）. In addition, the AP group experience shorter GT and HT as compared with the controls using normal saline （All P 〈 0.01 ）. ④IL-1β in wound fluid in patients with diabetic foot ulcer exhibited a significant positive linear with GT and GT （ r = 0. 7123 and 0. 6866, all P 〈 0. 01 ） . Conclusion： Difficulty healing with chronic diabetic tbot ulcers may be related to high concentration of IL-1β in oozes which inhibits fibroblast proliferation. APs for external application may lower IL-1β concentration and shorten the GT and HT of DFU significantly.