血管内皮祖细胞和血管内皮生长因子促进预构皮瓣血管新生作用的比较

Comparison of the effect of local administration of endothelial progenitor cells and VEGF on improving neovascularization in flap prefabrication

目的比较血管内皮祖细胞（endothelial progenitor cells，EPCs）与血管内皮生长因子（vascular endothelial growth factor，VEGF）在促进预构皮瓣血管新生作用上的差异，探讨EPCs移植提高预构皮瓣存活面积的可行性。方法分离雄性Wistar大鼠（45只）一侧股血管束，转位植入腹部皮下，建立预构皮瓣实验模型。将体外诱导分化的EPCs（组Ⅰ，n=15）和VEGF（组Ⅱ，n=15）分别注射于皮瓣局部，对照组仅注射PBS溶液（组Ⅲ，n=15）。4周后形成以植入血管为蒂的岛状皮瓣，原位缝合；术后7d对皮瓣存活率、血管密度计数进行检测。结果组Ⅰ、组Ⅱ、组Ⅲ的皮瓣存活率分别为（87．26±10．13）％、（66．13±9．9）％、（55．59±13．06）％，组1分别与组Ⅱ和组Ⅲ比较，差异均有统计学意义（P〈0．001）；微血管密度分别为：（38．67±9．52）个/mm^2、（25．83±6．33）个/mm^2、（26．5±5．61）个/mm^2（P〈0．05）。结论EPCs促进预构皮瓣血管新生的作用优于VEGF，局部应用骨髓来源的EPCs可以有效地提高预构皮瓣存活面积。

Objective To compare the effect of local administration of endothelial progenitor cells （EPCs） and VEGF on improving neovascularization and augmenting the survival areas in a rat model of prefabricated flap. Methods Prefabricated flaps were created by ligating the right femoral vascular pedicle and implanting it underneath the abdominal flap. The in vitro cultured EPCs（ Group Ⅰ , n = 15）and VEGF protein （Group Ⅱ , n = 15）were injected subcutaneously around the implanted pedicle in experimental groups. PBS was injected in control group（Group Ⅲ, n = 15）. 4 weeks later, the abdominal island flap based solely on the implanted vessels was elevated and sutured back. Then flap viability and numbers of capillary were evaluated on day7. Results There was more statistically significant augmentation of flap survival [（87.26 ± 10.13）%versus（66.13 ± 9.9） % and（55.59 ± 13.06） %, P 〈 0.001 ], a higher capillary density（38.67 ± 9.52 versus 25.83 ± 6.33 and 26.5 ± 5.61 capillary/mm^2, P 〈 0.05）in EPCs group than in the other two groups. Conclusions EPCs are superior to VEGF in improving neovaseularization during flap prefabrication. Local transplantation of bone marrow-derived EPCs may be a useful strategy for augmentation of the survival areas of prefabricated flaps.