重组人粒细胞巨噬细胞集落刺激因子凝胶对烧伤后残余创面的促愈合作用

Healing-promoting effects of recombinant human granulocyte-macrophage colony-stimulating factor gel on residual burn wounds

目的:探讨局部应用重组人粒细胞巨噬细胞集落刺激因子(rhGM-CSF)凝胶对烧伤后残余创面愈合的影响。方法:采用随机、双盲、安慰剂同体对照的研究方法,将120处烧伤后残余创面,随机分为试验组(n=60)和对照组(n=60)。试验组采用rhGM-CSF凝胶治疗,对照组采用空白基质安慰剂治疗,试验周期为21 d。观察用药后7,14 d的创面愈合率以及愈合时间,病理学观察创面肉芽组织中毛细血管数和纤维母细胞数,免疫组化检测创面增殖细胞核抗原(PCNA)的表达。结果:用药7,14 d后,试验组创面愈合率分别为(62±13)%,(95±10)%,均显著高于对照组(46±11)%,(83±12)%(P<0.01);试验组创面平均愈合时间为12.6 d[95%可信区间(11.9～13.3)d],较对照组16.8 d[95%可信区间(16.1～17.5)d]明显缩短(P<0.01)。用药7,14 d后,试验组创面肉芽组织中毛细血管数分别为(10.3±0.6),(14.5±0.9),均显著多于对照组(7.2±0.7),(10.4±0.8)(P<0.01);试验组创面肉芽组织中纤维母细胞数分别为(143.1±10.3),(137.8±6.9),均显著多于对照组(110.2±11.7),(126.4±7.7)(P<0.01);试验组创面组织PCNA的表达也较对照组明显增强。结论:局部应用rhGM-CSF凝胶能促进烧伤后残余创面愈合。

OBJECTIVE To investigate the effects of recombinant human granulocyte-macrophage colony-stimulating factor （rhGM-CSF） gel on residual burn wound healing. METHODS The study was a randomized, double-blind, placebo-controlled and self-controlled clinical trial. One hundred and twenty residual burn wounds were divided into group A （n = 60, with treatment of rhGM-CSF gel） and group C （n = 60,with treatment of placebo）, the patients were treated for 21 days totally. Wound healing rate on 7th, 14th day after treatment and wound healing time were observed. The wound tissue samples （n = 6） at different time points were obtained for taking count of blood capillaries and fibroblasts through optical microscope and evaluation of expression change of proliferating cell nuclear antigen （PCNA）. RESULTS The wound healing rate in group A was （62 ± 13） %, （95 ± 10）% respectively on 7th, 14th day after treatment, which was obviously higher than that in group C [（46 ±11）%,（83 ± 12）%,P〈0. 01]. The mean wound healing time was 12. 6 （95% confidence interval 11.9 to 13.3） days in group A,which was obviously shorter than that in group C [16. 8 （ 16. 1 to 17.5） days,P〈0.01]. On 7th, 14th day after treatment, histopathology showed the number of blood capillaries which was （10. 3 ± 0. 6）, （14. 5 ± 11. 9） and fibroblasts which was （143.1 ± 10. 3）, （137. 8 ± 6. 9） in group A was obviously improved as compared with group C （7. 2 ± 11. 7）, （10. 4 ± 0. 8）（P〈0. 01 ） ; （110. 2 ± 11.7）, （126. 4 ± 7. 7）（P〈0. 01） respectively, the expression intensity of PCNA in wound tissue of group A was also significantly higher than that in group C. CONCLUSION rhGM CSF gel can accelerate wound healing in patients with residual burn wounds.