烧伤皮肤再生医疗对糖尿病足ERK1/2和p38信号通路分子的调控

Regulation of Burn Skin Regeneration on ERK1 /2 and p38 Signaling Pathway Molecules in Diabetic Foot

目的观察烧伤皮肤再生医疗技术〔湿润暴露疗法(MEBT)/湿润烧伤膏(MEBO)〕对ERK1/2和p38信号通路分子表达的调控作用,探讨MEBT/MEBO对糖尿病足部溃疡的修复机制。方法选择2013年1月—2014年6月于右江民族医学院附属医院和广西中医药大学第一附属医院内分泌科确诊的2型糖尿病(T2DM)并发糖尿病足患者40例,其均按照MEBT/MEBO操作规程行创面治疗。分别留取治疗前后肌肉肉芽组织,行免疫组化检测ERK1/2和p38信号通路关键分子ERK1/2、p38、促分裂原活化蛋白激酶激酶(MAPKK6)及其底物原癌基因(c-myc)、Akt、活化复制因子2抗体(ATF2)的表达情况。结果患者经MEBT/MEBO治疗,显效14例(35.0%),有效25例(62.5%),无效1例(2.5%),总有效率为97.5%(39/40)。治疗前后,信号分子(任一信号分子)阳性表达率比较,差异有统计学意义(P<0.001);治疗后信号分子ERK1/2、p38、MAPKK6及其底物c-myc、Akt、ATF2阳性表达率均高于治疗前,差异有统计学意义(P<0.001)。免疫组化病理结果显示,治疗前患者创面组织信号分子弥漫分布,治疗后患者创面组织信号分子分布范围较治疗前更广泛。结论 MEBT/MEBO可有效促进糖尿病足部溃疡创面愈合,其机制可能是参与了ERK1/2和p38信号通路的调控。

Objective To investigate the regulation of moist exposed burn therapy/moist exposed burn ointment（ MEBT/MEBO） on the expression of ERK1 /2 and p38 signaling pathway molecules in diabetic foot and to study the repair mechanism of MEBT / MEBO therapy on diabetic foot ulcer. Methods We enrolled 40 patients who were definitely diagnosed with T2 DM and diabetic foot in the Endocrinology Department of the Affiliated Hospital of Youjiang Medical University for Nationalities and the First Affiliated Hospital of Guangxi University of Chinese Medicine from January 2013 to June 2014. The patients were all administrated with wound surface treatment by MEBT / MEBO operating process and were administrated with MEBO treatment. The muscle granulation tissue was taken before and after treatment,immuno-histochemistry was undertaken to measure the expression of key molecules of ERK1 /2 and p38 signaling pathways, including ERK1 /2, p38, MAPKK6, c-myc,Akt and ATF2. Results After MEBT / MEBO treatment,14（ 35. 0%） patients saw obvious efficacy,25（ 62. 5%）saw efficacy,and 1（ 2. 5%） saw no efficacy,with a total effective rate of 97. 5%（ 39 /40）. The positive expression rates of signaling molecules（ any signaling molecule） after treatment were significantly different from those before treatment（ P〈0. 001）; the positive expression rates of signaling molecules,such as ERK1 /2,p38,MAPKK6 and its substrate c-myc,Aktand ATF2 after treatment were significantly different from those before treatment（ P〈0. 001）. The immuno-histochemical pathology results showed that the signaling molecules had diffusive distribution on wound surface before treatment, and the distribution area became more extensive after treatment. Conclusion MEBT / MEBO can promote the healing of diabetic foot ulcer,the mechanism may be that it is involved in the regulation of ERK1 /2 and p38 signaling pathways.