封闭负压引流联合生物敷料对糖尿病足溃疡创面植皮后血管新生、炎症反应的影响

Effect of vacuum sealing drainage combined with biological dressings on the angiogenesis and inflammatory response after diabetic foot ulcer wound grafting

目的:研究封闭负压引流联合生物敷料对糖尿病足溃疡创面植皮后血管新生、炎症反应的影响。方法:选择2014年5月~2017年2月在四川省人民医院就诊的糖尿病足患者,随机分为负压引流组和常规对照组,分别使用封闭负压引流联合生物敷料以及常规清创换药来处理创面。治疗前及治疗后1、3、5d时,采集创面组织并检测血管新生分子、血管新生通路信号分子、炎症反应分子的表达量。结果:治疗后1、3、5d时,负压吸引组创面组织中血管内皮生长因子(VEGF)、VEGFR、CD105、基质金属蛋白酶(MMP)9、PI3K、AKT、cyclinD1、p38MAPK、NF-κB的蛋白表达量均显著高于常规对照组(P<0.05),COX-2、iNOS、肿瘤坏死因子(TNF)-α、白介素(IL)-6的mRNA表达量均显著低于常规对照组(P<0.05)。结论:封闭负压引流联合生物敷料对糖尿病足溃疡创面植皮后的血管新生具有促进作用,炎症反应具有抑制作用。

Objective： To study the effect of vacuum sealing drainage combined with biological dressings on the angio- genesis and inflammatory response after diabetic foot ulcer wound grafting. Methods： Patients with diabetic foot who were trea- ted in Sichuan Provincial People＇s Hospital between May 2014 and February 2017 were selected and randomly divided into vac- uum drainage group and normal control group who received vacuum sealing drainage combined with biological dressings as well as conventional clebridement and dressing change to deal with the wound respectively. Before treatment as well as 1 d, 3 d and 5 d after treatment, the wound tissue was collected to determine the expression of angiogenesis molecules, angiogenesis signa- ling pathway molecules and inflammatory response molecules. Results： At time points of 1 d, 3 d and 5 d after treatment, VEGF, VEGFR, CD105, MMP9, PI3K, AKT, cyclinD1, p38MAPK and NF-kB protein expression in wound tissue of vacu- um drainage group were significantly higher than those of normal control group while COX-g, iNOS, TNF-α and IL-6 mRNA expression were significantly lower than those of normal control group （P〈0.05）. Conclusion： Vacuum sealing drainage corn-bined with biological dressings promotes the angiogenesis and inhibits the inflammatory response after diabetic foot ulcer wound grafting.