血管腔内成形术治疗对糖尿病足患者创面肉芽组织VEGF/VEGF-R2/SRC表达的影响

Influence of percutaneous transluminal angioplasty on expressions of VEGF/VEGF-R2/SRC axis in wound granulation tissue in patients with diabetic foot

目的探讨血管腔内成形术治疗对糖尿病足患者创面肉芽组织VEGF/VEGF-R2/SRC表达的影响。方法将137例糖尿病足患者随机分为手术组69例和对照组68例,对照组予以常规治疗,手术组在常规治疗基础上给予经皮血管腔内球囊扩张成形术联合支架置入术治疗。监测两组患者创面愈合率;患肢病变血管内膜中层厚度、收缩期血管峰值血流速度、静息状态下血管管径、充盈状态下血管管径,并计算弹性程度;免疫组化及Real-time PCR检测创面肉芽组织VEGF、VEGF-R2、SRC含量及基因表达变化。结果治疗后第2、4周手术组的创面愈合率较对照组明显升高,差异有统计学意义(P<0.05);两组患者患肢内膜中层厚度、收缩期血管峰值血流速度等指标均有明显改善,而手术组疗效更明显(P<0.05);手术组患者创面肉芽组织VEGF、VEGF-R2、SRC含量及基因表达明显升高(P<0.05)。结论经皮血管腔内球囊扩张成形术联合支架置入术治疗可改善糖尿病足患者创面愈合,提高患肢血运功能,而其对创面愈合的促进作用可能是源于创面肉芽组织VEGF/VEGF-R2/SRC轴的表达增加。

Objective To investigate the influence of percutaneous transluminal angioplasty(PTA)on expressions of vascular endothelial growth factor(VEGF)/vascular endothelial growth factor receptor-2(VEGFR-2)/SRC(a non-receptor tyrosine kinase)axis in wound granulation tissue in patients with diabetic foot.Methods The patients(n=137)were randomly divided into PTA group(n=69)and control group(n=68).The control group was given routine treatment and PTA group was additionally given balloon dilation PTA combined with stent implantation.The wound healing rate was monitored in 2 groups.The intima-media thickness(IMT)of lesion vessels in affected limb,peak systolic velocity(PSV),and vessel diameters in resting state and filling state were observed,and vessel elasticity was calculated.The changes of levels and expressions of VEGF,VEGF-R2 and SRC in wound granulation tissue were detected by using immunohistochemistry technique and RT-PCR.Results The wound healing rate increased significantly in PTA group compared with control group(P<0.05)after treatment for 2 and 4 weeks.The indexes of IMT and PSV were significantly improved in 2 groups,which was more significant in PTA group(P<0.05).The levels and expressions of VEGF,VEGF-R2 and SRC in wound granulation tissue increased significantly in PTA group(P<0.05).Conclusion Balloon dilation PTA combined with stent implantation can improve wound healing and blood supply in affected limb in patients with diabetic foot,and this effect may be derived from the increased expression of VEGF/VEGF-R2/SRC axis in wound granulation tissue.