高压氧联合成纤维细胞生长因子治疗皮肤创伤对患者创面愈合与血清指标的影响

Effects of hyperbaric oxygen combined with fibroblast growth factor on skin wound healing and serum indicators

目的探讨高压氧(HBO)联合成纤维细胞生长因子(FGF)治疗皮肤创伤对患者创面愈合的疗效和血清指标的影响。方法选取2017年3月至2019年7月在重庆医科大学附属第三医院皮肤整形美容中心收治的84例皮肤创伤患者作为研究对象。按照随机数字表法将患者分为观察组(n=42)和对照组(n=42)。对照组采用人成纤维细胞生长因子(FGF)治疗,观察组在对照组治疗的基础上联用HBO治疗。统计2组患者创面愈合时间及治疗15 d后创面愈合率。在治疗前及治疗后5、10、15 d取患者创面渗出液,用双抗体夹心酶联免疫吸附法(ELISA)测定C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-33(IL-33)、可溶性ST2(sST2)、转化生长因子-β1( TGF-β1) 、结缔组织生长因子(CTGF)、血管内皮生长因子(VEGF)等指标的表达水平。观察2组患者在治疗过程中出现的瘙痒及创面发红等不良反应。结果治疗15 d后,观察组患者创面愈合时间短于对照组,创面愈合率明显高于对照组,差异均有统计学意义(P<0.05)。2组患者治疗5、10、15 d后CRP与TNF-α水平较治疗前明显降低,且观察组CRP与TNF-α水平明显低于对照组,差异均有统计学意义(P<0.05或P<0.01)。2组患者治疗5、10、15 d后创面血清IL-33、sST2水平明显低于治疗前,且观察组治疗后IL-33、sST2水平明显低于对照组,差异均有统计学意义(P<0.05)。2组患者治疗5、10、15 d后创面血清TGF-β1、VEGF、CTGF水平均明显高于治疗前,且观察组治疗后TGF-β1、VEGF、CTGF水平显著高于对照组,差异有统计学意义(P<0.05或P<0.01)。患者在入院治疗过程中,预期出现的瘙痒、创面发红的不良反应发生率均较低,差异无统计学意义(P>0.05)。结论采用HBO联合FGF治疗皮肤创伤患者临床疗效好,且安全性高,其主要通过调节炎性因子和皮肤创面修复促进因子水平实现的。

Objective To investigate the effects of hyperbaric oxygen combined with fibroblast growth factor(FGF)on skin wound healing and serum indicators.Methods A total of 84 patients with skin wounds treated at the Third Affiliated Hospital of Chongqing Medical University between March 2017 and July 2019 were selected and evenly divided into observation group and control group(42 cases in each group)using a random number table.The control group was treated with human FGF;and the observation group was additionally treated with hyperbaric oxygen.The wound healing time and wound healing rate after 15 days of treatment in the two groups were recorded.The wound exudate was collected before treatment and on the 5th,10th,and 15th days of treatment.Enzyme-linked immunosorbent assay(ELISA)was used to measure the wound serum inflammatory factor C-reactive protein(CRP),the levels of tumor necrosis factor-α(TNF-α),and the levels of wound serum indicators interleukin-33(IL-33),soluble suppression of tumorigenicity 2(sST2),transforming growth factor-β1(TGF-β1),connective tissue growth factor(CTGF),and vascular endothelial growth factor(VEGF).The itching and reddening of the skin lesions were also observed besides other adverse reactions.Results After 15 days of treatment,the wound healing time in the observation group was shorter than that of the control group;and the wound healing rate was significantly higher than that in the control group;the differences were statistically significant(P<0.05).On the 5th,10th,and 15th days of treatment,the CRP and TNF-αlevels in both groups were reduced than those before the treatment.Moreover,the levels of CRP and TNF-αin the observation group were distinctly lower than those in the control group,and the differences were statistically significant(P<0.05 and P<0.01,respectively).On the 5th,10th,and 15th days of treatment,the wound lesion serum levels of IL-33 and sST2 in both groups were significantly reduced,and the levels of IL-33 and sST2 in the observation group were significantly lower than those in the control group(P<0.05).On the 5th,10th,and 15th days of treatment,the wound lesion serum levels of TGF-β1,VEGF,and CTGF in both groups were significantly increased after treatment,and the levels of TGF-β1,VEGF,and CTGF in the observation group were significantly higher than those in the control group,and the differences were statistically significant(P<0.05 and P<0.01,respectively).During the inpatient treatment,the incidence of adverse reactions,such as itching and reddening of the skin lesion,was lower than expected,and there was no significant difference between the two groups(P>0.05).Conclusion Hyperbaric oxygen combined with FGF in the treatment of patients with skin wounds produces better curative effects and reduce risks,through regulating the levels of inflammatory factors and promoting factors for skin wound repair.