医用胶原蛋白海绵外敷糖尿病足溃疡创面Ⅰ、Ⅲ型胶原蛋白和基质金属蛋白酶2,9的变化

Changes of type Ⅰ and Ⅲ collagen and matrix metalloproteinase 2 and 9 on the wound of diabetic foot ulcer with external application of medical collagen dressing

背景:胶原蛋白已被广泛应用于口腔、血管、神经、骨及软骨组织等领域中,但胶原蛋白海绵在糖尿病足溃疡伤口的应用鲜有研究。目的:分析医用胶原蛋白海绵对糖尿病足溃疡伤口肉芽组织Ⅰ、Ⅲ型胶原蛋白及基质金属蛋白酶2、9表达的影响。方法:选择2019年1-12月天津医科大学代谢病医院足病科收治的46例糖尿病足溃疡患者,其中男25例,女21例,类随机法分2组治疗,对照组换药清创,实验组在对照组治疗的基础上创面填充胶原蛋白海绵。治疗前及治疗后第3,7,14天记录创面面积,计算创面愈合率;同时取创面肉芽组织,免疫组织化学染色观察基质金属蛋白酶2、基质金属蛋白酶9的表达情况,Western blot检测分析Ⅰ、Ⅲ型胶原蛋白表达情况。研究已通过天津医科大学朱宪彝纪念医院伦理委员会批准。结果与结论:①随着治疗时间的延长,两组创面愈合率增加,试验组治疗后3,7,14 d的创面愈合率高于对照组(P<0.05);②随着治疗时间的延长,两组创面肉芽组织中的基质金属蛋白酶2、基质金属蛋白酶9沉积减少,实验组治疗后各时间点的基质金属蛋白酶2、9表达少于对照组(P<0.05);③随着治疗时间的延长,两组创面肉芽组织中的Ⅰ、Ⅲ型胶原蛋白表达增加,实验组治疗后各时间点的Ⅰ、Ⅲ型胶原蛋白表达表达高于对照组(P<0.05);④结果表明,医用胶原蛋白海绵可减少创面组织中基质金属蛋白酶2/9的表达,有助于Ⅰ、Ⅲ型胶原蛋白的合成,提高创面愈合率。

BACKGROUND:Collagen has been widely used in the fields of oral cavity,blood vessel,nerve,bone and cartilage,but the application of collagen sponge in ulcer wound of diabetic foot is seldom studied.OBJECTIVE:To analyze the effect of medical collagen sponge on the expression of type Ⅰ and Ⅲ collagen and matrix metalloproteinase 2 and 9 in granulation tissue of diabetic foot ulcer wound.METHODS:Forty-six patients with diabetic foot ulcers,25 males and 21 females,admitted to the Department of Podiatry,Metabolic Disease Hospital of Tianjin Medical University from January to December 2019 were randomly divided into two groups.The control group received dressing change and debridement.The experimental group was treated with collagen sponge on the basis of the control group.Wound area was recorded before treatment and 3,7,14 days after treatment.Wound healing rate was calculated.Granulation tissue was taken and immunohistochemical staining was used to observe the expression of matrix metalloproteinase 2 and matrix metalloproteinase 9.Western blot analysis was used to measure type Ⅰ and Ⅲ collagen protein expression.This study was approved by the Ethics Committee of Zhu Xianyi Memorial Hospital of Tianjin Medical University.RESULTS AND CONCLUSION:(1)The wound healing rate of the two groups increased with the time of treatment.The wound healing rate of the test group was higher than that of the control group at 3,7,and 14 days after treatment(P<0.05).(2)With the treatment time prolonged,the deposition of matrix metalloproteinase 2 and matrix metalloproteinase 9 in wound granulation tissue decreased in both groups.The expression of matrix metalloproteinase 2 and 9 in the experimental group was lower than that in the control group at various time points(P<0.05).(3)The expression of type Ⅰ and type Ⅲ collagen in the wound granulation tissue increased with the treatment time,and the expression of typeⅠ and type Ⅲ collagen in the experimental group was higher than that in the control group(P<0.05).(4)The results showed that medical collagen sponge could reduce the expression of matrix metalloproteinase 2/9 in wound tissue,promote the synthesis of type Ⅰ and Ⅲ collagen,and improve the wound healing rate.