局部应用重组人Ⅲ型胶原蛋白水凝胶对糖尿病患者创面愈合的影响

Effect of topical application of recombinant human type-Ⅲ collagen hydrogels on diabetic wound healing

目的探讨局部应用重组人Ⅲ型胶原蛋白水凝胶治疗糖尿病合并下肢难愈性创面的效果及其对创面炎症反应的影响。方法选择2020年9月至2021年6月北京市化工职业病防治院医疗部收治的糖尿病合并下肢难愈性创面患者20例作为研究对象,采用随机数字表法分为试验组与对照组,每组各10例。在实施基础抗糖尿病治疗基础上,试验组局部外敷重组人Ⅲ型胶原蛋白水凝胶,对照组给予常规清创换药治疗,比较2组创面愈合率及创面组织肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)、白细胞介素6(IL-6)及基质金属蛋白酶9(MMP-9)水平。结果2组患者治疗后创面面积均较治疗前缩小,试验组患者治疗后7、14 d的创面愈合率分别为(34.00±2.53)%、(73.90±13.00)%,明显高于对照组(23.30±3.89)%、(48.30±6.30)%,差异均有统计学意义(t=1.330、2.640,P<0.05);治疗后14 d,2组患者创面中TNF-α、IL-1β、IL-6、MMP-9水平较治疗前均降低,差异均有统计学意义(P<0.05),且试验组患者创面中TNF-α、IL-1β、IL-6、MMP-9的含量[(87.60±8.78)、(71.70±10.30)、(79.80±13.60)、(11.27±2.45)ng/L]均分别低于对照组[(111.60±9.86)、(81.10±8.03)、(96.90±14.50)、(15.05±2.82)ng/L],差异均有统计学意义(t=-5.740、-2.260、-2.720、3.200,P<0.05)。结论局部应用重组人Ⅲ型胶原蛋白水凝胶治疗糖尿病合并下肢难愈性创面,可有效提高创面愈合率,降低创面炎症反应,临床治疗效果显著。

Objective To observe the therapeutic effect of recombinant human type-Ⅲcollagen hydrogels on chronic diabetic wounds,and to explore its influence on the expression levels of inflammatory cytokines in wound tissues.Methods From September 2020 to June 2021,20 diabetes mellitus patients with chronic wounds in lower extremities were selected from Beijing Prevention and Treatment Hospital of Occupational Disease for Chemical Industry,and were divided into the experimental group(10 cases)and the control group(10 cases)according to the random number table.In addition to the basic treatment of diabetes and conventional debridement,the experimental group received topical application of recombinant human type-Ⅲcollagen hydrogels.The wound healing rate,expression levels of tumor necrosis factor-α(TNF-α),interleukin 1β(IL-1β),interleukin 6(IL-6)and matrix metalloproteinase-9(MMP-9)were observed and compared.Results After treatment,the area of wounds in both groups decreased.The wound healing rate of the treatment group at 7 d and 14 d after treatment were(34.00±2.53)%and(73.90±13.00)%,which were significantly higher than those of the control group[(23.30±3.89)%,(48.30±6.30)%],the differences were statistically significant(t=1.330,2.640;P<0.05),14 d after treatment,the expression levels of TNF-α、IL-1β、IL-6 and MMP-9 decreased,and the expression levels of the treatment group[(87.60±8.78),(71.70±10.30),(79.80±13.60),(11.27±2.45)ng/L]were significantly lower than those of the control group[(111.60±9.86),(81.10±8.03),(96.90±14.50),(15.05±2.82)ng/L],the differences were statistically significant(t=-5.740,-2.260,-2.720,3.200;P<0.05).Conclusions The treatment of chronic diabetic wounds by recombinant human type-Ⅲcollagen hydrogels can accelerate wound healing,reduce wound inflammation and result in significant clinical therapeutic effects.[JP]