重组人表皮生长因子联合Ilizarov胫骨横向骨搬移技术治疗Wagner 2-4级糖尿病足的疗效及对血清创面修复相关因子水平的影响

Effect of recombinant human epidermal growth factor combined with Ilizarov tibial transverse bone transfer technique on Wagner 2-4 grade diabetic foot and its effect on serum wound repair related factors

目的探讨重组人表皮生长因子联合Ilizarov胫骨横向骨搬移技术治疗Wagner 2-4级糖尿病足的临床疗效以及其对患者血清创面修复相关因子水平的影响。方法选择2019年1月—2022年3月本院收治的70例Wagner 2-4级糖尿病足患者作为研究对象,以随机数表法分为对照组和观察组两组,每组各35例。对照组接受Ilizarov胫骨横向骨搬移技术治疗,术后给予常规治疗,观察组在对照组基础上术后联合重组人表皮生长因子治疗。于术后12周时对两组疗效进行评估。术前和术后12周时,比较两组受试者血清创面修复相关因子[血管内皮生长因子(VEGF)、表皮生长因子(EGF)、碱性成纤维细胞生长因子(bFGF)、基质金属蛋白酶-9(MMP-9)]水平以及患肢踝肱指数(ABI)、患足皮温、患肢疼痛视觉模拟量表(VAS)评分,并采用糖尿病患者生存质量特异性量表(DSQL)评价两组对象生活质量状况。统计两组术后并发症和药物不良反应情况。结果观察组总有效率为100.00%(35/35),与对照组[88.57%(31/35)]相比显著升高(P<0.05)。术后12周,两组血清VEGF、EGF、bFGF水平以及患肢ABI、患足皮温均显著高于术前(P<0.05),血清MMP-9水平和患肢疼痛VAS评分均显著低于术前(P<0.05);术后12周,观察组血清VEGF、EGF、bFGF水平以及患肢ABI、患足皮温均显著高于对照组(P<0.05),血清MMP-9水平和患肢疼痛VAS评分均显著低于对照组(P<0.05)。术后12周,两组DSQL中各维度(生理功能、心理/精神、社会关系、治疗影响)评分均较术前显著降低(P<0.05),以观察组为著(P<0.05)。两组术后均未出现针道感染、骨折等并发症,观察组治疗过程中也未出现与外用重组人表皮生长因子凝胶有关的不良反应。结论重组人表皮生长因子联合Ilizarov胫骨横向骨搬移技术治疗Wagner 2-4级糖尿病足能有效调节血清创面修复相关因子水平,促进溃疡创面愈合。

Objective To investigate the clinical effect of recombinant human epidermal growth factor combined with Ilizarov tibial transverse bone transport technology in the treatment of Wagner grade 2-4 diabetic foot and its influence on serum levels of wound repair related factors.Methods Seventy patients with Wagner grade 2-4 diabetic foot those were admitted to our hospital from January 2019 to March 2022 were selected as the research objects.They were divided into a control group and an observation group according to random number table method,with 35 cases in each group.The control group was treated with Ilizarov transverse tibial bone transport technology and conventional treatment after operation.The observation group was treated with recombinant human epidermal growth factor on the basis of the control group.The efficacy of the two groups was evaluated at 12 weeks after operation.Before surgery and 12 weeks after surgery,the serum levels of wound repair related factors[vascular endothelial growth factor(VEGF),epidermal growth factor(EGF),basic fibroblast growth factor(bFGF),matrix metalloproteinase-9(MMP-9)],ankle-brachial index(ABI)of the affected limb,skin temperature of the affected limb,and visual analogue scale(VAS)score of the affected limb were compared between the two groups.Diabetes specific quality of life scale(DSQL)was used to evaluate the quality of life of the two groups.The postoperative complications and adverse drug reactions of the two groups were counted.Results The total effective rate of the observation group was 100.00%(35/35),which was significantly higher than 88.57%(31/35)of the control group(P<0.05).At 12 weeks after operation,the levels of serum VEGF,EGF,bFGF,ABI and skin temperature of the affected limb in the two groups were significantly higher than those before operation(P<0.05).The serum MMP-9 level and pain VAS score of affected limb were significantly lower than those before operation(P<0.05).At 12 weeks after operation,the levels of serum VEGF,EGF,bFGF,ABI and skin temperature of the affected limb in the observation group were significantly higher than those in the control group(P<0.05).The serum MMP-9 level and pain VAS score of limb in the observation group were significantly lower than those in the control group(P<0.05).At 12 weeks after surgery,the DSQL scores of each dimension(physical function,psychological/spiritual,social relationship,treatment impact)in both groups were significantly lower than those before surgery(P<0.05),especially in the observation group(P<0.05).There were no complications such as pin tract infection and fracture in the two groups,and no adverse reactions related to topical recombinant human epidermal growth factor gel occurred in the observation group during the treatment.Conclusions Recombinant human epidermal growth factor combined with Ilizarov transverse tibial bone transport in the treatment of Wagner grade 2-4 diabetic foot can effectively regulate the levels of serum wound repair related factors and promote the healing of ulcer wounds.