异体输血诱发巨噬细胞分化失调对糖尿病足溃疡患者创面愈合的影响分析

Effect analysis of allogeneic blood transfusion induced macrophage dysdifferentiation on wound healing in diabetic foot ulcer patients

目的探讨异体输血诱发巨噬细胞分化失调对糖尿病足溃疡患者创面愈合的影响。方法90例异体输血诱发巨噬细胞分化失调患者,按照溃疡原因分为糖尿病足溃疡组和足部外伤溃疡组,各45例。所有患者均在入院后进行细菌培养+药敏试验,根据细菌培养结果对患者进行抗生素治疗,同时反复清创,直到创面新鲜,肉芽组织生长良好。比较两组患者干预前后足功能、创面组织炎症浸润细胞计数及创面组织白细胞介素-12β(IL-12β)、一氧化氮合成酶(iNOS)、肿瘤坏死因子-α(TNF-α)的信使核糖核酸(mRNA)相对表达量。结果糖尿病足溃疡组和足部外伤溃疡组干预前美国足与踝关节协会(AOFAS)评分、AOFAS功能评分对比,统计学结果无显著差异(P>0.05);糖尿病足溃疡组和足部外伤溃疡组干预后AOFAS评分、AOFAS功能评分均高于干预前,统计学结果有显著差异(P<0.05);糖尿病足溃疡组干预后AOFAS评分(62.53±4.21)分、AOFAS功能评分(42.14±3.21)分均低于足部外伤溃疡组的(89.68±6.51)、(48.37±4.59)分,统计学结果有显著差异(P<0.05)。糖尿病足溃疡组和足部外伤溃疡组干预前创面组织炎症浸润细胞计数对比,统计学结果无显著差异(P>0.05);糖尿病足溃疡组和足部外伤溃疡组干预后创面组织炎症浸润细胞计数均低于干预前,统计学结果有显著差异(P<0.05);糖尿病足溃疡组干预后创面组织炎症浸润细胞计数(41.33±4.09)个/高倍镜视野高于足部外伤溃疡组的(33.21±1.75)个/高倍镜视野,统计学结果有显著差异(P<0.05)。糖尿病足溃疡组和足部外伤溃疡组干预前创面组织IL-12β、iNOS、TNF-α的mRNA相对表达量对比,统计学结果无显著差异(P>0.05);糖尿病足溃疡组和足部外伤溃疡组干预后创面组织IL-12β、iNOS、TNF-α的mRNA相对表达量均低于干预前,统计学结果有显著差异(P<0.05);糖尿病足溃疡组干预后创面组织IL-12β、iNOS、TNF-α的mRNA相对表达量分别为(0.068±0.012)、(56.822±12.116)、(1.812±0.246),均高于足部外伤溃疡组的(0.025±0.011)、(33.032±11.005)、(0.833±0.115),统计学结果有显著差异(P<0.05)。结论异体输血诱发巨噬细胞分化失调会影响糖尿病足溃疡患者的足功能、创面组织炎症浸润细胞计数及创面组织IL-12β、iNOS、TNF-α的mRNA相对表达量,临床需引起足够的重视。

Objective To investigate the effect of macrophage dysdifferentiation induced by allogeneic blood transfusion on wound healing in diabetic foot ulcer patients.Methods 90 patients with macrophage dysdifferentiation induced by allogeneic blood transfusion were divided into diabetic foot ulcer group and foot trauma ulcer group according to the causes of ulcers,each with 45 cases.After admission,all patients underwent bacterial culture+drug sensitivity test.According to the results of bacterial culture,the patient was treated with antibiotics.Meanwhile,repeated debridement was performed until the wound was fresh and the granulation tissue was well grown.The foot function score,number of inflammatory infiltrating cells,message ribonucleic acid(mRNA)relative expression levels of interleukin-12β(IL-12β),inducible nitric oxide synthase(iNOS)and tumor necrosis factor-α(TNF-α)in wound tissue of two groups before and after intervention were compared.Results Before intervention,there were no significant differences in American Orthopaedic Foot and Ankle Society(AOFAS)score and AOFAS function score between diabetic foot ulcer group and foot trauma ulcer group(P>0.05).After intervention,the AOFAS score and AOFAS functional score of diabetic foot ulcer group and foot trauma ulcer group were higher than those before intervention,and the statistical difference was significant(P<0.05).After intervention,the AOFAS score and AOFAS function score of diabetic foot ulcer group were(62.53±4.21)and(42.14±3.21)points,which were lower than(89.68±6.51)and(48.37±4.59)points of traumatic foot ulcer group,and the statistical difference was significant(P<0.05).Before intervention,there was no significant difference in the number of inflammatory infiltrating cells between diabetic foot ulcer group and foot trauma ulcer group(P>0.05).After intervention,the number of inflammatory infiltrating cells in diabetic foot ulcer group and foot trauma ulcer group was lower than that those before intervention,and the statistical difference was significant(P<0.05).After intervention,the number of inflammatory infiltrating cells in diabetic foot ulcer group was(41.33±4.09)/high-power field,which was higher than(33.21±1.75)/high-power field in foot trauma ulcer group,and the statistical difference was significant(P<0.05).Before intervention,there was no significant difference in the mRNA relative expression levels of IL-12β,iNOS and TNF-αbetween diabetic foot ulcer group and foot trauma ulcer group(P>0.05).After intervention,the mRNA relative expressions of IL-12β,iNOS and TNF-αin diabetic foot ulcer group and foot trauma ulcer group were lower than those before intervention,and the statistical difference was significant(P<0.05).The mRNA relative expression levels of IL-12β,iNOS and TNF-αin the diabetic foot ulcer group were(0.068±0.012),(56.822±12.116)and(1.812±0.246),which were higher than(0.025±0.011),(33.032±11.005)and(0.833±0.115)in the foot trauma ulcer group after intervention,and the statistical difference was significant(P<0.05).Conclusion Macrophage dysdifferentiation induced by allogeneic blood transfusion can affect the foot function,the count of inflammatory infiltrating cells in the wound tissue,and mRNA relative expression levels of IL-12β,iNOS and TNF-αin the wound tissue,which should be paid sufficient attention in clinic.