上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

负压吸引疗法通过减轻炎症反应促进糖尿病足溃疡愈合

汪 涛1，赵 珺1，于 敏1，杨文超1，蒋玉洁1，何 蕊2，刘 芳2，贾伟平2   

  1. 上海交通大学附属第六人民医院 1.血管外科，2.内分泌代谢科，糖尿病足病多学科协作组，上海市糖尿病临床医学中心，上海市糖尿病研究所，上海市糖尿病重点实验室，上海200233
  • 出版日期:2016-08-29 发布日期:2016-08-31
  • 通讯作者: 赵 珺，电子信箱：junnzhao@126.com；刘芳，电子信箱：f-liu@sjtu.edu.cn。
  • 作者简介:汪 涛(1989—)，男，住院医师；电子信箱：wangtaoo710@126.com。
  • 基金资助:

    国家自然科学基金（81270397）；上海市教育委员会高峰高原学科建设计划（20152232）

Negative pressure wound therapy promotes wound healing by alleviating inflammatory reaction in patients with diabetic feet

WANG Tao1, ZHAO Jun1, YU Min1，YANG Wen-chao1, JIANG Yu-jie1, HE Rui2, LIU Fang2, JIA Wei-ping2   

  1. 1. Department of Vascular Surgery, 2. Department of Endocrinology & Metabolism, Multi-disciplinary Diabetic Foot Collaborative Group, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Institute for Diabetes, Shanghai Key Laboratory of Diabetes, Shanghai 200233, China

  • Online:2016-08-29 Published:2016-08-31
  • Supported by:

    National Natural Science Foundation of China，81270397；Shanghai Municipal Education Commission—Gaofeng Clinical Medicine Grant Support，20152232

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摘要：

目的·通过将负压吸引治疗技术（NPWT）应用于糖尿病足患者创面，观察其对糖尿病足伤口炎症反应的影响。方法·纳入22例糖尿病足患者，随机分为2组：实验组（n=11）伤口采用清创联合NPWT，对照组（n=11）则单纯采用清创技术。2组患者术后0、7和14 d时采集伤口组织标本，行苏木精染色，观察炎症反应；免疫组织化学方法观察伤口IL-6和TNF-α含量，ELISA检测iNOS和COX-2蛋白水平的变化。结果·术后7、14 d时实验组伤口炎症反应较对照组平缓。免疫组织化学结果提示：术后7 d时，实验组TNF-α阳性面积低于对照组[ （619.5±15.7）μm2 vs （636.1±14.1） μm2，t=2.597，P=0.017]；术后7、14 d，实验组IL-6阳性面积均较对照组降低[ （626.0±11.5） μm2 vs （664.6±18.8） μm2，t=5.810，P=0.000；（611.4±19.2） μm2 vs （642.1±22.5） μm2，t=3.447，P=0.003]。ELISA检测结果揭示：实验组iNOS蛋白表达在术后7 d [ （367.0±24.9） pg/mL对（404.6±29.9） pg/mL，t=3.206，P=0.004]和14 d [ （241.8±24.1） pg/ml vs （356.7±41.9） pg/mL，t=7.882，P=0.000]均明显低于对照组；术后7 d 时，实验组COX-2蛋白水平明显低于对照组[ （622.1±52.4） pg/mL vs （725.1±15.4） pg/mL，t=6.256，P=0.000]；术后14 d时，NPWT仍然抑制了COX-2的表达[ （554.3±25.7） pg/mL vs （639.2±50.8） pg/mL，t=4.945，P=0.000]。结论·抑制伤口局部炎症反应是NPWT促进糖尿病足溃疡愈合的机制之一。

关键词: 负压吸引治疗, 炎症反应, 糖尿病伤口

Abstract:

Objective · To apply the negative pressure wound therapy (NPWT) to the wounds in patients with diabetic feet and observe the effect of NPWT on inflammatory reaction. Methods · Twenty-two patients with diabetic feet were enrolled and randomly assigned to two groups, i.e. the experimental group (n=11) treated with NPWT and debridement regiment and the control group (n=11) treated with debridement regiment alone. Wound tissue samples were collected 0, 7, and 14 d after therapy and the hematoxylin staining was performed to observe the inflammatory reaction. IL-6 and TNF-α levels were measured with immunohistochemistry and changes in levels of iNOS and COX-2 proteins were detected with ELISA. Results · The inflammatory response was milder in the experimental group than in the control group 7 and 14 d after therapy. Results of immunohistochemistry suggested that the areas of TNF-α positive regions were smaller in the experimental group than in the control group 7 d after therapy [(619.5±15.7) μm2 vs (636.1±14.1) μm2, t=2.597, P=0.017]. The areas of IL-6 positive regions were smaller in the experimental group than in the control group 7 and 14 d after therapy [(626.0±11.5) μm2 vs (664.6±18.8) μm2, t=5.810, P=0.000; (611.4±19.2) μm2 vs (642.1±22.5) μm2, t=3.447, P=0.003]. The results of ELISA showed that the levels of iNOS protein were significantly lower in the experimental group than in the control group 7 and 14 d after therapy [(367.0±24.9) pg/mL vs (404.6±29.9) pg/mL, t=3.206, P=0.004; (241.8±24.1) pg/ml vs (356.7±41.9) pg/mL, t=7.882, P=0.000]. The levels of COX-2 protein were significantly lower in the experimental group than in the control group 7 d after therapy [(622.1±52.4) pg/mL vs (725.1±15.4) pg/mL, t=6.256, P=0.000], as well as 14 d after therapy [(554.3±25.7) pg/mL vs (639.2±50.8) pg/mL, t=4.945, P=0.000]. Conclusion · Inhibition of inflammatory reaction in wounds is one of mechanisms that NPWT can promote the ulcer healing in patients with diabetic feet.

Key words: negative pressure wound therapy, inflammatory reaction； diabetic wound