网络出版日期: 2021-10-22
Clinical effect of recombinant human granulocyte-macrophage colony stimulating factor gel on donor site after medium to thickness skin transplantation in patients with diabetes
Online published: 2021-10-22
目的·探讨重组人粒细胞-巨噬细胞集落刺激因子（recombinant human granulocyte-macrophage colony stimulating factor，rhGM-CSF）凝胶应用于糖尿病皮肤溃疡患者中厚皮移植术后供皮区的效果。方法·回顾性分析2016年3月—2021年4月于温州医科大学附属第一医院烧伤·伤口中心行中厚皮移植的74例糖尿病皮肤溃疡患者。所有患者均予积极血糖监测，药物控制血糖，适当的抗炎、补液、营养等对症支持治疗。按术后供皮区处理方式的不同，将供皮区采用rhGM-CSF凝胶治疗的患者设为rhGM-CSF组（38例），将采用常规换药治疗的患者设为对照组（36例）。分别计算2组患者治疗后第8日和第14日供皮区愈合率及供皮区完全愈合时间，比较rhGM-CSF组患者治疗前后实验室检查结果。结果·2组患者的年龄，治疗前白蛋白、糖化血红蛋白水平和供皮区面积比较，差异均无统计学意义。治疗后第8日和第14日，rhGM-CSF组创面愈合率分别为（53±19）%、（92±14）%，高于对照组的（35±18）%和（77±20）%，差异具有统计学意义（t=-4.159，P=0.000；t=-3.462，P=0.000）。rhGM-CSF组供皮区完全愈合时间为（14±3）d，较对照组的（16±3）d缩短，差异具有统计学意义（t=3.452，P=0.000）。rhGM-CSF组治疗前后的血小板计数，血红蛋白、谷丙转氨酶、肌酐水平比较，差异无统计学意义；治疗后白细胞计数低于治疗前（Z=-3.491，P=0.000），但均在正常参考值范围，无临床意义。结论·糖尿病皮肤溃疡患者中厚皮移植术后供皮区使用rhGM-CSF凝胶，能够促进创面愈合，缩短创面愈合时间，并有一定的安全性，值得在临床推广应用。
关键词： 糖尿病; 皮肤移植; 重组人粒细胞-巨噬细胞集落刺激因子; 供皮区创面
夏卫东 , 陈光夷 , 戴文统 , 赵胜 , 李粟 , 林才 . 重组人粒细胞-巨噬细胞集落刺激因子凝胶应用于糖尿病患者中厚皮移植术后供皮区的临床效果[J]. 上海交通大学学报（医学版）, 2021 , 41(11) : 1498 -1501 . DOI: 10.3969/j.issn.1674-8115.2021.11.014
·To explore the effect of recombinant human granulocyte-macrophage colony stimulating factor (rhGM-CSF) gel on the donor site of patients with diabetic skin ulcer after medium to thickness skin transplantation.
·Seventy-four patients with diabetic skin ulcer who were admitted to the Burn Wound Center, the First Affiliated Hospital of Wenzhou Medical University from March 2016 to April 2021 and underwent medium to thickness skin transplantation were analyzed retrospectively. All patients were given active monitoring, drug control of blood glucose, appropriate symptomatic and supportive treatment such as anti-inflammatory, fluid rehydration and nutrition. According to the different treatment methods of the donor site, patients treated with rhGM-CSF gel in the skin donor sites were assigned to the rhGM-CSF group (38 cases); patients treated with routine dressing change in the skin donor sites were assigned to the control group (36 cases). The healing rate and the complete healing time of the donor site on the 8th and 14th day after treatment were calculated respectively in the two groups, and the changes of laboratory examination results before and after treatment in the rhGM-CSF group were compared.
·There were no significant differences in age, pre-treatment albumin level, glycated hemoglobin level and the area of donor site between the two groups. On the 8th and 14th day after treatment, the wound healing rates of the rhGM-CSF group were (53±19) % and (92±14) %, respectively, which were significantly higher than (35±18) % and (77±20) % of the control group, and the difference was statistically significant (t=-4.159, P=0.000; t=-3.462, P=0.000). The complete healing time of the donor site in the rhGM-CSF group was (14±3) d, which was shorter than (16±3) d in the control group (t=3.452, P=0.000). There was no significant difference in platelet count, the levels of hemoglobin, glutamic-pyruvic transaminase, and creatinine. Leukocyte count after treatment was lower than before treatment (Z=-3.491, P=0.000), but both of them were in the normal reference range and had no clinical significance.
·The application of rhGM-CSF gel to the donor site after medium to thickness skin transplantation in diabetic skin ulcer patients can promote the healing of wounds, shorten the wound healing time, and has certain safety. It is worthy of application and popularization.
| 1 | Guariguata L, Whiting DR, Hambleton I, et al. Global estimates of diabetes prevalence for 2013 and projections for 2035[J]. Diabetes Res Clin Pract, 2014, 103(2): 137-149. |
| 2 | 中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2020年版)[J]. 中华糖尿病杂志, 2021, 13(4): 315-409. |
| 3 | 谷红艳. 糖尿病足的预防和护理研究进展[J]. 继续医学教育, 2020, 34(4): 124-126. |
| 4 | 程玉霞, 赵凤卉, 朱平, 等. 复发性糖尿病足溃疡的危险因素分析[J]. 北京医学, 2019, 41(11): 1024-1027. |
| 5 | 薛春利, 胡志成, 杨祖贤, 等. 异体脱细胞真皮基质治疗糖尿病足溃疡临床效果荟萃分析[J]. 中华烧伤杂志, 2016, 32(12): 725-729. |
| 6 | 李玉华. 糖尿病足的外科治疗[J]. 糖尿病新世界, 2014, 34(14): 45. |
| 7 | 宋来权, 赵红翠. 糖尿病足创面愈合过程的动态组织学特征[J]. 智慧健康, 2017, 3(5): 181-182. |
| 8 | 宋萌, 陈庆杰, 王宏宇, 等. 外用rhGM-CSF凝胶联合磺胺嘧啶银乳膏治疗小面积深Ⅱ度难愈创面的疗效及安全性[J]. 解放军医药杂志, 2019, 31(5): 67-70. |
| 9 | 中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2013年版)[J]. 中国糖尿病杂志, 2014, 22(8): 2-42. |
| 10 | 司向, 翟屹, 朱晓磊, 等. 2014年中国慢性非传染性疾病预防控制能力评估[J]. 中华流行病学杂志, 2019, 40(2): 231-236. |
| 11 | Barrett EJ, Liu ZQ, Khamaisi M, et al. Diabetic microvascular disease: an endocrine society scientific statement[J]. J Clin Endocrinol Metab, 2017, 102(12): 4343-4410. |
| 12 | Chin JS, Madden L, Chew SY, et al. Drug therapies and delivery mechanisms to treat perturbed skin wound healing[J]. Adv Drug Deliv Rev, 2019, 149-150: 2-18. |
| 13 | Yan DX, Liu S, Zhao XC, et al. Recombinant human granulocyte macrophage colony stimulating factor in deep second-degree burn wound healing[J]. Medicine (Baltimore), 2017, 96(22): e6881. |
| 14 | Zhao JL, Chen L, Shu B, et al. Granulocyte-macrophage colony-stimulating factor influences angiogenesis by regulating the coordinated expression of VEGF and the Ang/Tie system[J]. PLoS One, 2014, 9(3): e92691. |
| 15 | Krzyszczyk P, Schloss R, Palmer A, et al. The role of macrophages in acute and chronic wound healing and interventions to promote pro-wound healing phenotypes[J]. Front Physiol, 2018, 9: 419. |
| 16 | Wu F, Dai LL, Geng L, et al. Practically feasible production of sustained-release microspheres of granulocyte-macrophage colony-stimulating factor (rhGM-CSF)[J]. J Control Release, 2017, 259: 195-202. |
/
| 〈 |
|
〉 |