烧伤创面与糖尿病溃疡创面的比较  

Comparison of the bum wound and diabetic ulcer wound

作　　者：林才[1] 乔亮[2] 张鹏[1] 陈更新[1] 徐建军[1] 杨宁[1] 陆树良[2] 

机构地区：[1]浙江温州医学院附属第一医院烧伤科,325000 [2]上海交通大学医学院附属瑞金医院烧伤科

出　　处：《中华烧伤杂志》2007年第5期339-341,共3页Chinese Journal of Burns

基　　金：国家重点基础研究发展规划(G1999054205);国家自然科学基金(C03030308)

摘　　要：目的比较烧伤创面与糖尿病溃疡创面的差异,初步分析糖尿病患者溃疡创面难愈的机制。方法分别切取非糖尿病烧伤患者的足部创面(对照组)和糖尿病患者的足部溃疡创面(试验组)组织,行组织块培养。用酶联免疫吸附测定(ELISA)法、反转录-PCR法分别检测创面组织释放的成纤维细胞生长因子2(FGF2)、血管内皮生长因子(VEGF)蛋白质及其mRNA水平;免疫组织化学法检测创面微血管密度(MVD)的变化。人脐静脉内皮细胞分别在含5 mmol/L葡萄糖的培养液(正常培养液组)、含30 mmol/L葡萄糖的培养液(高糖组)、含30 mmol/L甘露醇的培养液(甘露醇组)中培养7 d,以ELISA法测定VEGF蛋白质水平。结果对照组患者FGF2、VEGF蛋白质水平分别为(59±3)ng/ml、(56±7)pg/ml,试验组2种蛋白质水平分别为(89±6)ng/ml、(108±5)pg/ml,组间比较差异均有统计学意义(P<0.05或P<0.01),mRNA比较结果与蛋白质相似;2组的MVD水平,差异亦有统计学意义(P<0.05)。体外细胞培养时当培养液含FGF2,高糖组与正常培养液组的VEGF蛋白质水平相近(P>0.05);移去FGF2后2、5 d,正常培养液组该指标明显高于高糖组(P<0.05或P<0.01)。结论糖尿病患者溃疡创面难愈与血管化受到抑制以及调控血管生长的因子低表达密切相关。Objective To compare the difference between the burn wound and diabetic ulcer wound, and to preliminarily analyze the nonhealing mechanism of diabetic uncler. Methods The tissue of foot ulcer of diabete patients and skin wound tissues from bum patients were harvested. The levels of （ FGF）2 and VEGF in the wound tissues were determined after tissue cultivation with enzyme-linked immosoburent assay （ELISA）. The changes in micro-vascular density （MVD）were examined by immunohistochemistry. Human umbilical vein endothelial cells were cultured in medium containing different components, and divided into following groups： A （with treatment of 5 mmol/L glucose for 7 days） , B （with treatment of 30 mmol/L glucose for 7 days） and C （with treatment of 30 mmol/L Mannitol for 7 days） groups, then the level of VEGF protein was determined by ELISA. Results The levels of FGF2 and VEGF protein in the burn wound were （59 ± 3）ng/ml and （56 ± 7）pg/ml, respectively, which were obviously lower than those in diabetic ulcer wound[ （89 ± 6）ng/ml, （108 ± 5 ）pg/ml, P 〈 0.05 ]. There was also obvious difference in MVD between two kinds of wound （ P 〈 0.05）. The level of VEGF protein in both wounds were similar after the addition of FGF2 to the cell culture in vitro, while there were statistically significant difference 2 and 5 days after removal of FGF. Conclusion The nonhealing mechanism of diabetic ulcer wound may be related to the inhibition of vaseulation and low expression of factors controlling vessel growth.

关 键 词：烧伤 糖尿病 溃疡 成纤维细胞生长因子2 血管内皮生长因子A 创面愈合 

分 类 号：R644[医药卫生—外科学] R587.2[医药卫生—临床医学] R632.1