体外震波治疗对糖尿病大鼠慢性创面愈合及组织学影响  

EFFECT OF EXTRACORPOREAL SHOCK WAVE THERAPY ON DIABETIC CHRONIC WOUND HEALING AND ITS HISTOLOGICAL FEATURES

作　　者：燕晓宇[1] 杨光[1] 成亮[1] 陈明[1] 程相国[1] 柴益民[1] 罗从风[1] 曾炳芳[1] 

机构地区：[1]上海交通大学附属第六人民医院骨科,上海200233

出　　处：《中国修复重建外科杂志》2012年第8期961-967,共7页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：国家自然科学基金资助项目(30901565);上海市青年科技启明星计划(A类)项目(10QA1405400)~~

摘　　要：目的体外震波(extracorporeal shock wave,ESW)可促进血管新生和组织修复,通过观察低能量ESW治疗糖尿病大鼠慢性创面的效果,探讨其促进糖尿病慢性创面愈合的机制。方法 6～8周龄雄性SD大鼠96只,体重(220±20)g,随机分为3组(糖尿病对照组、ESW治疗组及正常对照组),每组32只。取糖尿病对照组、ESW治疗组大鼠,腹腔注射链脲佐菌素(60 mg/kg)制备糖尿病大鼠模型后,于背部制备1个直径1.8 cm的圆形皮肤全层创面,建立糖尿病大鼠慢性创面模型。正常对照组大鼠同法制备创面。创面制备后1 d ESW治疗组采用0.11 mJ/mm2、1.5 Hz的ESW对创面干预500脉冲;糖尿病对照组及正常对照组创面未行ESW治疗。观察创面愈合情况;于3、7、14 d取创面组织行HE及Masson染色,观察创面组织学变化;行CD31和增殖细胞核抗原(proliferating cell nuclear antigen,PCNA)免疫组织化学染色,观察创面细胞增殖及血管化程度。结果糖尿病对照组创面闭合率低于正常对照组,创面闭合时间延长(P<0.05),治疗后3、7、14 d,创面组织炎性细胞浸润明显,胶原纤维相对面积密度、创面微血管密度、PCNA阳性细胞相对密度均低于正常对照组(P<0.05)。ESW治疗组与糖尿病对照组相比,创面愈合时间缩短,创面闭合率提高(P<0.05),各时间点炎性细胞计数减少,肉芽组织生长良好,创面内胶原纤维相对面积密度、微血管密度和PCNA阳性细胞相对密度增加,差异有统计学意义(P<0.05);ESW治疗组与正常对照组相比,微血管密度和PCNA阳性细胞相对密度差异均无统计学意义(P>0.05)。结论低能量ESW治疗可以抑制糖尿病大鼠慢性创面内局部炎性反应,提高创面内修复细胞增殖能力,增加微血管形成和胶原沉积,使肉芽组织形成增加,最终促进创面愈合。Objective Extracorporeal shock wave （ESW） can promote anglogenesls and tissue repair, to mvesugate the influence of ESW therapy on the histological features of diabetic chronic wounds and wound healing. Methods Ninety- six male Sprague Dawley rats with weight （220±20） g were divided into 3 groups （n=32）： diabetic control group, ESW treatment group, and normal control group. The diabetic rats were prepared in diabetic control group and ESW treatment group by intraperitoneal injection of Streptozotocin （60 mg/kg）. Then a circular full-thickness skin wound of 1.8 cm in diameter was made at the back of diabetic rats to establish the diabetic chronic wound model, and the same wound was made in normal control group. In ESW treatment group, ESW （0.11 mJ/mm2, 1.5 Hz energy, and 500 pulses） was applied to treat the wound at 1 day after wounding; in two control groups, no ESW treatment was given. The wound healing and histological changes were observed by HE and Masson staining at 3, 7, and 14 days after treatment; and the cell proliferation, angiogenesis, and collagen deposition were observed by CD31 and proliferating cell nuclear antigen （PCNA） immunohistochemical staining. Results The wound closure rate in diabetic control group was lower, and the healing time was significantly longer than those in normal control group （P 〈 0.05）; at 3, 7, and 14 days after treatment, the inflammatory cell infiltration in wound tissue was obvious, and the relative area density of collagen fibers, wound microvessel density （MVD）, and the relative density of PCNA-positive cells were significantly lower than those in normal control group （P 〈 0.05）. The wound healing time was significantly shorter and the wound closure rate was significantly higher in ESW treatment group than those in the diabetic control group （P 〈 0.05）. At different time points in ESW treatment group, the inflammatory cells signficantly reduced, while the relative area density of collagen fibers, MVD, and relative density

关 键 词：体外震波 糖尿病慢性创面 血管新生 创面愈合 大鼠 

分 类 号：R641[医药卫生—外科学]