负压吸引疗法通过减轻炎症反应促进糖尿病足溃疡愈合  

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

作　　者：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] 

机构地区：[1]上海交通大学附属第六人民医院血管外科,上海200233 [2]上海交通大学附属第六人民医院内分泌代谢科,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　　处：《上海交通大学学报（医学版）》2016年第8期1159-1164,共6页Journal of Shanghai Jiao tong University:Medical Science

基　　金：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)~~

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、14d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7d时,实验组TNF-α阳性面积低于对照组[(619.5±15.7)μm^2 vs(636.1±14.1)μm^2,t=2.597,P=0.017];术后7、14d,实验组IL-6阳性面积均较对照组降低[(626.0±11.5)μm^2 vs(664.6±18.8)μm^2,t=5.810,P=0.000;(611.4±19.2)μm^2 vs(642.1±22.5)μm^2,t=3.447,P=0.003]。ELISA检测结果揭示:实验组iNOS蛋白表达在术后7d[(367.0±24.9)pg/mL对(404.6±29.9)pg/mL,t=3.206,P=0.004]和14d[(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7d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14d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。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） μm^2 vs （636.1±14.1） μm^2, 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） μm^2 vs （664.6±18.8） μm^2, t=5.810, P=0.000; （611.4±19.2） μm^2 vs （642.1±22.5） μm^2, 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

关 键 词：负压吸引治疗 炎症反应 糖尿病伤口 

分 类 号：R587.2[医药卫生—内分泌]