胫骨横向骨搬移术后皮肤干细胞促进重度糖尿病足创面再生愈合的机制研究  

Mechanism of Activating Skin Stem Cells to Promote Regeneration and Healing of Severe Diabetic Foot Wound After Transverse Tibial Bone Transfer

作　　者：姜圣洁 花奇凯[2,3] 陈炎 李山郎 刘光炜 聂新宇 苏宏杰 邝晓聪[1,3] Jiang Shengjie;Hua Qikai;Chen Yan(School of Basic Medicine,Guangxi Medical University,Nanning 530021,China;The First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China;Research Center of Regenerative Medicine of Guangxi Medical University,Nanning 530021,China)

机构地区：[1]广西医科大学基础医学院,广西南宁530021 [2]广西医科大学第一附属医院,广西南宁530021 [3]广西医科大学再生医学研究中心,广西南宁530021 [4]广西生物医药协同创新中心,广西南宁530021

出　　处：《实用骨科杂志》2021年第5期444-447,455,共5页Journal of Practical Orthopaedics

基　　金：广西壮族自治区自然科学基金(2017GXNSFAA198293);广西医科大学第一附属医院攀登计划(YYZS2020010);广西壮族自治区。

摘　　要：目的从局部创面毛囊干细胞激活的角度,探讨胫骨横向骨搬移技术促进重度糖尿病足溃疡创面再生、愈合修复的机制。方法选取2014年6月至2018年1月在广西医科大学第一附属医院骨关节外科行胫骨横向骨搬移的126例重度糖尿病足患者,其中男94例,女32例,年龄39~86岁,中位数年龄61岁。Wagner分级构成:3级67例,4级57例,5级2例;TEXAS分级构成:2B级50例,2C级6例,2D级9例,3B级17例,3C级1例,3D级43例。针对患者进行创面愈合情况临床观察,并在治疗前后取创面边缘组织,进行HE染色观察创面组织学变化,还采用免疫组织化学染色观察富含亮氨酸重复序列的G蛋白偶联受体5(leucine-rich repeat-containing G protein-coupled receptor 5,LGR5)、角蛋白19(cytokeratin 19,CK19)蛋白表达与分布情况。结果126例重度糖尿病足患者平均愈合时间为(143.5±86.4)d,愈合过程基本呈现炎性期、增殖修复期等阶段特点,即搬移后早期出现创面边缘收缩,表面覆盖较多黄色纤维素样炎性渗出物;换药后逐渐出现鲜红肉芽组织,且边缘上皮组织向中心部位移行增生而基本覆盖创面,仅存线性或条状瘢痕。术后取移行修复创面边缘皮肤组织检测,发现有完整分层结构的表皮,可见大量微血管、胶原纤维和腺体结构,与术前对比,坏死组织减少,真皮有炎细胞浸润减少。治疗后LGR5与和CK19阳性细胞面积比分别为(6.781±1.889)%与(9.095±2.926)%,均显著高于术前创面组织中LGR5和CK19阳性面积比的(1.398±0.620)%与(1.834±0.772)%(P<0.05)。结论胫骨横向骨搬移技术能促进糖尿病足溃疡创面再生愈合,其机制可能是通过LGR5和CK19等阳性细胞的活化,调控皮肤干细胞,参与创面过程。Objective To study the mechanism of tibial transverse transport technology enhancing the regeneration,healing and repair of severe diabetic foot ulcers though activation of local hair follicle stem cell.Methods We selected 126 severely infected diabetic foot patients who underwent tibial transverse transport in the Department of Osteopathic and Joint Surgery of the First Affiliated Hospital of Guangxi Medical University from June 2014 to January 2018.According to Wagner classification,there were 67 cases of gradeⅢ,57 cases of gradeⅣand 2 cases of grade V.According to TEXAS classification structure,there were 50 cases of grade 2B,6 cases of grade 2C,9 cases of grade 2D,17 cases of grade 3B,1 case of grade 3C,and 43 cases of grade 3D.The features of wound healing was assessed.The edge tissues of the wound were taken before and after treatment,and HE staining was performed to observe the histological changes of the wound.Immunohistochemical staining was used to detect the expression and distribution of the Leucine-rich repeat-containing G protein-coupled receptor 5(LGR5)and cytokeratin 19(CK19)protein.Results The average healing time of 126 patients with severe diabetic foot was(143.5±86.4)days.The wound edge contracted early after removal,where surface was covered with yellow fibrinoid inflammation exudation;red granulation tissue gradually appeared after dressing change,while the peripheral epithelial tissue proliferated and shifted to the center.The wound was covered and linear or striped scars were remained.The complete layered structure of the epidermis,a large number of microvessels,collagen fibers and glandular structures were seen in edge tissues of the wound.Compared with the tissues of preoperative,the necrotic tissue and the inflammatory cell infiltration in the dermis were reduced.After treatment,the ratio of LGR5 to CK19 positive cell area were(6.781±1.889)%and(9.095±2.926)%,respectively,which were significantly higher than the positive area ratio of LGR5(1.398±0.620)%and CK19(1.834±0.772)%in t

关 键 词：胫骨横向骨搬移术 皮肤干细胞 糖尿病足 愈合 

分 类 号：R654.4[医药卫生—外科学]