创面渗出液VEGF、MMP-13、TIMP-1水平对负压封闭引流术联合人工真皮修复难愈性创面效果的预测价值  

Predictive value of VEGF,MMP-13 and TIM P-1 levels in wound exudate on the effect of VSD combined with artificial dermis repair in the treatment of refractory wounds

作　　者：隋磊 谢强[1] 孔宇 郝宇 王晓雪 李小东[1] SUI Lei;XIE Qiang;KONG Yu;HAO Yu;WANG Xiao-xue;LI Xiao-dong(Department of Hand Foot Surgery,the Affiliated Hospital of Chengde Medical University,Hebei Province,Chengde 067000,China;Health Admin istration of Weichang Manchu andMongolian Autonomous County,Hebei Province,Chengde 068450,China)

机构地区：[1]承德医学院附属医院手足外科,河北承德067000 [2]河北省围场满族蒙古族自治县卫生健康局,河北承德068450

出　　处：《河北医科大学学报》2024年第4期445-450,共6页Journal of Hebei Medical University

基　　金：河北省医学科学研究课题计划(20241445)。

摘　　要：目的观察难愈性创面患者创面渗出液血管内皮生长因子(vascular endothelial growth factor,VEGF)、基质金属蛋白酶13(matrix metalloproteinase-13,MMP-13)、金属蛋白酶抑制剂1(tissue inhibitor of matrix metalloproteinases-1,TIMP-1)水平,并分析其对负压封闭引流术(vacuum sealing drainage,VSD)联合人工真皮修复治疗难愈性创面临床效果的预测价值。方法选取难愈性创面患者60例纳入难愈组,普通创面患者60例为对照组。所有入选者均检测创面渗出液VEGF、MMP-13、TIMP-1水平,并计算MMP-13/TIMP-1值。采用VSD联合人工真皮修复治疗难愈性创面患者,观察临床效果,并依据临床效果将其分为有效组与无效组,比较有效组与无效组创面渗出液VEGF、MMP-13、TIMP-1水平与MMP-13/TIMP-1值,采用Logistic回归分析上述指标对VSD联合人工真皮修复治疗难愈性创面患者效果的影响,并绘制受试者工作特征曲线(receiver operating characteristic curve,ROC),分析上述指标对VSD联合人工真皮修复治疗难愈性创面患者效果的预测价值。结果难愈组MMP-13水平及MMP-13/TIMP-1值高于对照组,VEGF、TIMP-1水平低于对照组(P<0.05)。60例难愈性创面患者经VSD联合人工真皮修复治疗有效49例(81.67%),无效11例(18.33%)。无效组MMP-13、MMP-13/TIMP-1值高于有效组,VEGF、TIMP-1水平低于有效组(P<0.05)。Logistic回归分析结果显示,MMP-13(95%CI:1.037~1.165)及MMP-13/TIMP-1值(95%CI:1.410~3.458)是难愈性创面患者治疗效果的危险因素,VEGF(95%CI:0.972~0.995)、TIMP-1(95%CI:0.264~0.756)是保护因素(P<0.05)。点二列相关性分析结果显示,VEGF、TIMP-1水平与难愈性创面患者VSD联合人工真皮修复治疗效果呈正相关(r=0.410、0.448,P<0.05),MMP-13水平、MMP-13/TIMP-1值与其治疗效果呈负相关(r=-0.477、0.570,P<0.05)。绘制ROC曲线,结果显示,VEGF(95%CI:0.643~0.908)、MMP-13(95%CI:0.706~0.986)、TIMP-1(95%CI:0.712~0.943)水平及MMP-13/TIMP-1值(95%CI:0.829~0.981)对难愈Objective To observe the levels of vascular endothelial growth factor(VEGF)and matrix metalloproteinase-13(MMP-13)and tissue inhibitor of matrix metalloproteinases-1(TIMP-1)in wound exudate of patients with refractory wounds,and to analyze their predictive value for the clinical ffect of negative pressure vacuum sealing drainage(VSD)combined with artificial dermal repair in the treatment of refractory wounds.Methods Sixty patients with refractory wounds were selected to be included in the refractory group,and 60 patients with common wounds in the same period were selected as the control group.VEGF,MMP-13 and TIMP-1 were detected in wound exudate of all people enrolled,and MMP-13/TIMP-1 values were calculated.Patients with refractory wounds were treated with VSD combined with artificial dermal repair,and the clinical efect was observed.The patients were subdivided into ffective subgroup and nffective subgroup according to the elinical effect.The levels of VEGF,MMP-13,TIMP-1 and MMP-13/TIMP-1 in wound exudate between the efctive group and the inffective group were compared.Logistic regression was used to analyze the impact of the above indexes on the efficacy of VSD combined with artificial dermal repair in the treatment of refractory wounds,and receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of the above indexes on the efficacy of VSD combined with artificial dermal repair in the treatment of refractory wounds.Results The levels of MMP-13 and MMP-13/TIMP-1 in refractory group were higher than those in control group,while VEGF and TIMP-1 levels were lower than those in control group(P<0.05).In 60 patients with refractory wounds,VSD combined with artificial dermal repair was efective in 49 patients(81.67%)and inffective in 11 patients(18.33%).The values of MMP-13 and MMP-13/TIMP-1 in the nffctive group were higher than those in the effective group,and the levels of VEGF and TIMP-1 were lower than those in the efective group(P<0.05).Logistic regression analysis showed that MMP-13

关 键 词：难愈性创面 血管内皮生长因子类 基质金属蛋白酶13 

分 类 号：R649.9[医药卫生—外科学]