糖尿病足溃疡创面中免疫细胞及血管标志物的变化与预后相关性研究  

The correlation between the changes of immune cells and vascular markers in diabetic foot ulcer wound and prognosis

作　　者：杨小文[1,2] 陈永德 马方旭 陈永健 YANG Xiaowen;CHEN Yongde;MA Fangxu(Jinan University,Guangzhou,Guangdong,510632,China)

机构地区：[1]暨南大学,广东广州510632 [2]暨南大学附属深圳华侨医院手足显微外科,广东深圳518111

出　　处：《实用手外科杂志》2024年第4期511-515,共5页Journal of Practical Hand Surgery

基　　金：广东省医学科学技术研究基金项目(项目编号:B2023312)。

摘　　要：目的研究糖尿病足坏死组织旁肉芽组织的病理学改变及其分子机制,为治疗糖尿病足的难愈性创面提供理论支持。方法收集2024年1月-2024年7月在暨南大学附属深圳华侨医院行糖尿病足手术后的组织5例,取坏死组织和坏死旁接近正常组织行HE染色、免疫组化染色以及qPCR检测。将糖尿病足的坏死状态进行病理学和mRNA水平分析;对比观察CD4+、CD20+免疫细胞以及血管标志物CD34、CD31的变化。结果与邻近正常组织相比坏死组织大量炎性细胞浸润,成纤维细胞和血管内皮细胞大量死亡,肉芽组织无法有效增生重构。糖尿病足坏死组织的血管标志物CD34呈束状带分布,微小血管标志物CD31表达显著增加。坏死组织中CD4+T细胞和CD20+B细胞的表达量显著增加。坏死组织中血管标志物CD31 mRNA转录水平显著上升。结论糖尿病足坏死组织中CD4+、CD20+免疫细胞显著增加;血管标记物CD31显著增加,而CD34未见差异。因此,本研究推测,CD4和CD20可能是评估糖尿病足患者创面预后的重要指标,而CD31则有望成为糖尿病足创面难愈合的治疗靶点。Objective To investigate the pathological changes and molecular mechanisms in granulation tissue adjacent to necrotic tissue in diabetic foot ulcers(DFUs),providing theoretical support for the treatment of hard-to-heal DFU wounds.Methods Tissue samples were collected from five DFU patients who underwent surgery at Shenzhen Overseas Chinese Hospital,Jinan University,from January to July 2024.Necrotic tissue and adjacent near-normal tissue were subjected to hematoxylin-eosin(HE)staining,immunohistochemistry,and qPCR analysis.The pathological and mRNA-level changes in necrotic DFU tissues were analyzed,focusing on the differences in immune cells(CD4+T cells,CD20+B cells)and vascular markers(CD34,CD31).Results Compared with adjacent normal tissue,necrotic tissue showed extensive inflammatory cell infiltration,significant death of fibroblasts and endothelial cells,and impaired granulation tissue proliferation and remodeling.CD34 expression in necrotic tissue displayed a band-like distribution,while CD31 expression was significantly upregulated.Additionally,the expression of CD4+T cells and CD20+B cells was markedly increased in necrotic tissue.qPCR analysis revealed a significant increase in CD31 mRNA transcription levels in necrotic tissue.Conclusion The significant increase in CD4+T cells and CD20+B cells,along with elevated CD31 expression,suggests that CD4 and CD20 may serve as important prognostic markers for DFU wound healing.CD31 may also represent a potential therapeutic target for refractory DFU wounds.

关 键 词：糖尿病足 CD4+ CD20+ 血管标记物CD34 创面愈合 

分 类 号：R587.2[医药卫生—内分泌]