[1]焦娇,王鹏华,褚月颉,等.封闭负压引流促进糖尿病足溃疡愈合机制的研究[J].国际内分泌代谢杂志,2014,(01):10-14.[doi:10.3760/cma.j.issn.1673-4157.2014.01.003]
　Jiao Jiao,Wang Penghua,Chu Yuejie,et al.Study of the mechanism of vacuum assisted closure in promoting the healing of diabetic foot ulcers[J].International Journal of Endocrinology and Metabolism,2014,(01):10-14.[doi:10.3760/cma.j.issn.1673-4157.2014.01.003]
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封闭负压引流促进糖尿病足溃疡愈合机制的研究()
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《国际内分泌代谢杂志》[ISSN:1673-4157/CN:12-1383/R]

卷:
期数:
2014年01期
页码:
10-14
栏目:
论著
出版日期:
2014-02-28

文章信息/Info

Title:
Study of the mechanism of vacuum assisted closure in promoting the healing of diabetic foot ulcers
作者:
焦娇; 王鹏华; 褚月颉; 郑丛丛; 李喜文
300070　天津医科大学代谢病医院糖尿病足科 　　
Author(s):
Jiao Jiao; Wang Penghua; Chu Yuejie; Zheng Congcong; Li Xiwen.
Department of Diabetic Foot,The Metabolic Disease Hospital,Tianjin Medical University,Tianjin 300070,China Corresponding author：Wang Penghua,Email：penghuawang2011@163.com
关键词:
封闭负压引流; 糖尿病足溃疡; 血管内皮细胞生长因子; 基质金属蛋白酶; 组织型基质金属蛋白酶抑制因子-1
Keywords:
Vacuum assisted closure; Diabetic foot ulcer; Vascular endothelial cell growth factor;  Matrix metalloproteinases; Tissue inhibitor of matrix metalloproteinase-1
DOI:
10.3760/cma.j.issn.1673-4157.2014.01.003
摘要:
目的　探讨封闭负压引流（VAC）对糖尿病足溃疡创面中血管内皮细胞生长因子（VEGF）、基质金属蛋白酶-2（MMP-2）、MMP-9以及组织型基质金属蛋白酶抑制因子-1（TIMP-1）的影响。 方法　采用随机分组方法（抛硬币法）将31例清创术后的糖尿病足溃疡患者分为负压组与对照组,其中负压组17例,对照组14例。对负压组给予创面封闭负压引流（压力-450～-125 mmHg,1 mmHg=0.133 kPa）7 d,去除负压后,分别收集0,3,7和14 d的创面渗液。 同时收集经过7 d常规换药的对照组0,3,7和14 d的创面渗液。 采用双抗体夹心法酶联免疫吸附试验测定渗液中VEGF,MMP-2,MMP-9及TIMP-1含量的变化。分别计算负压组拆除负压后第1,2,3,4周以及对照组相应时间的创面愈合率。结果　与对照组相比,负压组的住院天数及住院期间总费用明显较少,差异具有统计学意义（t =-3.556,-3.449；P均＜0.05）。负压组各时段的创面愈合率均明显高于对照组（Z=2.159,2.239,-2.688,-3.033；P均＜0.05）。负压组各时段创面渗液中VEGF（0 d除外,P ＞0.05,P均＜0.05）、MMP-2（P均＜0.05）、MMP-9（P均＜0.05）、TIMP-1（P均＜0.05）的含量及MMP-9/TIMP-1（P均＜0.05）与对照组相比较,差异均具有统计学意义。与对照组相比,负压组VEGF含量较多,但差异具有统计学意义是从拆除负压后3 d开始出现的。负压组各时段创面渗液中MMP-2、MMP-9及MMP-9/TIMP-1均少于对照组,两组间MMP-2含量的差别逐渐增大,于拆除负压14 d后达高峰；而两组间MMP-9含量以及MMP-9/TIMP-1差别的高峰则出现在拆除负压后7 d。与对照组相比,负压组各时段TIMP-1含量均较多,差别的高峰出现在拆除负压后7 d。 结论　VAC能够减少糖尿病足溃疡创面中MMP-2、MMP-9的含量及增加VEGF、TIMP-1的含量,从而促进创面愈合。
Abstract:
Objective　To investigate the effect of vacuum assisted closure on the changes of vascular endothelial cell growth factor（VEGF）,matrix metalloproteinase（MMP）-2,MMP-9 and tissue inhibitor of matrix metalloproteinase（TIMP）-1 in diabetic foot ulcers. Methods　Randomized method（Coin toss method）was used to divide 31 patients with diabetic foot ulcer who suffered debridement into negative pressure group（n =17） and control group（n =14）.Negative pressure group were treated with wound vacuum assisted closure（pressure -450--125 mmHg,1 mmHg=0.133 kPa） for 7 days.After removal of negative pressure, the wound exudates at 0,3,7 and 14 day were collected.Meanwhile the wound exudates from control group who went through conventional dressing for 7 days were collected.Double antibody sandwich enzyme-linked immunosorbent assay was used to determine the changes of VEGF,MMP-2,MMP-9 and TIMP-1 in the wound exudates.The wound healing rate in negative pressure group after removal of negative pressure 1,2,3,4 w and the corresponding time of control group were calculated respectively. Results　Compared with control group,the hospitalization days and the expenses of negative pressure group were significantly less,and the difference was statistically significant（t =-3.556,-3.449；all P ＜0.05）.The wound healing rate of each period in negative pressure group was significantly higher than that in control group（Z=2.159,2.239,-2.688,-3.033；all P ＜0.05）.Compared the concentrations of VEGF（excepted for the 0 d,P ＞0.05,all P ＜0.05）,MMP-2（all P ＜0.05）,MMP-9(all P ＜0.05）,TIMP-1(all P ＜0.05） and MMP-9/TIMP-1（all P ＜0.05） from wound exudates at every time point of negative pressure group with control group, the differences have statistical significance.Compared with control group,the concentration of VEGF in negative pressure group was higher,but the statistical significance of the difference occurred from the 3 rd day after the demolition of negative pressure.Compared the concentrations of MMP-2,MMP-9 and MMP-9/TIMP-1 at every time point of negative pressure group with control group,those in the former group were lower.The difference of concentration of MMP-2 between two groups gradually increased,after the 14 d that demolished the negative pressure,the difference was the biggest.While the difference of MMP-9 and MMP-9/TIMP-1 between two groups was the biggest after the 7 d that demolished the negative pressure.Compared with control group,the concentrations of TIMP-1 at every time point were higher in the negative pressure group,and the difference also was the biggest after the 7 d that demolished the negative pressure．Conclusion　Vacuum assisted closure can promote wound healing in the diabetic foot ulcers by reducing the concentrations of MMP-2,MMP-9 and increasing the concentrations of VEGF,TIMP-1.

参考文献/References:

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备注/Memo

备注/Memo:
基金项目：天津市应用基础及前沿技术研究计划项目（10JCZDJC19800）；天津市卫生局科技基金（09kz87）；天津医科大学科学基金（2008KY17） 通信作者：王鹏华,Email:penghuawang2011@163.com
更新日期/Last Update: 2014-01-20