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中华损伤与修复杂志(电子版)

中华损伤与修复杂志(电子版) ›› 2017, Vol. 12 ›› Issue (06) : 432 -436. doi: 10.3877/cma.j.issn.1673-9450.2017.06.006

所属专题： 文献；

论著

负压伤口疗法对老年糖尿病溃疡创面表皮干细胞增殖的影响
刘坡1,†(), 柯昌能1, 舒斌2, 李维珊1, 童志远1, 王香梅1, 张中强1, 邹松云1   
  1. 1. 518110　深圳市龙华区中心医院烧伤整形科
    2. 510080　广州，中山大学附属第一医院烧伤科
  • 收稿日期:2017-11-17 出版日期:2017-12-01
  • 通信作者: 刘坡
  • 基金资助:
    广东省自然科学基金项目(2015A030313162，2017A030313619); 深圳市龙华新区科技计划社会公益科研项目(2013109)

Effect of negative pressure wound therapy on proliferation of epidermal stem cell in elderly diabetic ulcer wounds

Po Liu1,†(), Changneng Ke1, Bin Shu2, Weishan Li1, Zhiyuan Tong1, Xiangmei Wang1, Zhongqiang Zhang1, Songyun Zou1   

  1. 1. Department of Burns and Plastic Surgery, Shenzhen Longhua District Central Hospital, Shenzhen 518110, China
    2. Department of Burns, First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
  • Received:2017-11-17 Published:2017-12-01
  • Corresponding author: Po Liu
  • About author:
    Corresponding author: Liu Po, Email:
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刘坡, 柯昌能, 舒斌, 李维珊, 童志远, 王香梅, 张中强, 邹松云. 负压伤口疗法对老年糖尿病溃疡创面表皮干细胞增殖的影响[J]. 中华损伤与修复杂志(电子版), 2017, 12(06): 432-436.

Po Liu, Changneng Ke, Bin Shu, Weishan Li, Zhiyuan Tong, Xiangmei Wang, Zhongqiang Zhang, Songyun Zou. Effect of negative pressure wound therapy on proliferation of epidermal stem cell in elderly diabetic ulcer wounds[J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2017, 12(06): 432-436.

目的

探讨负压伤口疗法(NPWT)治疗老年糖尿病溃疡创面过程中表皮干细胞增殖的变化。

方法

选取2011年1月至2015年12月间中山大学附属第一医院、深圳市龙华区中心医院收入院治疗的老年糖尿病合并慢性难愈合创面患者10例为研究对象，应用NPWT治疗创面，分别于治疗前，治疗后2、4周于创缘切取组织，采用免疫组织化学方法，检测创面愈合过程中创缘基底细胞中表皮干细胞(β1整合素)阳性细胞变化，治疗前后数据采用配对样本t检验。

结果

NPWT治疗前创缘基底细胞中未见表皮干细胞(β1整合素)阳性细胞，治疗后2周，出现表皮干细胞(β1整合素)阳性细胞，阳性单位值为1.74±0.07，治疗后4周，表皮干细胞(β1整合素)阳性细胞增多，阳性单位值为29.07±0.65；治疗后2、4周表皮干细胞(β1整合素)阳性细胞与治疗前差异有统计学意义(t＝75.29、140.31，P值均小于0.05)。治疗后4周表皮干细胞表达与治疗后2周比较差异有统计学意义(t＝134.25，P<0.05)。

结论

NPWT促进老年糖尿病溃疡创面表皮干细胞的增殖，促进溃疡创面上皮化及愈合。

关键词: 负压伤口疗法, 糖尿病, 溃疡, 老年人, 细胞增殖, 表皮干细胞
Objective

To study on the changes of epidermal stem cells proliferation in the treatment of elderly diabetic ulcer wound by negative-pressure wound therapy (NPWT).

Methods

Elderly patients with diabetes mellitus complicated with chronic refractory wounds were selected from First Affiliated Hospital, Sun Yat-sen University and Shenzhen Longhua District Central Hospital from January 2011 to December 2015. NPWT was used to treat these wounds. Immunohistochemical method was used to detect the changes of integrin beta 1 in basal cells of wound healing process(respectively before treatment, 2 weeks after treatment, 4 weeks after treatment). The paired-samples t test was used.

Results

No integrin beta 1 positive cells were found in the basal cells of the limbus wound before the NPWT, the integrin beta 1 positive cells appeared at the periphery of the wound at 2 weeks after NPWT, the positive unit was 1.74±0.07. At 4 weeks after received NPWT, the positive unit (expression of integrin beta 1 positive cells) was 29.07±0.65. The expression of epidermal stem cells (integrin beta 1) at the 2 and 4 weeks after received NPWT was significantly different from that before received NPWT (t=75.29, 140.31, with P values below 0.05). There was significant difference in the expression of epidermal stem cells (integrin beta 1) at the 4 weeks after received NPWT and 2 weeks after received NPWT (t=134.25, P<0.05).

Conclusion

NPWT promotes the proliferation of epidermal stem cells in elderly diabetic ulcer wounds and promotes epithelial wound healing.

Key words: Negative-pressure wound therapy, Diabetes mellitus, Ulcer, Aged, Cell proliferation, Epidermal stem cells
图1 糖尿病溃疡患者采用负压伤口疗法治疗前后表皮干细胞表达情况(免疫组织化学×200)。A示治疗前，创缘皮肤基底层未见表皮干细胞(β1整合素)；B示治疗后2周，创缘皮肤基底层可见表皮干细胞；C示治疗后4周，创缘皮肤基底层可见较多表皮干细胞(β1整合素)
图2 糖尿病溃疡患者采用负压伤口疗法治疗前后创面的情况。A示治疗前，创面有较多坏死组织及脓性分泌物；B示治疗后2周，糖尿病足部溃疡坏死组织、分泌物明显减少，肉芽组织较治疗前新鲜；C示治疗后4周，溃疡创面床肉芽组织新鲜，逐渐充填创面，创面较治疗后2周缩小；D示治疗后6周，溃疡创面床恢复正常，创面边缘上皮沿创面床爬行，创面进一步缩小；E为治疗后8周，创面上皮化、愈合
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