局部应用重组人Ⅲ型胶原蛋白水凝胶对糖尿病患者创面愈合的影响

doi:10.3877/cma.j.issn.1673-9450.2022.05.009

中华损伤与修复杂志(电子版) ›› 2022, Vol. 17 ›› Issue (05) : 430 -434. doi: 10.3877/cma.j.issn.1673-9450.2022.05.009

论著

局部应用重组人Ⅲ型胶原蛋白水凝胶对糖尿病患者创面愈合的影响

黄晓罡¹, 牛东升², 闫香果¹, 张克松³, 何军民³, 王晓军³, 刘媛媛⁴^,^†(

)

^1. 100093　北京市化工职业病防治院医疗部，综合内科/医务科
^2. 100093　北京市化工职业病防治院职防部，职业卫生科
^3. 100093　北京市化工职业病防治院医疗部，血管外科
^4. 100039　北京，解放军医学院

收稿日期:2022-07-03 出版日期:2022-10-01
通信作者: 刘媛媛

Effect of topical application of recombinant human type-Ⅲ collagen hydrogels on diabetic wound healing

Xiaogang Huang¹, Dongsheng Niu², Xiangguo Yan¹, Kesong Zhang³, Junmin He³, Xiaojun Wang³, Yuanyuan Liu⁴^,^†()

^1. Department of Internal Medicine/Medical, Beijing Prevention and Treatment Hospital of Occupational Disease for Chemical Industry, Beijing 100093, China
^2. Department of Occupational Health, Beijing Prevention and Treatment Hospital of Occupational Disease for Chemical Industry, Beijing 100093, China
^3. Department of Vascular Surgery, Beijing Prevention and Treatment Hospital of Occupational Disease for Chemical Industry, Beijing 100093, China
^4. Chinese PLA Medical School, Beijing 100039, China

Received:2022-07-03 Published:2022-10-01
Corresponding author: Yuanyuan Liu

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引用本文：

黄晓罡, 牛东升, 闫香果, 张克松, 何军民, 王晓军, 刘媛媛. 局部应用重组人Ⅲ型胶原蛋白水凝胶对糖尿病患者创面愈合的影响[J]. 中华损伤与修复杂志(电子版), 2022, 17(05): 430-434.

Xiaogang Huang, Dongsheng Niu, Xiangguo Yan, Kesong Zhang, Junmin He, Xiaojun Wang, Yuanyuan Liu. Effect of topical application of recombinant human type-Ⅲ collagen hydrogels on diabetic wound healing[J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2022, 17(05): 430-434.

目的

探讨局部应用重组人Ⅲ型胶原蛋白水凝胶治疗糖尿病合并下肢难愈性创面的效果及其对创面炎症反应的影响。

方法

选择2020年9月至2021年6月北京市化工职业病防治院医疗部收治的糖尿病合并下肢难愈性创面患者20例作为研究对象，采用随机数字表法分为试验组与对照组，每组各10例。在实施基础抗糖尿病治疗基础上，试验组局部外敷重组人Ⅲ型胶原蛋白水凝胶，对照组给予常规清创换药治疗，比较2组创面愈合率及创面组织肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)、白细胞介素6(IL-6)及基质金属蛋白酶9(MMP-9)水平。

结果

2组患者治疗后创面面积均较治疗前缩小，试验组患者治疗后7、14 d的创面愈合率分别为(34.00±2.53)%、(73.90±13.00)%，明显高于对照组(23.30±3.89)%、(48.30±6.30)%，差异均有统计学意义(t＝1.330、2.640，P<0.05)；治疗后14 d，2组患者创面中TNF-α、IL-1β、IL-6、MMP-9水平较治疗前均降低，差异均有统计学意义(P<0.05)，且试验组患者创面中TNF-α、IL-1β、IL-6、MMP-9的含量[(87.60±8.78)、(71.70±10.30)、(79.80±13.60)、(11.27±2.45)ng/L]均分别低于对照组[(111.60±9.86)、(81.10±8.03)、(96.90±14.50)、(15.05±2.82)ng/L]，差异均有统计学意义(t＝－5.740、－2.260、－2.720、3.200，P<0.05)。

结论

局部应用重组人Ⅲ型胶原蛋白水凝胶治疗糖尿病合并下肢难愈性创面，可有效提高创面愈合率，降低创面炎症反应，临床治疗效果显著。

关键词: 重组人Ⅲ型胶原蛋白, 水凝胶, 伤口愈合, 糖尿病

Objective

To observe the therapeutic effect of recombinant human type-Ⅲ collagen hydrogels on chronic diabetic wounds, and to explore its influence on the expression levels of inflammatory cytokines in wound tissues.

Methods

From September 2020 to June 2021, 20 diabetes mellitus patients with chronic wounds in lower extremities were selected from Beijing Prevention and Treatment Hospital of Occupational Disease for Chemical Industry, and were divided into the experimental group (10 cases) and the control group (10 cases) according to the random number table. In addition to the basic treatment of diabetes and conventional debridement, the experimental group received topical application of recombinant human type-Ⅲ collagen hydrogels. The wound healing rate, expression levels of tumor necrosis factor-α(TNF-α), interleukin 1β(IL-1β), interleukin 6(IL-6)and matrix metalloproteinase-9(MMP-9) were observed and compared.

Results

After treatment, the area of wounds in both groups decreased. The wound healing rate of the treatment group at 7 d and 14 d after treatment were(34.00±2.53)% and (73.90±13.00)%, which were significantly higher than those of the control group[(23.30±3.89)%, (48.30±6.30)%], the differences were statistically significant (t=1.330, 2.640; P<0.05), 14 d after treatment, the expression levels of TNF-α、IL-1β、IL-6 and MMP-9 decreased, and the expression levels of the treatment group [(87.60±8.78), (71.70±10.30), (79.80±13.60), (11.27±2.45) ng/L] were significantly lower than those of the control group [(111.60±9.86), (81.10±8.03), (96.90±14.50), (15.05±2.82) ng/L], the differences were statistically significant(t=-5.740, -2.260, -2.720, 3.200; P<0.05).

Conclusions

The treatment of chronic diabetic wounds by recombinant human type-Ⅲ collagen hydrogels can accelerate wound healing, reduce wound inflammation and result in significant clinical therapeutic effects.

Key words: Recombinant human type-Ⅲ collagen, Hydrogels, Wound healing, Diabetes mellitus

表1 2组糖尿病合并下肢难愈性创面患者一般资料比较

组别	例数(例)	性别(例)		年龄(岁，±s)	体重指数(kg/m²，±s)	HbA1c(%，±s)	创面病程[d，M(Q₁，Q₃)]	创面面积[cm²，M(Q₁，Q₃)]
组别	例数(例)	男	女	年龄(岁，±s)	体重指数(kg/m²，±s)	HbA1c(%，±s)	创面病程[d，M(Q₁，Q₃)]	创面面积[cm²，M(Q₁，Q₃)]
试验组	10	6	4	55.70±6.88	22.58±1.67	9.30±1.15	56(35，100)	21.50(14.25，38.00)
对照组	10	5	5	51.40±8.22	21.90±1.83	9.43±1.02	42(35，100)	26.00(18.75，34.75)
χ²/t/u值		0.202		1.268	0.882	－0.267	26	49
P值		0.653		0.221	0.390	0.792	0.069	0.940

表1 2组糖尿病合并下肢难愈性创面患者一般资料比较

组别	例数(例)	性别(例)		年龄(岁，±s)	体重指数(kg/m²，±s)	HbA1c(%，±s)	创面病程[d，M(Q₁，Q₃)]	创面面积[cm²，M(Q₁，Q₃)]
组别	例数(例)	男	女	年龄(岁，±s)	体重指数(kg/m²，±s)	HbA1c(%，±s)	创面病程[d，M(Q₁，Q₃)]	创面面积[cm²，M(Q₁，Q₃)]
试验组	10	6	4	55.70±6.88	22.58±1.67	9.30±1.15	56(35，100)	21.50(14.25，38.00)
对照组	10	5	5	51.40±8.22	21.90±1.83	9.43±1.02	42(35，100)	26.00(18.75，34.75)
χ²/t/u值		0.202		1.268	0.882	－0.267	26	49
P值		0.653		0.221	0.390	0.792	0.069	0.940

表2 2组糖尿病合并下肢难愈性创面患者治疗后不同时间创面愈合率比较(%，±s)

组别	例数(例)	治疗后7 d	治疗后14 d
试验组	10	34.00±2.53	73.90±13.00
对照组	10	23.30±3.89	48.30±6.30
t值		1.330	2.640
P值		<0.001	<0.001

表2 2组糖尿病合并下肢难愈性创面患者治疗后不同时间创面愈合率比较(%，±s)

组别	例数(例)	治疗后7 d	治疗后14 d
试验组	10	34.00±2.53	73.90±13.00
对照组	10	23.30±3.89	48.30±6.30
t值		1.330	2.640
P值		<0.001	<0.001

表3 2组糖尿病合并下肢难愈性创面患者治疗前及治疗后7 d创面炎症因子水平比较(ng/L，±s)

组别	TNF-α		IL-1β		IL-6		MMP-9
组别	治疗前	治疗后14 d	治疗前	治疗后14 d	治疗前	治疗后14 d	治疗前	治疗后14 d
试验组	143.10±9.10	87.60±8.78^a	99.30±11.60	71.70±10.30^a	118.40±12.98	79.80±13.60^a	23.31±4.48	11.27±2.45^a
对照组	148.90±8.90	111.60±9.86^a	100.80±12.10	81.10±8.03^a	119.80±12.34	96.90±14.50^a	20.48±3.19	15.05±2.82^a
t值	－1.440	－5.740	－0.282	－2.260	－0.237	－2.720	1.630	3.200
P值	0.168	<0.001	0.781	0.036	0.815	0.014	0.121	0.005

表3 2组糖尿病合并下肢难愈性创面患者治疗前及治疗后7 d创面炎症因子水平比较(ng/L，±s)

组别	TNF-α		IL-1β		IL-6		MMP-9
组别	治疗前	治疗后14 d	治疗前	治疗后14 d	治疗前	治疗后14 d	治疗前	治疗后14 d
试验组	143.10±9.10	87.60±8.78^a	99.30±11.60	71.70±10.30^a	118.40±12.98	79.80±13.60^a	23.31±4.48	11.27±2.45^a
对照组	148.90±8.90	111.60±9.86^a	100.80±12.10	81.10±8.03^a	119.80±12.34	96.90±14.50^a	20.48±3.19	15.05±2.82^a
t值	－1.440	－5.740	－0.282	－2.260	－0.237	－2.720	1.630	3.200
P值	0.168	<0.001	0.781	0.036	0.815	0.014	0.121	0.005

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Effect of topical application of recombinant human type-Ⅲ collagen hydrogels on diabetic wound healing

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Effect of topical application of recombinant human type-Ⅲ collagen hydrogels on diabetic wound healing