负压创面治疗技术对糖尿病足创面肉芽组织生长及VEGF表达的影响

摘要

目的：探讨负压创面治疗技术（ negative pressure wound therapy, NPWT)对糖尿病足创面肉芽组织生长及血管内皮生长因子（ vascular endothelial growth factor, VEGF)表达的影响。方法选取2010年1月—2014年12月糖尿病足患者40例,采用随机法分为NPWT组和对照组各20例,分别予NPWT和传统纱布换药治疗。两组分别于治疗前及治疗后12 d取创面活组织,并行HE染色、免疫组织化学染色（免疫组化)及Western Blot分析,观察肉芽组织生长情况、微血管密度（ MVD)及VEGF表达情况。结果 HE染色结果显示：两组治疗后创面活组织均可见新鲜肉芽组织形成,其中NPWT组创面新鲜肉芽组织形成明显,并伴有大量成纤维细胞形成；两组治疗后创面活组织MVD均大于治疗前（NPWT组：t=19．76,P<0．01；对照组：t=4．29,P<0．01)；且NPWT组治疗后MVD变化值大于对照组（t=13．07,P <0．01)。免疫组化及 Western Blot 分析均显示：两组治疗后均存在 VEGF 表达的上调,且 NPWT 组VEGF表达上调幅度较对照组明显（t=11．34, P<0．01；t=13．07,P<0．01)。结论 NPWT较传统纱布换药治疗更能促进糖尿病足VEGF表达的上调及新生血管形成,进而促进创面愈合。%Objective To explore the expression of the vascular endothelial growth factor (VEGF) of diabetic foot wound granulation tissues in negative pressure wound therapy ( NPWT) . Methods 40 patients with diabetic foot ulcers dur-ing January 2010 and December 2014 fitting in the inclusion criteria were enrolled in our study and divided into control group (n=20) treated with conventional gauze therapy and the experimental group (n=20) treated with NPWT, according to com-puter randomized algorithm. Granulation tissue biopsies were taken before (day 0) and after (day 12) treatment respectively. HE staining was applied to observe the growth of the granulation tissue and micro vessel density ( MVD) . The expression of VEGF was evaluated with immunohistochemical staining and Western Blot. Independent sample test was used for statistical analysis. Results Compared with the control group, there were more fresh granulation tissues in the NPWT group, with for-mation of more neovascularizations, which was statistically proved by a significant increase in MVD (t=19. 76,P<0. 01;t=4. 29,P<0. 01). Immunohistochemical analysis revealed that there was a more significant up-regulation in the NPWT group compared with that of the control group (t=13. 34, P<0. 01), which was further confirmed by Western blot analysis (t=13. 07, P<0. 01). Conclusion Compared with conventional gauze therapy, NPWT can promote the up-regulation of VEGF expression of granulation tissues, and subsequently help wound healing.