藻酸盐敷料与mEGF联合应用对难愈性创面bFGF影响的随机对照试验

目的:探讨联合应用藻酸盐敷料(alginate dressing)与冻干鼠表皮生长因子(mouse epidermal growth fac-tor,mEGF)对难愈性创面碱性成纤维细胞生长因子(basic fibroblast grow thfactor,bFGF)表达的影响,评价其疗效。方法:采用前瞻性、随机、对照设计方法,选择经常规换药抗炎治疗1个月创面仍未愈合的18例患者,年龄18～61岁,平均36.4岁;男12例,女6例;足部11例,小腿3例,手4例。随机分成3组:藻酸盐敷料与mEGF联合治疗组(A组)、mEGF治疗组(B组)、常规治疗组(C组),每组6例。治疗7、14、21、28d后评价其创面愈合指数,7d和14d时行活组织检查常规病理学观察,免疫组织化学SP法评定bFGF表达阳性细胞数目。结果:A、B组创面愈合均明显,A组较B组突出(P<0.05)。病理学检查显示:A组创面修复细胞增殖明显,表皮增厚,上皮化活跃;B组虽也有类似改变,但不如A组显著。免疫组织化学SP染色显示:3组bFGF表达均有上调,但以A组最为显著(P<0.05)。结论:藻酸盐敷料与mEGF联合应用治疗难愈性创面,能协同两者优势,较单用mEGF疗效更佳。

Effects of alginate dressing and mouse epidermal growth factor combination therapy on expression of basic fibroblast growth factor in patients with refractory wound:a randomized controlled trial

Objective:To explore the influence of alginate dressing and mouse epidermal growth factor(mEGF) combination therapy on expression of basic fibroblast growth factor in patients with refractory wound and evaluate its clinical effect.Methods:Eighteen patients of skin defects treated by change dressing for one month in this study.There were 12 males and 6 females aged from 18 to 61 years(mean 36.4 years).The wounds occurred at foot in 11,calf in 3 and the hand in 4.The patients were randomly divided into 3 groups(there were 6 cases in every group):alginate dressing and mEGF group(group A),mEGF group(group B) and control group(group C).Wound closure indexes were measured in 7,14,21,28 days.The samples were harvested in 7,14 days for pathologic examination and the positive staining cells of basic fibroblast growth factor(bFGF) were determined by SP immunohistochemical staining technique.Results:Wound healing was promoted in group A and group B and the wound closure indexes was increased in group A(P<0.05).Pathological examination showed the epidermis was thicker in group A than that in group B.Treatment by the alginate dressing combined with the mEGF,angiogenesis was active and granulation was enhanced.The expression of the bFGF was shown in the fibroblasts,the blood capillaries and the basal layer of the epidermis in group A,B and C.There was significant difference between group A and group B(P<0.05),group B and group C(P<0.05).Conclusion:Combination therapy of alginate dressing and mEGF have a better results than that with mEGF only in patients with refractory wound.