糖尿病足部非缺血性溃疡皮肤血管内皮生长因子受体3的表达☆

背景：糖尿病足部溃疡的发病机制和溃疡修复的机制尚不清楚，有研究表明和炎症反应延迟有关，而炎症和淋巴管形成关系密切。目的：探讨糖尿病足部非缺血性溃疡淋巴管内皮标志物血管内皮生长因子受体3表达。 设计、时间及地点：分组对比观察，于2007-06/2008-05在南方医科大学南方医院内分泌代谢科完成。材料：标本来自2007-05/2008-03南方医院内分泌代谢科、急诊科、创骨科患者自愿捐献皮肤组织。分为正常对照组10例，男6例，女4例，平均年龄（51.2±4.1）岁；非糖尿病足溃疡组10例，男6例，女4例，平均年龄（55.2±4.7）岁，溃疡出现时间为（67.3±10.1）d；糖尿病足溃疡组10例，男5例，女5例，平均年龄（52.3±4.7）岁，溃疡出现时间为（64.0±10.4）d。方法：采用半定量反转录-聚合酶链反应的方法检测3组皮肤中血管内皮生长因子受体3mRNA的表达。采用免疫组织化学的方法检测以上3组皮肤中血管内皮生长因子受体3蛋白表达。主要观察指标：①反转录-聚合酶链反应结果。②免疫组织化学各组阳性细胞定位，表皮组织中阳性细胞数量，真皮组织中积分吸光度值。结果：与正常对照组比较，非糖尿病足溃疡组血管内皮生长因子受体3mRNA表达增加（P < 0.001），糖尿病足溃疡组表达减少（P < 0.001）。正常组皮肤表皮层基底层细胞中可见明显的阳性细胞，非糖尿病足溃疡组和糖尿病足溃疡组表皮层基底层细胞阳性信号消失。正常对照组、非糖尿病足溃疡组和糖尿病足溃疡组真皮组织中血管内皮生长因子受体3积分吸光度值比较，差异有非常显著性意义（82.800±1.643，179.400±2.608，71.800±3.347，P < 0.01）。结论：糖尿病足非缺血性溃疡血管内皮生长因子受体3表达减少，提示淋巴管形成减少。

Expression of vascular endothelial growth factor 3 in non-ischemic diabetic foot ulcer

BACKGROUND: Pathogenesis and mechanism of diabetic foot ulcer repair is unknown. Some studies show that there is a relation between diabetic foot and delay of inflammation. And delay of inflammation is closely related to lymphangiogenesis.OBJECTIVE: To explore the expression of vascular endothelial growth factor (VEGFR) 3, non-ischemic ulcer lymphatic vessel endothelium marker, in diabetic foot.DESIGN, TIME AND SETTING: Grouping comparison and observation was performed at the Department of Endocrinology, Nanfang Hospital of Southern Medical University from Jun 2007 to May 2008. MATERIALS: Samples of skin tissues were provided by volunteer patients from Department of Emergency, Endocrinology and Orthopedics, Nanfang Hospital. There were three groups: Normal control group, including 6 males and 4 females with an average age of (51.2±4.1) years; Non-diabetic foot group, including 6 males and 4 females with an average age of (55.2±4.7) years and disease course of (67.3±10.1) days; Diabetic foot group, including 5 males and 5 females with an average age of (52.3±4.7) years and disease course of (64.0±10.4) days. METHODS: The gene expression of VEGFR3 was detected by RT-PCR. The expression of protein VEGFR 3 was determined by immunohistochemistry. MAIN OUTCOME MEASURES: RT-PCR results; positive cell localization, quantity of positive cells in epidermis, and integral optical density value in derma.RESULTS: Compared with normal control group, the gene expression of VEGFR 3 in non-diabetic foot group was significantly increased (P < 0.01), while in diabetic foot group was significantly decreased (P < 0.001). Positive cells were found in normal skin cuticular layer and basilar membrane cells, while no were found in the other two groups. The integral optical density value in control, non-diabetic foot and diabetic foot groups was 82.800±1.643, 179.400±2.608, and 71.800±3.347, which were significantly different (P < 0.001).CONCLUSION: The expression of VEGFR 3 is decreased in diabetic foot group, indicating there is decrease in lymphangiogenesis in diabetic foot ulcer.