联合应用rhGM-CSF和莫匹罗星于烧伤后残余创面的疗效观察

目的:观察烧伤后残余创面联合应用rhGM-CSF、莫匹罗星的疗效及局部不良反应。方法:选择2014年4月-2015年4月收治的60例烧伤后残余创面患者,采用同体对照的研究方法,每例患者选取2处烧伤后残余创面,随机分为联合治疗组(n=60)和对照组(n=60),2组受试创面面积比较差异无统计学意义(P>0.05),具有可比性。联合治疗组创面外用rhGM-CSF凝胶剂及莫匹罗星软膏,对照组创面外用莫匹罗星软膏。观察两组创面分泌物、炎症反应、肉芽组织的变化及局部不良反应。观察治疗后7,14 d的创面细菌清除率及创面愈合率,记录创面愈合时间。选择10例患者于治疗前及治疗后7,14 d切取创面边缘组织标本,免疫组化法检测TNF-α、IL-1β的表达水平。结果:与对照组相比较,联合治疗组创面分泌物明显减少,炎症反应减轻,肉芽组织较为鲜红。未观察到明显局部不良反应。治疗7,14 d后的创面细菌清除率联合治疗组为(45±11)%、(92±9)%,均高于对照组(28±12)%、(70±11)%,P<0.05]。联合治疗组创面愈合率分别为(68±14)%、(97±10)%,均高于对照组(53±12)%、(89±13)%,P<0.05]。联合治疗组创面平均愈合时间为(12±2)d,明显短于对照组(14±3)d,P<0.001]。治疗前2组创面TNF-α、IL-1β积分光密度(IOD值)均无显著差异(P>0.05)。治疗后7,14 d联合治疗组创面TNF-α和IL-1β IOD值分别为2740±248,1385±116和7876±596,4185±399,均低于对照组(3419±178,2112±297和9912±578,6657±412,P<0.001)。结论:联合应用rhGM-CSF、莫匹罗星能促进烧伤后残余创面愈合,可能与其抑制细菌生长及创面TNF-α、IL-1β的过度表达有关。

Effects of rhGM-CSF combined with mupirocin on residual burn wounds

OBJECTIVE To investigate efficacy and local side effects of rhGM-CSF hydrogel combined with mupirocin ointment on residual burn wounds. METHODS Sixty patients with residual burn wounds in were enrolled from April 2014 to April 2015.Two residual burn wounds were selected from every patient and were randomly divided into combination group (n=60, rhGM-CSF gel combined with mupirocin ointment) and control group (n=60,only mupirocin ointment).No significant difference was observed in wound area between 2 groups (P>0.05).Wound secretion, inflammation,granulation tissues and local side effects were investigated.Wound bacterial clearance rate and healing rate were determined 7 and 14 days after treatment. Wound healing time was recorded.Wound tissue samples (n=10) were collected before,7 and 14 days after treatment for evaluation of changes of TNF-α and IL-1β by immunohistochemistry. RESULTS Compared with control group, wound secretion and inflammation were decreased and granulation tissues were more healthy in combination group.Obvious side effects were not investigated.Seven and 14 days after treatment, wound bacterial clearance rate in combination group was (45±11)% and (92±9)%,respectively, higher than in control group(28±12)% and (70±11)%,P<0.05].Seven and 14 days after treatment,wound healing rate in combination group was (68±14)% and (97±10)%,respectively, higher than in control group(53±12)% and (89±13)%,P<0.05].Average wound healing time in combination group was (12±2) days,significantly shorter than in control group(14±3) days,P<0.001].Before treatment, no significant difference was observed in integral optical density(IOD) of TNF-α and IL-1β in wound tissues between two groups (P>0.05).Seven and 14 days after treatment,IOD of TNF-α (2740±248 and 1385±116) and IL-1β (7876±596 and 4185±399) were obviously decreased in combination group compared with control group (TNF-α:3419±178 and 2112±297; IL-1β:9912±578 and 6657±412) (P<0.001 in all). CONCLUSION rhGM-CSF combined with mupirocin can accelerate healing of residual burn wounds,which may be associated with inhibiting effects against bacterial growth and over expression of TNF-α and IL-1β in wound.