糖尿病患者与非糖尿病患者下肢烧伤的治疗结局差异性及机制研究

目的探讨合并糖尿病对下肢烧伤患者创面愈合的影响及其可能机制。 方法采用病例对照研究的方法，以汕头市第二人民医院烧伤整形科2010年9月至2013年7月收治的47例合并糖尿病的下肢烧伤患者作为糖尿病组，选取同期60例非糖尿病的下肢烧伤患者作为非糖尿病组。两组患者均采用创面处理、抗感染、基因重组碱性纤维细胞生长因子(bFGF)治疗等常规疗法；糖尿病组加用降糖治疗。采用酶联免疫吸附(ELISA)测定两组患者治疗后7 d创面溃疡组织中的成纤维细胞生长因子2(FGF2)、血管内皮生长因子(VEGF)蛋白及mRNA表达水平；采用免疫组织化学法检测创面组织微血管密度(MVD)差异，并比较两组患者的隔离治疗时间、总住院时间、并发症发生比例及出院后治疗情况。数据比较采用t检验、χ²检验及Fisher确切概率法检验。 结果治疗后7 d，糖尿病组患者的创面组织中FGF2蛋白(87.4±7.8) ng/mL，VEGF蛋白(106.3±14.2) ng/mL表达水平均高于非糖尿病组患者(61.3±9.2) ng/mL、(68.8±13.1) ng/mL，比较差异均有统计学意义(t＝15.55、19.88，P值均小于0.01)；糖尿病组患者的FGF2 mRNA(11.5±4.7)×10⁴拷贝数、VEGF mRNA(8.7±3.9)×10⁴拷贝数表达水平高于非糖尿病组患者(4.9±2.6)×10⁴拷贝数、(2.8±1.7)×10⁴拷贝数，比较差异均有统计学意义(t＝9.23、10.52，P值均小于0.01)；糖尿病组患者创面组织中MVD(14.6±2.5)个/视野低于非糖尿病组的(23.9±5.4)个/视野，比较差异有统计学意义(t＝11.83，P<0.01)。糖尿病组患者的隔离治疗时间(8.9±7.2)d与非糖尿病组(8.6±6.5)d比较，差异无统计学意义(P>0.05)；总住院时间(16.3±5.5)d长于非糖尿病组患者(10.8±4.8)d，差异有统计学意义(P<0.05)。糖尿病组患者的并发症发生比例31.9%高于非糖尿病组患者13.3%，差异有统计学意义(P<0.05)。糖尿病组患者需家庭护理、社区治疗、康复设施的比例均高于非糖尿病组患者，差异均有统计学意义(P值均小于0.05)。 结论合并糖尿病下肢烧伤患者的创面组织中MVD低表达表明创面愈合血管化受到抑制，这可能是延缓糖尿病患者创面愈合的原因之一，同时合并糖尿病还会增加患者的并发症，对烧伤患者恢复产生不良影响。

Treatment differences and mechanism of diabetes mellitus patients and non-diabetes mellitus patients with lower extremity burns

ObjectiveTo discuss on lower extremity wound healing of burn patients with diabetes mellitus and its possible mechanism. MethodsWith the method of case-control study, 47 cases of diabetic patients with lower extremity burns were set as the diabetic group, 60 cases of non-diabetic lower limb burn patients were set as non-diabetic group. Two groups of the patients were admitted to the department of burns and plastics surgery, the second People′s hospital of Shantou from July 2013 to September 2010. Two groups of patients were treated with conventional therapy such as wound treatment, anti infection, gene recombinant basic fibroblast growth factor (bFGF) treatment and so on. In addition, the patients of diabetes group were treated with hypoglycemic therapy. The protein and mRNA expression levels of the fibroblast growth factor 2 (FGF2), vascular endothelial growth factor (VEGF) were measured with the enzyme linked immunosorbent assay (ELISA) in two groups of patients at the time of 7 days after treatment. Tissue microvessel density (MVD) was detected by immunohistochemistry. Isolation treatment time, total length of stay, incidence of complications and treatment outcome were compared between the two groups. The data were compared with the t test, the Chi square test and the Fisher exact probability test. ResultsTreatment after 7 days, the expression levels of FGF2 protein, VEGF protein in diabetes group (87.4±7.8) ng/mL, (106.3±14.2) ng/mL were significantly higher than the non-diabetes group (61.3±9.2) ng/mL, (68.8±13.1) ng/mL, the differences were statistically significant (t=15.55, 19.88, P values were less than 0.01). The expression levels of FGF2 mRNA, VEGF mRNA in diabetes group (11.5±4.7)×10⁴ copies, (8.7±3.9)×10⁴ copies were significantly higher than the non-diabetes group(4.9±2.6)×10⁴ copies, (2.8±1.7)×10⁴ copies, the differences were statistically significant (t=9.23, 10.52, P values were less than 0.01). The wound tissue MVD in diabetes group (14.6±2.5)/vision were less than the non-diabetes group (23.9±5.4)/vision, the difference was statistically significant (t=11.83, P value was less than 0.01). There was no significant difference (P value was more than 0.05) in the isolation treatment time between the diabetes group (8.9±7.2) d and non-diabetes group (8.6±6.5)d. There was significant difference (P value was more than 0.05) in total length of stay between the diabetes group (16.3±5.5)d and non-diabetes group(10.8±4.8)d. The incidence of complications in the diabetic group (31.9%) was higher than that in the non-diabetic group(13.3%), and the difference was statistically significant (P value was less than 0.05). The proportion of family care, community treatment and rehabilitation facilities in the diabetes group was higher than that in the non-diabetic group, and the difference was statistically significant (P value was less than 0.05). ConclusionsThe wound tissue in diabetic patients with lower extremity burns in the low expression of MVD showed that wound healing angiogenesis had been inhibited, which may be one of the causes of delayed wound healing in diabetes. While diabetes will increase the complications of patients, which have adverse effects on the recovery of burn patients.