利用组织工程双层皮肤修复糖尿病溃疡的研究

目的 探讨组织工程双层皮肤修复糖尿病溃疡的效果.方法 利用同种异体的皮肤表皮细胞和皮肤成纤维细胞分别作为表皮和真皮的种子细胞制备组织工程双层皮肤,选取已制备的溃疡面积相当的糖尿病溃疡动物模型20例,随机分为实验组和对照组各10例,临床选取26例溃疡面积差异无统计学意义的糖尿病患者,随机分为试验组和对照组各13例,分别将制备的皮肤用于动物模型和用于临床糖尿病足溃疡患者,同时控制血糖,对溃疡进行清创处理,以制备的组织工程双层皮肤覆盖创面,行常规护理;对动物模型的创面愈合情况和临床创面愈合效果分别进行统计和分析.结果 动物实验中,实验组愈合速度明显快于对照组,平均愈合时间较对照组提前6d,实验组与对照组愈合时间差异有统计学意义（F=0.178,P＞0.05,方差齐,t=-10.919,P＜0.05）;移植4周时,实验组愈合率为60％,对照组10例均未完全愈合,愈合率为0,两组愈合率比较差异有统计学意义（t=0.011,P＜0.05）.临床试验中,移植6周时,试验组愈合率为84.6％;对照组愈合率为23.1％,两组比较差异有统计学意义（χ^2=0.001,P＜0.05）.试验组的平均愈合时间为43.25 d,对照组的平均愈合时间为76.69 d,与对照组相比,试验组创面的平均愈合时间缩短了约33 d,对照组的愈合速率较试验组明显缓慢,试验组与对照组的创面愈合时间差异有统计学意义（方差齐性检验结果,χ^2=16.971,P ＜0.05,方差不齐,χ^2=7.649,P＜0.05）.结论 应用组织工程双层皮肤修复糖尿病足溃疡是一种切实可行的临床治疗方法.

Functional tissue engineering bilayered skin substitute for diabetes ulcer repair

Objective To investigate the effect of restoring diabetes ulcer using double layer tissue engineering skin. Methods Two layers tissue engineering skins were prepared using the epidermic cells and fiberblast from the same race as epidermal seeds cells and dermal seeds cells. First,20 animal model were prepared with quite area diabetes ulcer of experimental group and the control group （ n = 10） were set up, and 26 cases of diabetic patients were selected in the clinical selection, respectively, set up the experimental group and the control group （n = 13 ）, then the skins were used in animal models and in patients with clinical diabetic foot ulcer, blood glucose were controlled, and the ulcer debridement were treated, tissue engineering skins were covered in the wound with routine nursing. The effect of clinical wound healing and animal model was statistics and analysed. Results In the experimental group, animal experiments in healing speed is obviously faster than that of the control group, the average healing time was 6 days in advance compared with the controlgroup, the experimental group healing rate was 60% and the control group healing rate was 0 at 4 weeks, P 〈 0. 05, significant difference, the clinical trials, 6 weeks after transplantation, test group healing rate was 84.6%, and it was 23. 1% in the control group, P 〈 0.05, significant differences in test group, the average healing time was 33 days in advance compared with the controlgroup, P 〈 0.05, significant difference. Conclusion It is a feasible clinical treat method to restore diabetes ulcer using double layer tissue engineering skin.