【摘要】 目的:观测糖尿病足部溃疡渗出液中白介素1β(IL-1β)动态变化,探讨用黄芪提取液外敷促进溃疡愈合的可能机理。方法:收集急慢性糖尿病伤口渗出液,用ELISA法检测IL-1β的变化,用酶标仪测定不同剂量IL-1β的变化对成纤维细胞(Fb)增殖能力的影响,观测外敷黄芪提取液治疗过程中IL-1β量的改变,同时观测足部溃疡肉芽开始出现时间(GT)、溃疡愈合时间(HT)、截肢率、病死率的差异。结果:糖尿病足溃疡病人创面渗出液中IL-1β含量为(89.16±38.14)ng/mL,糖尿病急性损伤病人创面渗出液中IL-1β含量为(8.84±7.06)ng/mL,其差异有统计学意义(P<0.01);IL-1β在0.5~5 ng/mL浓度范围可明显促进Fb增殖,随着其浓度增加,这种作用逐渐减弱,当IL-1β为50 ng/mL对Fb增殖没有影响,IL-1β再继续增加时对Fb增殖表现为抑制作用;黄芪外敷组与生理盐水外敷组在治疗前伤口渗出液中IL-1β的浓度在两组间无显著性差异(P>0.05),第1周末黄芪组IL-1β量低于生理盐水组,但两组间仍无显著性差异(P>0.05),自第2周末开始黄芪治疗组伤口渗出液中的IL-1β量均显著低于生理盐水治疗组(P<0.05),并且黄芪治疗组GT和HT亦显著短于生理盐水组(P均<0.01)。黄芪治疗组患者溃疡愈合过程中的GT、HT均与伤口渗出液中IL-1β浓度有显著正相关(P分别为0.7123,0.6866,P均<0.01)。结论:糖尿病足部溃疡难以治愈的原因与伤口渗出液中IL-1β量过高,成纤维细胞增殖能力明显受抑有关,黄芪多糖外敷可以降低伤口渗出液中IL-1β浓度,显著缩短溃疡GT和HT,降低截肢率。更多还原

【Abstract】 Objective:To explore the dynamics of IL-1β level in diabetic ulcer oozes and possible mechanisms underlying topical use of Astragalus extract(Astragalus Polysaccharides,APs) to promote healing.Methods: We determined the level of IL-1β in oozes from acute trauma and chronic diabetic ulcers and the effects of IL-1β on fibroblast proliferation.Dynamics of IL-1β level during topical use of APs were observed.Time to growth of granulation tissue(GT) and healing(HT),rate of amputation and mortality were also compared between groups with and without AP treatment.Results: ①There was a significant difference in IL-1β between oozes from acute traumatic lesion(8.84±7.06) ng/mL and from unhealed diabetic foot ulcer(89.16±38.14) ng/mL(P<0.001),②Over the range from 0.5 ng/mL to 5 ng/mL,IL-1β significantly promoted fibroblast proliferation,but the action gradually declined with increase of IL-1β,and the fibroblast proliferation was inhibited when the level of IL-1β exceeded 50ng/mL.③The level of IL-1β in oozes from wounds was comparable between the group using APs for and the group using normal saline for external application before treatment(P>0.05) and by the end of first week(P>0.05),but was significantly lower in the AP group since the end of second week(P<0.05).In addition,the AP group experience shorter GT and HT as compared with the controls using normal saline(All P<0.01).④IL-1β in wound fluid in patients with diabetic foot ulcer exhibited a significant positive linear with GT and HT(r=0.7123 and 0.6866,all P<0.01).Conclusion: Difficulty healing with chronic diabetic foot ulcers may be related to high concentration of IL-1β in oozes which inhibits fibroblast proliferation.APs for external application may lower IL-1β concentration and shorten the GT and HT of DFU significantly.更多还原