摘要
目的探讨脐带间充质干细胞(UCMSCs)对重度糖尿病足溃疡(DFU)患者创面愈合的改善作用及其对肝肾功能的影响。方法选择2019年6月于新乡市第二人民医院伤口治疗科接受常规治疗的1例女性DFU患者为研究对象,入院时患者创面宽度约为2 cm,长度8 cm,第1跖骨处向内连接,中间约有0.5 cm距离,正常组织暴露约有1/5,第3~5跖骨处全部被坏死组织覆盖,创面周围结痂较硬且厚,无法进行剥离。常规治疗同时进行UCMSCs创面周围局部注射治疗。于UCMSCs治疗当天(第0天),距伤口处1 cm范围内注射UCMSCs 1.0×10^(7)个;于治疗第3、6天,距创面3 cm处围绕全足注射UCMSCs 1.0×10^(7)个;于治疗第9、10天,距创面5 cm处围绕全足注射UCMSCs 1.5×10^(7)个;于第15、18天,围绕脚踝处注射UCMSCs 2.0×10^(7)个。分别于治疗第1、10、25天,检测患者血常规;于治疗第1、25天,检测患者肝功能和肾功能。于治疗第32、40、46,54、62、70天,对患者进行随访观察。结果治疗第3天,创面脂肪坏死组织较多,第1跖骨处有向内愈合迹象,但未连接,正常组织暴露仍约有1/5,第3~5跖骨处创面均被坏死组织覆盖,创面周围结痂较硬且厚,无法进行剥离。治疗第12天,第1跖骨处已愈合,第2跖骨处开始向内生长,中间缝隙约有0.5 cm,创面周围出现结痂痕迹,未结痂处开始有向内生长的痕迹,创面后部脓胎较重,异味减轻。治疗第21天,第1跖骨处彻底愈合,第2跖骨处基本愈合,结痂痕迹较之前减弱,未结痂处逐渐向内生长,创面处脓性分泌物和异味进一步减轻。治疗第27天,创面周围结痂基本消失,未结痂处逐渐向内生长明显,创面后部脓性分泌物和异味均较治疗第21天时进一步改善。患者血常规C-反应蛋白水平随着UCMSCs移植呈明显下降趋势;UCMSCs移植对患者肝肾功能无不良影响。结论UCMSCs可通过抑制炎症、促进肉芽形成以及协助愈后组织重塑、防止瘢痕形成等作用促进糖尿病患者重度DFU创面修复。
Objective To investigate the effect of umbilical cord mesenchymal stem cells(UCMSCs)transplantation on promoting wound healing of severe diabetic foot ulcer(DFU)and its effect on the function of liver and kidney.Methods A female patient with DFU who received routine treatment at Department of Wound Treatment,the Second People′s Hospital of Xinxiang in June 2019 was selected as the research subject.On admission,the width and length of the patient′s wound were about 2 cm and 8 cm,the first metatarsal was connected inward,with a distance of about 0.5 cm,and about 1/5 of the normal tissue was exposed.The metatarsal bones from 3 rd to 5 th were almost covered by necrotic tissue,and the scab around the wound was hard and thick,which could not be dissected.The day of UCMSCs treatment was recorded as day 0 of treatment.At day 0 of treatment,UCMSCs(1.0×10^(7))were injected within 1 cm around the wound;at the 3 rd day and 6 th day of treatment,UCMSCs(1.0×10^(7))were injected around the whole foot within 3 cm from the wound;at the 9 th day and 12 th day of treatment,UCMSCs(1.5×10^(7))were injected around the whole foot within 5 cm from the wound;at 15 th day and 18 th day of treatment,UCMSCs(2.0×10^(7))were injected around the ankle.The routine blood of the patient were detected at the 1 st,10 th and 25 th day of treatment,respectively;the liver and kidney function of the patient were examined at the 1 st and 25 th day of treatment.The follow-up was performed at the 32 th,40 th,46 th,54 th,62 th and 70 th day of treatment,respectively.Results At the 3 rd day of treatment,there were many adipose necrotic tissues on the wound surface,and signs of inward healing at the first metatarsal bone was observed,but it was not no connected,about 1/5 of the normal tissues were still exposed.The metatarsal bones from 3 rd to 5 th were almost covered by necrotic tissue,and the scab around the wound was hard and thick,which could not be dissected.At the 12 th day of treatment,the first metatarsal was healed,the second metatarsal began to grow inward,and the gap was about 0.5 cm.Scab traces appeared around the wound,and there were signs of ingrown growth in the unscabbed area.The pus was heavier at the back of the wound,and the odor was relieved.At the 21 th day of treatment,the first metatarsal healed completely,the second metatarsal almost healed.The scab trace was weakened compared with that before the 21 th day of treatment,the unscabbed area gradually grew inward,and the pus and odor at the wound surface were further reduced.At the 27 th day of treatment,the scab around the wound almost disappeared,and the unscabbed area grew inward obviously.The pus and peculiar smell at the back of the wound were further improved compared with that at the 21 th day of treatment.Simultaneously,the result of routine blood tests showed that the concentration of C-reactive protein had a significant decrease after UCMSCs transplantation;the UCMSCs transplantation have no significant side effect on the liver and kidney functions.Conclusion UCMSCs treatment can promote wound repair of patient with DFU by inhibiting inflammation,promoting granulation formation and assisting tissue remodeling to prevent scar formation.
作者
毛水红
张家鹏
张勇超
徐功志
吕璐
任新华
孙钰椋
赵东轮
刘彦礼
郭志坤
MAO Shuihong;ZHANG Jiapeng;ZHANG Yongchao;XU Gongzhi;LYU Lu;REN Xinhua;SUN Yuliang;ZHAO Donglun;LIU Yanli;GUO Zhikun(Henan Key Laboratory of Medical Tissue Regeneration,Xinxiang Medical University,Xinxiang 453003,Henan Province,China;Department of Wound Treatment,the Second People′s Hospital of Xinxiang,Xinxiang 453002,Henan Province,China;Henan Intercell Biotechnology co.LTD,Xinxiang 453000,Henan Province,China)
出处
《新乡医学院学报》
CAS
2021年第7期639-644,共6页
Journal of Xinxiang Medical University
关键词
脐带间充质干细胞
糖尿病足溃疡
干细胞治疗
创面愈合
umbilical cord mesenchymal stem cells
diabetic foot ulcer
stem cell based therapy
wound healing
