摘要
目的 观察脐带间充质干细胞移植(UCMSCs)联合负压封闭引流技术(VSD)治疗糖尿病足溃疡(DFU)的疗效。方法纳入2020年5月至2022年5月邯郸市中心医院收治的86例DFU病人,根据随机数字表法分为引流组(43例)和联合组(43例)。其中引流组给予VSD,联合组给予UCMSCs联合VSD。比较两组创面愈合时间及创面愈合率,足部相关指标[足背动脉血管内径、血流速度、踝肱指数(ABI)],周围血管恢复情况[密歇根神经体征评分(MNSI)、CT血管造影(CTA)检查],炎症指标[C反应蛋白(CRP)、白细胞(WBC)、中性粒细胞百分比(NEU%)],肾功能(尿酸、肌酐)及临床疗效。结果 联合组创面愈合率[(68.42±6.95)%比(52.78±5.35)%]明显高于引流组(P<0.05),创面愈合时间[(27.34±2.76)d比(31.46±3.25)d]明显低于引流组(P<0.05);引流组和联合组治疗后足背动脉血管内径[(1.95±0.21)mm比(1.86±0.17)mm,(2.10±0.35)mm比(1.82±0.15)mm]、ABI(0.87±0.26比0.61±0.15,0.75±0.21比0.64±0.17)均明显升高(P<0.05),且与引流组比较,联合组明显升高(P<0.05);与治疗前比较,引流组和联合组治疗后足背动脉血流速度[(47.35±4.75)cm/s比(52.75±5.32)cm/s,(41.78±4.27)cm/s比(52.14±5.26)cm/s]、MNSI评分(4.68±0.51比5.74±0.61,4.12±0.42比5.89±0.65)、CRP[(35.78±3.62)mg/L比(41.78±4.25)mg/L,(29.36±3.02)mg/L比(2.14±4.31)mg/L]、WBC[(7.58±0.79)×10^(9)/L比(9.45±1.06)×10^(9)/L,(6.42±0.67)×10^(9)/L比(9.12±1.01)×10^(9)/L]、NEU%[(64.31±6.53)%比(69.72±7.02)%,(58.14±5.86)%比(70.54±7.11)%]水平均明显降低(P<0.05),且与引流组比较,联合组明显降低(P<0.05);联合组总有效率(95.35%)明显高于引流组(72.09%),联合组临床疗效优于引流组(Z=2.09,P<0.05)。结论UCMSCs联合VSD治疗DFU可有效减轻炎症反应,改善临床症状,促进创面恢复,效果较好。
Objective To observe the efficacy of umbilical cord mesenchymal stem cells(UCMSCs)transplantation combined with vacuum sealing drainage(VSD)for diabetic foot ulcer(DFU).Methods Eighty-six DFU patients admitted to Handan Central Hospital from May 2020 to May 2022 were randomly assigned into a drainage group(n=43)and a combination group(n=43)using a random num-ber table method.The drainage group was given VSD,while the combination group was given UCMSCs combined with VSD.A compari-son was made of the wound healing time and wound healing rate,foot-related indicators[inner diameter of the dorsal foot artery,blood flow velocity,ankle-brachial index(ABI)],peripheral blood vessel recovery[Michigan Neuropathy Screening Instrument(MNSI),CT an-giography(CTA)],inflammatory indicators[C-reactive protein(CRP),white blood cells(WBC),percentage of neutrophils(NEU%)],renal function(uric acid,creatinine)and clinical efficacy between the two groups.Results The wound healing rate of the combination group[(68.42±6.95)%vs.(52.78±5.35)%]was significantly higher than that of the drainage group(P<0.05),and the wound healing time[(27.34±2.76)d vs.(31.46±3.25)d]was significantly lower than that of the drainage group(P<0.05).After treatment,the inner di-ameters of the dorsal foot artery[(1.95±0.21)mm vs.(1.86±0.17)mm,(2.10±0.35)mm vs.(1.82±0.15)mm]and ABI(0.87±0.26 vs.0.61±0.15,0.75±0.21 vs.0.64±0.17)were significantly increased in both the drainage group and the combination group(P<0.05),and compared with the drainage group,the combination group showed a more significant increase(P<0.05).Compared with pretreatment,the posttreatment blood flow velocity of the dorsal foot artery[(47.35±4.75)cm/s vs.(52.75±5.32)cm/s,(41.78±4.27)cm/s vs.(52.14±5.26)cm/s],MNSI score(4.68±0.51 vs.5.74±0.61,4.12±0.42 vs.5.89±0.65),CRP[(35.78±3.62)mg/L vs.(41.78±4.25)mg/L,(29.36±3.02)mg/L vs.(2.14±4.31)mg/L],and WBC[(7.58±0.79)×10^(9)/L vs.(9.45±1.06)×10^(9)/L,(6.42±0.67)×10^(9)/L vs.(9.12±1.01)×10^(9)/L],NEU%[(64.31±6.53)%vs.(69.72±7.02)%,(58.14±5.86)%vs.(70.54±7.11)%]in both groups were significantly reduced(P<0.05),and compared with the drainage group,the combination group showed a more significant decrease(P<0.05).The total effective rate of the combination group(95.35%)was significantly higher than that of the drainage group(72.09%),and the clinical efficacy of the com-bination group was better than that of the drainage group(Z=2.09,P<0.05).Conclusion UCMSCs combined with VSD for DFU can effectively reduce inflammation,ameliorate clinical symptoms,and promote wound recovery,which achieves better effect.
作者
王小飞
高素文
张贞
WANG Xiaofei;GAO Suwen;ZHANG Zhen(Department of Burns and Plastic Surgery,Handan Central Hospital,Handan,Hebei 056001,China;Department Two of Endocrinology,Handan Central Hospital,Handan,Hebei 056001,China;Department Six of General Surgery,Handan Central Hospital,Handan,Hebei 056001,China)
出处
《安徽医药》
CAS
2024年第4期777-781,I0004,共6页
Anhui Medical and Pharmaceutical Journal
基金
邯郸市科学技术研究与发展计划项目(21422083135)。
关键词
糖尿病足
溃疡
负压封闭引流技术
脐带间充质干细胞
疗效
Diabetic foot
Ulcer
Vacuum sealing drainage
Umbilical cord mesenchymal stem cells
Curative effect
