中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2011年
45期
3214-3218
,共5页
马辕华%雷永红%周敏%李雪%赵宏宇
馬轅華%雷永紅%週敏%李雪%趙宏宇
마원화%뢰영홍%주민%리설%조굉우
高压氧%导管插入术,外周%干细胞%创伤和损伤
高壓氧%導管插入術,外週%榦細胞%創傷和損傷
고압양%도관삽입술,외주%간세포%창상화손상
Hyperbaric oxygenation%Catheterization,peripheral%Stem cells%Wounds and injuries
目的 探讨高压氧(HBO)对中国人下肢创伤后小腿部慢性创面愈合的影响,以及创面愈合与外周循环中CD34+内皮干细胞(EPCs)的相关性.方法 选择119例下肢创伤后小腿部慢性创面病程＞3个月的患者,进行一个随机、单中心和对照的临床研究.其中97例接受HBO治疗,22例接受相同高气压非氧气治疗作为压力效应对照的安慰剂治疗组.每天治疗90 min(总过程120min),每周5d连续4周,观察患者在HBO治疗前、后小腿慢性创面愈合率,流式细胞仪检测其外周循环中CD34+ EPCs细胞平均计数和设门选定的细胞群中CD34 +/Scal-1+,CD34 +/CXCR4细胞的百分比,并统计分析CD34+ EPCs细胞水平与下肢慢性创面愈合速率的相关性.结果 在接受HBO治疗第4周,在HBO治疗和对照组患者下肢创面愈合率差异有统计学意义(62.7％±22.3％vs34.4％±20.6％,P＜ 0.05).经过10次HBO治疗,外周循环中CD34+ EPCs细胞平均计数由HBO治疗前的(0.24±0.03)％升高到(1.32±0.05)％；而经过20次HBO治疗,患者外周循环中CD34+EPCs细胞平均计数为(1.75±0.17)％,较治疗之前差异有统计学意义(P＜0.05).在设门细胞中,HBO治疗20次后CD34 +/Scal-1+,CD34 +/CXCR4细胞百分比分别是HBO治疗前的5.8倍和5.2倍.在压力效应的对照组中,外周循环中CD34+ EPCs细胞没有增加.在经过10次HBO处理后,患者外周循环中CD34+ EPCs细胞数目和下肢创面愈合的相关性之间存在一个显著地正相关性(r2=0.84；P＜ 0.01).结论 HBO治疗可以通过动员外周循环中EPCs促进下肢创伤后慢性创面的愈合.
目的 探討高壓氧(HBO)對中國人下肢創傷後小腿部慢性創麵愈閤的影響,以及創麵愈閤與外週循環中CD34+內皮榦細胞(EPCs)的相關性.方法 選擇119例下肢創傷後小腿部慢性創麵病程＞3箇月的患者,進行一箇隨機、單中心和對照的臨床研究.其中97例接受HBO治療,22例接受相同高氣壓非氧氣治療作為壓力效應對照的安慰劑治療組.每天治療90 min(總過程120min),每週5d連續4週,觀察患者在HBO治療前、後小腿慢性創麵愈閤率,流式細胞儀檢測其外週循環中CD34+ EPCs細胞平均計數和設門選定的細胞群中CD34 +/Scal-1+,CD34 +/CXCR4細胞的百分比,併統計分析CD34+ EPCs細胞水平與下肢慢性創麵愈閤速率的相關性.結果 在接受HBO治療第4週,在HBO治療和對照組患者下肢創麵愈閤率差異有統計學意義(62.7％±22.3％vs34.4％±20.6％,P＜ 0.05).經過10次HBO治療,外週循環中CD34+ EPCs細胞平均計數由HBO治療前的(0.24±0.03)％升高到(1.32±0.05)％；而經過20次HBO治療,患者外週循環中CD34+EPCs細胞平均計數為(1.75±0.17)％,較治療之前差異有統計學意義(P＜0.05).在設門細胞中,HBO治療20次後CD34 +/Scal-1+,CD34 +/CXCR4細胞百分比分彆是HBO治療前的5.8倍和5.2倍.在壓力效應的對照組中,外週循環中CD34+ EPCs細胞沒有增加.在經過10次HBO處理後,患者外週循環中CD34+ EPCs細胞數目和下肢創麵愈閤的相關性之間存在一箇顯著地正相關性(r2=0.84；P＜ 0.01).結論 HBO治療可以通過動員外週循環中EPCs促進下肢創傷後慢性創麵的愈閤.
목적 탐토고압양(HBO)대중국인하지창상후소퇴부만성창면유합적영향,이급창면유합여외주순배중CD34+내피간세포(EPCs)적상관성.방법 선택119례하지창상후소퇴부만성창면병정＞3개월적환자,진행일개수궤、단중심화대조적림상연구.기중97례접수HBO치료,22례접수상동고기압비양기치료작위압력효응대조적안위제치료조.매천치료90 min(총과정120min),매주5d련속4주,관찰환자재HBO치료전、후소퇴만성창면유합솔,류식세포의검측기외주순배중CD34+ EPCs세포평균계수화설문선정적세포군중CD34 +/Scal-1+,CD34 +/CXCR4세포적백분비,병통계분석CD34+ EPCs세포수평여하지만성창면유합속솔적상관성.결과 재접수HBO치료제4주,재HBO치료화대조조환자하지창면유합솔차이유통계학의의(62.7％±22.3％vs34.4％±20.6％,P＜ 0.05).경과10차HBO치료,외주순배중CD34+ EPCs세포평균계수유HBO치료전적(0.24±0.03)％승고도(1.32±0.05)％；이경과20차HBO치료,환자외주순배중CD34+EPCs세포평균계수위(1.75±0.17)％,교치료지전차이유통계학의의(P＜0.05).재설문세포중,HBO치료20차후CD34 +/Scal-1+,CD34 +/CXCR4세포백분비분별시HBO치료전적5.8배화5.2배.재압력효응적대조조중,외주순배중CD34+ EPCs세포몰유증가.재경과10차HBO처리후,환자외주순배중CD34+ EPCs세포수목화하지창면유합적상관성지간존재일개현저지정상관성(r2=0.84；P＜ 0.01).결론 HBO치료가이통과동원외주순배중EPCs촉진하지창상후만성창면적유합.
Objective To evaluate the effects of hyperbaric oxygen(HBO)therapy in the management of chronic wound and observe the correlation between wound healing and CD34 + endothelial progenitor cells(EPCs).Methods A total of 119 patients with chronic wound in lower extremities lasting ＞3 months were recruited for this randomized,single-center,placebo-controlled clinical trial.The changes of CD34 + average count before and after HBO therapy were detected by flow cytometry(FACS).There were 97 patients on long-term HBO therapy and in 22 patients on hyperbaric air therapy as control group.The CD34/Scal-1 + and CD34/CXCR4 dual-positive populations of gated cell were determined respectively by FACs.The outcomes of two groups were compared.Treatment was administered within a single-place hyperbaric chamber for 90-main daily(session duration 120 main)for 5 days a week for 4 weeks (20 treatment sessions).Results The wound size decreased at the4-week end point(62.7％ +22.3％ in the HBO group vs 34.4％ +20.6％ in the control group,P ＜0.05).Mter 10 episodes of HBO therapies for chronic non-healing wound,the peripheral CD34 + EPCs average count rose from 0.24％ + 0.03％ at pretreatment to 1.32％ ±0.05％ while the number was 1.75％ + 0.17％ after 20 episodes of HBO(P ＜ 0.05)Both were significantly different from that of the patients at pre-treatment.However the overall circulating white cell count was not significantly elevated.The CD34/Scal-1 + and CD34/CXCR4 dual-positive populations of gated cell in HBO group were 5.8 and 5.2 folds than those at pre-treatment respectively.The number of EPCs was positively correlated with wound healing in lower extremities(correlation coefficient 0.84 ; P ＜ 0.01).Conclusion Adjunctive treatment of HBO facilitates the healing of chronic non-healing wound in selected patients through the mobilization of EPCs.
