CAJ | 학술논문

目的观察低能量体外震波(ESW)治疗对糖尿病慢性创面内胶原形成和转化生长因子-β1(TGF-β1)表达的影响,探讨其促进创面愈合的可能机制.方法 6～8周龄雄性SD大鼠,体质量(220 ±20)g,制作糖尿病慢性创面模型64只,随机分为ESW治疗组和糖尿病对照组,另有32只制作正常创面设为正常对照组.在ESW治疗组,在创面术后1d用ESW治疗,糖尿病对照组和正常对照组仅涂抹耦合液,未行ESW治疗.术后记录创面的愈合时间,在治疗后3、7、14 d采集组织标本,进行苏木素-伊红(HE)染色和Masson染色,观察创面组织学变化,并检测创面组织胶原面积密度、羟脯氨酸含量和TGF-β1的表达.结果在治疗后不同时点,与正常对照组比较,糖尿病创面内胶原沉积减少,胶原相对面积密度和羟脯氨酸含量降低(P＜0.05),TGF-β1表达明显下降(P＜0.05).在ESW治疗后,与糖尿病对照组比较,创面内成纤维细胞增多,肉芽组织生成增加,创面内胶原相对面积密度和羟脯氨酸含量均增加(P＜0.05),而与正常对照组比较差异无统计学意义(P＞0.05),TGF-β1含量均较糖尿病对照组高(P＜0.05),并在14 d时出现下降.结论胶原沉积减少是糖尿病创面愈合不良的一个重要原因,ESW治疗可增加创面内TGF-β1的表达,并促进创面内成纤维细胞的迁移或增殖,使创面组织内的胶原形成和羟脯氨酸含量增加,加快肉芽组织的生成和创面的愈合过程.
목적 관찰저능량체외진파(ESW)치료대당뇨병만성창면내효원형성화전화생장인자-β1(TGF-β1)표체적영향,탐토기촉진창면유합적가능궤제.방법 6～8주령웅성SD대서,체질량(220 ±20)g,제작당뇨병만성창면모형64지,수궤분위ESW치료조화당뇨병대조조,령유32지제작정상창면설위정상대조조.재ESW치료조,재창면술후1d용ESW치료,당뇨병대조조화정상대조조부도말우합액,미행ESW치료.술후기록창면적유합시간,재치료후3、7、14 d채집조직표본,진행소목소-이홍(HE)염색화Masson염색,관찰창면조직학변화,병검측창면조직효원면적밀도、간포안산함량화TGF-β1적표체.결과 재치료후불동시점,여정상대조조비교,당뇨병창면내효원침적감소,효원상대면적밀도화간포안산함량강저(P＜0.05),TGF-β1표체명현하강(P＜0.05).재ESW치료후,여당뇨병대조조비교,창면내성섬유세포증다,육아조직생성증가,창면내효원상대면적밀도화간포안산함량균증가(P＜0.05),이여정상대조조비교차이무통계학의의(P＞0.05),TGF-β1함량균교당뇨병대조조고(P＜0.05),병재14 d시출현하강.결론 효원침적감소시당뇨병창면유합불량적일개중요원인,ESW치료가증가창면내TGF-β1적표체,병촉진창면내성섬유세포적천이혹증식,사창면조직내적효원형성화간포안산함량증가,가쾌육아조직적생성화창면적유합과정.
Objective To investigate the effect of low-energy extracorporeal shock wave (ESW)treatment on collagen deposition and transforming growth factor-β1 (TGF-β1) expression in excisional wound of diabetic rats,and the possible mechanism of ESW promoting wound healing.Methods Chronic diabetic wound models were made in 64 6-8-week-old male SD rats weighing (220 ±20) g,and randomly divided into the ESW treatment group and the diabetic control group.Normal wound models were made in 32 SD rats and were used as the normal control group.In ESW treatment group,wound was treated by ESW with 0.11 mJ/mm2,1.5 Hz and 500 pulses one day post-wounding.In diabetic control group and normal control group,wound was only given coupling fluid and received no ESW treatment.Wound closing rate was calculated at 3rd,7th,14th and 21st day after treatment.Wound specimens were harvested to observe histological changes,hydroxyproline contents,density of collagen fibers and TGF-β1 expression.Resuits At different time points after treatment,collagen deposition,the relative density of collagen and hydroxyproline content were decreased in the diabetic control group as compared with those in the normal control group (P ＜ 0.05).At the same time,TGF-β1 expression was significantly decreased in the diabetic control group (P ＜ 0.05).After ESW treatment,fibroblasts and granulation tissue formation were increased,and collagen fibers density and hydroxyproline content in the wound were also increased simultaneously (P ＜ 0.05),and there was no significant difference in collagen fibers density and hydroxyproline content between the ESW group and normal control group (P ＞0.05).In addition,TGF-β1 expression at different time points was increased (P ＜ 0.05) and began to decline at 14th day in the ESW treatment group as compared with that in the diabetic control group.Conclusion The reduced collagen deposition is a major contributor of impaired diabetic wound healing and ESW treatment may increase the expression of TGF-β1,fibroblast migration or proliferation,collagen formation and hydroxyproline content within the wound tissue,and thus accelerate granulation tissue formation and wound healing process.