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2017年第3期
富血小板血浆促糖尿病创面愈合机制的初步研究
Preliminary study of the promotion mechanism of platelet-rich plasma to diabetic wound healing
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DOI:
作者:
李立,柴益民
LI Li,CHAI Yimin
作者单位:
上海市第一人民医院骨科 上海市第六人民医院骨科
Department of Orthopedics, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai 200080, China Department of Orthopedics, Shanghai Sixth People’s Hospital, Shanghai Jiaotong University, Shanghai 200233, China
关键词:
富血小板血浆;糖尿病创面;NLRP3炎症复合物;IL-1β
Platelet-rich plasma; Diabetic wound; NLRP3 inflammasome; IL-1β
摘要:
目的 探讨富血小板血浆促进糖尿病创面愈合与NLRP3炎症复合物/IL-1β信号通路的关系,旨在为糖尿病难愈性创面的研究提供新思路和治疗方案。 方法 共选取15例病人的组织标本,每组5例:(1)在糖尿病足截肢治疗患者中(Wagner IV级、V级),取得截下肢体远端坏死交界区创面组织标记为DMD组、截下肢体近端创面组织标记为DMP组,在非糖尿病截肢患者截下肢体近端创面取得组织标记为NDM组。(2)在糖尿病足保肢患者中(Wagner I级、II级、III级),取得使用富血小板血浆治疗前首次清创时创面组织标记为NPRP组、使用富血小板血浆治疗后创面组织标记为PRP组。对上述五组标本,分别使用Western blot检测NLRP3蛋白表达、ELISA检测IL-1β蛋白表达、RT-PCR检测NLRP3、IL-1β基因表达。 结果 在蛋白表达水平和基因表达水平中均显示:(1)NLRP3、IL-1β在糖尿病足截下肢体近端创面组织中的表达高于在糖尿病足截下肢体远端坏死交界区创面组织中的表达,且两者均明显高于NLRP3、IL-1β在非糖尿病患者截下肢体近端创面组织中的表达,具有统计学差异(P<0.05)。说明在糖尿病创面中NLRP3、IL-1β表达增加。(2)在糖尿病创面中,NLRP3、IL-1β在使用富血小板血浆治疗前创面组织中的表达高于其在使用富血小板血浆治疗后创面组织中的表达,具有统计学差异(P<0.05)。说明使用富血小板血浆治疗能够降低糖尿病创面中NLRP3、IL-1β的表达。 结论 (1)NLRP3炎症复合物/IL-1β信号通路上调可能是阻碍糖尿病创面愈合的因素。(2)富血小板血浆通过对NLRP3炎症复合物/IL-1β信号通路产生抑制,能加快糖尿病创面愈合进程,是富血小板血浆促进糖尿病创面愈合的机制之一。
Objective To explore the related promotion mechanism of platelet-rich plasma to the process of diabetic wound healing through NLRP3 inflammasome / IL-1β signaling pathway. And aim to provide new ideas for the research and clinical treatment of diabetic wound. Methods (1) In patients with severe diabetic foot ulcer who need amputations treatment (Wagner IV, Wagner V), obtain amputated limbs distal necrosis border area wound tissue named as DMD group, proximal wound tissue of amputated limbs in diabetic patients named as DMP group, proximal wound tissue of amputated limbs in non-diabetic patients named as NDM group. (2) In patients with mild diabetic foot who own limb-salvage indications (Wagner I, Wagner II, Wagner III), obtain wound tissue in the first debridement time before using of platelet-rich plasma named as NPRP group, after using of platelet-rich plasma therapy, and obtain wound tissue in the next debridement time as PRP group. Through ELISA, Western blot and Realtime-PCR method to detect the expression level of NLRP3 and IL-1β in this five groups of tissue samples. Result (1) With statistically difference (P < 0.05), the expression of NLRP3 and IL-1β in diabetic patients proximal wound tissue of amputated limbs is higher than in diabetic foot amputated limbs distal necrosis border area wound tissue, and both were significantly higher than the expression of NLRP3 and IL-1β in non-diabetic proximal wound tissue of amputated limbs. (2) With statistically difference (P < 0.05), taking use of platelet-rich plasma treatment can reduce the expression of NLRP3 and IL-1β in diabetic wound. Conclusion (1) NLRP3 inflammasome / IL-1β signaling pathway is one of the factors affecting the process of diabetic wound healing. (2) Platelet-rich plasma accelerate the process of diabetic wound healing by the inhibition of NLRP3 inflammasome / IL-1β signaling pathways, this may be one of the mechanisms of platelet rich plasma promoting diabetic wound healing.
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