从皮肤屏障功能及血管生成探讨MEBT/MEBO对四肢创伤创面的修复机制

白雪剑 马秀峰 张艺露

[摘要]目的：探討皮肤原位再生医疗技术（Moist exposed burn therapy/moist exposed burn ointment，MEBT/MEBO）对四肢创伤创面皮肤屏障功能及血管生成的影响。方法：选取2017年9月-2019年9月笔者医院110例四肢创伤患者，随机数字表法分组，各55例。对照组施行负压封闭引流技术（Vacuum sealing drainage，VSD），实验组施行MEBT/MEBO。观察两组治疗效果、创面愈合时间、疼痛程度、住院时间及并发症情况，对比治疗前、治疗后两周血管生成指标[微血管密度（Microvessel density，MVD）、血管内皮生长因子（Vascular endothelial growth factor，VEGF）、S100钙结合蛋白A9（Serum calcium-binding protein A9，S100A9）]、皮肤屏障功能[经皮水份丢失量（Transepider-malwaterloss，TEWL）、皮肤表面pH值]，并于治疗后24周随访瘢痕程度（Vancouver scar scale，VSS）。结果：实验组治疗总有效率90.91%高于对照组的74.55%，差异有统计学意义（P<0.05）。实验组创面愈合时间、住院时间短于对照组，VAS评分低于对照组，差异有统计学意义（P<0.05）。治疗后两周实验组肉芽组织中MVD、VEGF、S100A9水平高于对照组，差异有统计学意义（P<0.05）。治疗后两周两组TEWL低于治疗前，皮肤表面pH值高于治疗前，但组间比较差异无统计学意义（P>0.05）。实验组并发症发生率5.45%低于对照组的18.18%，差异有统计学意义（P<0.05）。治疗后24周实验组VSS评分低于对照组，差异有统计学意义（P<0.05）。结论：MEBT/MEBO应用于四肢创伤创面，有助于促进血管生成，减轻疼痛，缩短创面愈合时间，降低并发症，提高治疗效果。

[关键词]四肢创伤;皮肤原位再生医疗技术;负压封闭引流技术;皮肤屏障;微血管密度;血管内皮生长因子;瘢痕

[中图分类号]R622    [文献标志码]A    [文章编号]1008-6455（2021）03-0056-05

Study on the Mechanism of MEBT/MEBO in the Repair of Wounds of Limb from the Function of Skin Barrier and Angiogenesis

BAI Xue-jian1，MA Xiu-feng1，ZHANG Yi-lu2

（1.Department of Orthopaedics No.1;2.Department of Endocrinology，Fuxin General Hospital of Liaoning Health Industry Group，Fuxin 123000，Liaoning，China）

Abstract： Objective  To investigate the effect of moist exposed burn therapy/moist exposed burn ointment （MEBT/MEBO） in situ regenerative medical technology on skin barrier function and angiogenesis in wound repair of limb. Methods  From September 2017 to September 2019， 110 patients with limb trauma in our hospital were selected and grouped by random number table method， 55 cases each. The control group was treated with vacuum sealing drainage （VSD）， and the experimental group was treated with MEBT/MEBO. The treatment effect， time of wound healing， degree of pain （VAS）， hospitalization， and complications of the two groups were observed， and the angiogenesis indicators [microvessel density （MVD）， vascular endothelial growth factor （VEGF）， S100 calcium binding protein A9 （S100A9）]， skin barrier function [transepider-malwaterloss （TEWL）， pH value of skin surface] before treatment and two weeks after treatment were compared， and the degree of vancouver scar scale （VSS） was followed up for 24 weeks after treatment. Results  The total effective rate of treatment in the experimental group was 90.91% higher than that in the control group （74.55%）， the difference was statistically significant（P<0.05）. The time of wound healing and hospitalization of the experimental group were shorter than that of the control group， and the VAS score was lower than that of the control group（P<0.05）. The levels of MVD， VEGF and S100A9 in the granulation tissue of the experimental group were higher than that of the control group at two weeks after treatment（P<0.05）. Two weeks after treatment， the TEWL of the two groups was lower than before， and the pH value on the skin surface was higher than before， but there was no statistically significant difference between the two groups（P>0.05）. The incidence of complications in the experimental group was 5.45% lower than that in the control group （18.18%， P<0.05）. The VSS score in the experimental group was lower than that in the control group at 24 weeks after treatment（P<0.05）. Conclusion  MEBT/MEBO can be used to repair wounds of limb， which can promote angiogenesis， reduce pain， shorten the healing time of wounds， reduce complications and improve the treatment effect.

Key words： limb trauma; moist exposed burn therapy/moist exposed burn ointment（MEBT/MEBO）; vacuum sealing drainage（VSD）; skin barrier; microvessel density（MVD）; vascular endothelial growth factor（VEGF）; scar

四肢创伤主要由外力或暴力引起，多合并骨、肌腱组织外露，若未及时处理，易形成感染创面，增加创面愈合时间，加重患者经济负担[1-2]。传统治疗方法虽具有一定适用价值，但其效果有限。近年随科学技术不断发展与完善，创面修复中引进大量新技术，如负压封闭引流术（Vacuum sealing drainage，VSD）、皮肤原位再生医疗技术（Moist exposed burn therapy/moist exposed burn ointment，MEBT/MEBO），其临床效果已得到临床证实，但关于选取何种治疗方法尚无统一定论[3-4]。新近研究发现，血管内皮生长因子（Vascular endothelial growth factor，VEGF）、S100钙结合蛋白A9（S100A9）可通过抗炎、促进肉芽组织生长及成纤维细胞增殖等途径参与创面愈合[5-6]，但临床鲜少报道VSD、MEBT/MEBO对上述指标改善作用，故本研究检测四肢创伤患者治疗前后S100A9、VEGF水平，旨在明确MEBT/MEBO对血管新生、屏障功能保护作用及机制。……