Objective: To investigate the changes of transforming growth factor β 1 (TGF- β 1) and type Ⅱ of TGF-β-receptor (TβRⅡ) expressions in wound tissue after the treatment of diabetic foot with vaccum sealing drainage (VSD), and to analyze the mechanism of accelerating wound healing.
Methods: Between May 2012 and May 2016, 80 patients with diabetic foot were randomly divided into 2 groups, 40 cases in each group. After the same basic treatment, the wounds of VSD group and control group were treated with VSD and external dressing, respectively. There was no significant difference in gender, age, disease duration, body mass, foot ulcer area, and Wagner grade between 2 groups ( P>0.05). The time of foundation preparation and hospitalization stay of 2 groups were recorded. The wound tissue was collected before treatment and at 7 days after treatment, and the positive indexes of TGF-β 1 and TβRⅡexpressions were measured by immunohistochemical staining.
Results: Before skin grafting, the patients in VSD group were treated with VSD for 1 to 3 times (mean, 2 times), and the patients in control group were treated with dressing change for 1 to 6 times (mean, 4 times). The time of foundation preparation and hospitalization stay in VSD group were significantly shorter than those in control group ( t=-13.546, P=0.036; t=-12.831, P=0.041). The skin grafts of both groups survived smoothly and the wound healed well. Before treatment, immunohistochemical staining results showed that the positive indexes of TGF-β 1 and TβRⅡ expressions in VSD group were 5.3±2.4 and 14.0±2.6, while those in control group were 4.4±2.3 and 14.7±3.1, respectively. There was no significant difference between 2 groups ( t=1.137, P=0.263; t=1.231, P=0.409). At 7 days after treatment, the positive indexes of TGF-β 1 and TβRⅡ expressions in VSD group were 34.3±2.9 and 41.7±3.7, respectively, and those in control group were 5.8±2.0 and 18.1±2.5. There were significant differences between 2 groups ( t=-35.615, P=0.003; t=23.725, P=0.002).
Conclusion: VSD can increase the expressions of TGF-β 1 and TβRⅡ in diabetic ulcer tissue, promote granulation tissue growth, and accelerate wound healing.
目的: 探讨封闭式负压引流技术（vaccum sealing drainage，VSD）治疗糖尿病足后，创面组织中 TGF-β 1 及其Ⅱ型受体（type Ⅱ of TGF-β-receptor，TβRⅡ）表达的变化，分析 VSD 加快创面愈合的机制。.
方法: 将 2012 年 5 月—2016 年 5 月收治的 80 例糖尿病足患者纳入研究，随机分为两组（ n=40）。采用相同基础治疗的同时，VSD 组创面给予 VSD 治疗，对照组给予外用油纱换药治疗。两组患者性别、年龄、病程、体质量、足部溃疡面积以及 Wagner 分级比较，差异均无统计学意义（ P>0.05），具有可比性。记录两组患者创基准备时间、住院时间；治疗前及治疗后 7 d 时取创面组织行免疫组织化学染色，计算 TGF-β 1、TβRⅡ表达阳性指数。.
结果: VSD 组患者经 1～3 次 VSD 治疗后行植皮术，平均 2 次；对照组患者经 1～6 次换药后行植皮术，平均 4 次。VSD 组患者创基准备时间及住院时间均较对照组明显缩短，比较差异有统计学意义（ t=–13.546， P=0.036； t=–12.831， P=0.041）。两组植皮均顺利成活，创面愈合良好。免疫组织化学染色示，治疗前 VSD 组 TGF-β 1、TβRⅡ表达阳性指数分别为 5.3±2.4、14.0±2.6，对照组分别为 4.4±2.3、14.7±3.1，比较差异无统计学意义（ t=1.137， P=0.263； t=1.231， P=0.409）。治疗 7 d 后，VSD 组 TGF-β 1、TβRⅡ表达阳性指数分别为 34.3±2.9、41.7±3.7，对照组分别为 5.8±2.0、18.1±2.5，比较差异有统计学意义（ t=–35.615， P=0.003； t=23.725， P=0.002）。.
结论: VSD 可提高糖尿病足创面组织中 TGF-β 1、TβRⅡ的表达，促进肉芽组织生长，加快创面愈合。.
Keywords: Diabetic foot; transforming growth factor β1; type Ⅱ of transforming growth factor β-receptor; vacuum sealing drainage; wound healing.