围术期长期血糖控制对糖尿病SD大鼠术后伤口愈合的对比研究

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摘要目的通过观察糖尿病大鼠伤口愈合期间血清中肿瘤坏死因子-α(tumour necrosis factor-α，TNF-α)、白介素-6(Interleukin-6，IL-6)和局部巨噬细胞浸润程度以及成纤维细胞数量，探讨长期血糖控制是否可明显改善糖尿病大鼠术后的伤口愈合。方法 a)创建糖尿病大鼠伤口模型，A组：正常大鼠；B组：术前血糖控制1 d；C组：术前血糖控制3 d；D组：术前血糖控制7 d；E组：术前血糖控制1个月。采用相同术式制作相同大小的伤口进行对照分析。五组分别于造模后的第1天、3天、7天、14天(每个时间段3只)心脏采血并切取伤口组织样本，ELISA检测血清中TNF-α、IL-6水平，免疫组织化学染色观察伤口创面中巨噬细胞和成纤维细胞数量。b)糖尿病大鼠造模前后均使用中效胰岛素降低血糖水平，观察上述指标变化。结果 a)与对照组相比较，实验糖尿病组的伤口愈合均出现了延迟。在伤口造模后的早期阶段，围术期内控制血糖组(B、C、D组)局部巨噬细胞数量明显偏低(P＜0.05)，后期巨噬细胞数量明显增多(P＜0.05)。b)实验组组间进行比较后发现，局部巨噬细胞和成纤维细胞浸润程度，E组较B、C、D组能够明显改善伤口愈合情况。c)与对照组相比较，实验组血清中TNF-α和IL-6的表达均较高。在切口愈合的早、中期阶段，E组血清中TNF-α和IL-6的表达较B、C组明显低，但与对照组间仍存在有差异性(P＜0.05)。结论糖尿病大鼠伤口愈合过程中易发生持续性炎症反应且不易消退，并且这种炎症反应发生较迟，术前长期控制血糖较短期内控制能够进一步提升伤口的愈合率，但和正常大鼠相比，仍然有伤口不愈合的风险。

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	向川
	蔡龙
	梁智勇
	李帅杰

关键词 ：糖尿病, 伤口愈合, 血糖控制, 胰岛素

Abstract：Objective To observe the serum tumor necrosis factor alpha (TNF-α)，interleukin 6 (IL-6) and local macrophage infiltration degree and number of fibroblast in diabetic rats during wound healing and，discuss whether long-term blood sugar control can obviously improve the wound healing of diabetic rats.Methods a) Wound models of diabetic mice were divided into 4 groups.Including B：Preoperative blood glucose control 1 day，C：Preoperative blood glucose control 3 days，D：preoperative blood glucose control 7 days，E：preoperative blood glucose control 1 month.The normal rats were group A，which used the same procedure to produce the same size of wound as the control group.On the 1st day，3th day，7th day and 14th day after the surgery (3 rats each time)，we collected the heart blood and wound tissue.ELISA was used to detect serum level of TNF-α，IL-6，and immunohistochemistry was used to observe the macrophages and the number of fibroblasts.b) Intermediate-acting insulin was used to lower blood glucose levels before and after the modeling.Results a) Compared with the control group，there was a delay in the wound healing of the experimental diabetes group.In the early stage after surgery，the number of local macrophages in the control blood glucose groups (B、C、D) were significantly lower in the perioperative period (P＜0.05)，but the macrophages in the later stage were significantly increased (P＜0.05).b) Compared with group B、C、D，it was found that group E could significantly improve wound healing.c) Compared with A，the level of TNF-α and the IL-6 was higher in experimental groups，but with the extension of preoperative blood glucose control，in early and middle stage of wound healing，TNF-α and the IL-6 of E were lower compared with B、C group，but higher compared with A(P＜0.05).Conclusion In the process of wound healing，diabetic rats are prone to delayed inflammatory response and are not easy to subside.Preoperative long-term control of blood glucose can further improve the rate of wound healing，but compared with normal rats，there is still a risk of non healing wounds.

Key words： diabetes mellitus wound healing blood glucose control insulin

作者简介: 向川(1972－ )，男，教授，山西医科大学第二医院，030001。

引用本文:

向川，蔡龙，梁智勇，李帅杰. 围术期长期血糖控制对糖尿病SD大鼠术后伤口愈合的对比研究[J]. 实用骨科杂志, 2019, 25(3): 227-231.
Xiang Chuan，Cai Long，Liang Zhiyong，et al. Comparative Study on the Wound Healing of Diabetic Rats after Perioperative Period and Long-term Blood Glucose Control. sygkzz, 2019, 25(3): 227-231.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2019/V25/I3/227

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