Ⅳ期压疮愈合过程中创面渗出液基质金属蛋白酶-9、基质金属蛋白酶抑制剂-1的表达水平变化的研究

摘要

Objective To investigate the relationship between the expression level of matrix metalloproteinase-9 (MMP-9),matrix metalloproteinase inhibitor-1 (TIMP-1) and the healing of pressure ulcer in the exudate of stage Ⅳ pressure ulcer.Methods A total of 39 patients (59 wounds) with stage Ⅳ pressure ulcers from July 2017 to April 2018 in Hebei General Hospital were selected.The patients were divided into 2 groups according to the difference between receiving and the fourth weekend pressure ulcer scale for healing (PUSH) score.The difference ＞ 2 points was a good healing group (n =26) and ≤2 points was a poor healing group(n =13).After evaluation,cleaning and debridement in accordance with the unified method,appropriate therapeutic regimen was selected to change dressings and track for four weeks.Collect the wound exudate at different time points:the time of diagnosis,the first weekend of treatment,the second weekend of treatment,the third weekend of treatment and the fourth weekend of treatment.The changes of MMP-9,TIMP-1 expression level and MMP-9 / TIMP-1 ratio in wound effusion of the two groups were detected by enzyme-linked immuno sorbent assay.Date were compared by t test.Results There was no significant difference in MMP-9 expression between the two groups at the time of diagnosis and the first weekend of treatment (t =1.262,1.944,with P values above 0.05).At the second weekend,the third weekend,the fourth weekend of treatment,the expression level of MMP-9 in the poor healing group was (189.27 ± 90.15) ng/L,(176.95 ± 75.47) ng/L,(149.30 ± 63.08) ng/L,which was significantly higher than that in the good healing group [(114.97 ± 70.06) ng/L,(93.75 ± 55.15) ng/L,(71.62 ± 41.66) ng/L],the difference was statistically significant (t =2.835,3.921,4.608,with P values below 0.05).There was no statistically significant difference in TIMP-1 expression between the good healing group and the poor healing group at different time points (t =0.346,0.292,0.047,0.395,0.999,with P values below 0.05).There was no significant difference in the ratio of MMP-9/TIMP-1 between the two groups at the time of diagnosis and the first weekend of treatment(t =1.023,1.134,with P values above 0.05).At the second,third and fourth weekends of treatment,MMP-9 / TIMP-1 ratio in the poor healing group was (38.42 ± 9.25),(33.74 ± 9.58),(29.53 ± 8.04),which was significantly higher than that in the good healing group [(30.04 ± 10.67),(25.35 ± 10.18),(21.54 ± 9.29)],the difference was statistically significant (t =2.411,2.473,2.642,with P values below 0.05).Conclusion The changes of MMP-9 expression level and MMP-9/TIMP-1 ratio in wound exudate were related to the healing of pressure ulcer,while high level of expression of MMP-9 and MMP-9/TIMP-1 were not conducive to the healing of pressure ulcer.%目的 探讨Ⅳ期压疮愈合过程中创面渗出液中基质金属蛋白酶-9(MMP-9)、基质金属蛋白酶抑制剂-1 (TIMP-1)的表达情况及其与压疮愈合的关系.方法 选择2017年7月至2018年4月在河北省人民医院就诊的Ⅳ期压疮患者39例,创面共59处,根据接诊时与治疗第4周末压疮愈合评估表(PUSH)评分差值进行分组,差值＞2分为愈合良好组(n=26),≤2分为愈合不良组(n=13).按照统一方法评估、清洗及清创后,选择合适的治疗方案进行换药,追踪4周,采集接诊时、治疗第1周末、第2周末、第3周末、第4周末创面渗出液,酶联免疫吸附测定法检测2组创面渗出液中MMP-9、TIMP-1表达水平及MMP-9/TIMP-1比值的变化情况.数据比较采用￡检验.结果 接诊时及治疗第1周末2组MMP-9表达差异无统计学意义(t=1.262、1.944,P值均大于0.05),而在治疗第2周末、第3周末、第4周末愈合不良组MMP-9表达水平分别为(189.27 ±90.15) ng/L、(176.95±75.47) ng/L、(149.30±63.08) ng/L,显著高于愈合良好组[(114.97±70.06) ng/L、(93.75±55.15) ng/L、(71.62 ±41.66) ng/L],差异有统计学意义(t=2.835、3.921、4.608,P值均小于0.05);不同时间点愈合良好组与愈合不良组TIMP-1表达水平比较,差异均无统计学意义(t=0.346、0.292、0.047、0.395、0.999,P值均大于0.05);接诊时及治疗第1周末2组MMP-9/TIMP-1比值差异均无统计学意义(t=1.023、1.134,P值均大于0.05),而在治疗第2周末、第3周末、第4周末时愈合不良组MMP-9/TIMP-1比值分别为(38.42 ±9.25)、(33.74±9.58)、(29.53 ±8.04),显著高于愈合良好组的(30.04± 10.67)、(25.35 ±10.18)、(21.54 ±9.29),差异均有统计学意义(=2.411、2.473、2.642,P值均小于0.05).结论 创面渗出液中MMP-9表达水平及MMP-9/TIMP-1比值变化与压疮愈合有关,过高的MMP-9及MMP-9/TIMP-1不利于压疮的愈合.