【摘要】 目的 观察尿激酶在慢性创面中的疗效及临床应用的可行性。方法 本研究选取2019年6月至2021年4月重庆大学附属涪陵医院烧伤整形科52例慢性创面患者为研究对象。患者分为生理盐水组（n=27,0.9%生理盐水）和尿激酶组（n=25，尿激酶5 000 IU·mL-1），收集创面分泌物检测白细胞介素-6(interleukin 6,IL-6)、肿瘤坏死因子-α(tumor necrosis facfor-α,TNF-α)含量，并进行肉芽组织和渗液评分。治疗结束后，行HE染色和Masson染色评价肉芽组织血管生成、胶原含量和排列情况，免疫组化分析血管内皮生长因子（vascular endothelial growth factor,VEGF）、转化生长因子β(transforming growth factor β,TGF-β)的表达情况，Western blot和RT-qPCR检测创面肉芽组织Ⅰ型胶原（CollagenⅠ）、α-平滑肌肌动蛋白（α smooth muscle actin,α-SMA）的表达情况。结果 52例患者治疗后无严重并发症。尿激酶治疗后，尿激酶组创面分泌物的IL-6、TNF-α含量均低于生理盐水组（P均<0.05）。尿激酶组创面肉芽组织改善情况优于生理盐水组（P<0.05）。创面肉芽组织HE染色结果显示，尿激酶组创面肉芽组织新生血管数量高于生理盐水组（P<0.05）。Masson染色可见，尿激酶组创面肉芽组织中胶原蛋白排列较整齐，而生理盐水组胶原蛋白排列紊乱。尿激酶组胶原蛋白含量高于生理盐水组（P<0.05）。免疫组化结果提示，尿激酶组创面肉芽组织中VEGF、TGF-β含量均高于生理盐水组（P均<0.05）。Western blot和RT-qPCR结果提示，尿激酶组Collagen I、α-SMA表达增强（P均<0.05）。结论 尿激酶可以降低慢性创面的炎性反应，增加肉芽组织中新生血管数量和胶原含量，提高VEGF、TGF-β、Collagen I和α-SMA的含量，改善创面情况，使用安全、疗效可靠，便于临床推广应用。更多还原

【Abstract】 Objective To evaluate the effect and feasibility of urokinase used in chronic wound. Methods This study selected the 52 patients with chronic wound in the Department of Burn and Plastic Surgery of Fuling Hospital affiliated to Chongqing University from June 2019 to April 2021. Patients were divided into saline group(n=27,0.9% saline)and experimental group(n=25,urokinase 5 000 IU·m L-1). The wound secretion was collected to detect the contents of IL-6 and TNF-α. The granulation tissue and exudation of wound was graded. After treatment,HE and Masson staining were used to evaluate the neovascularization,content and arrangement of collagen fibers of granulation tissue. Immunohistochemical staining was used to observe the expression of VEGF and TGF-β in the granulation tissue of wound. Western blot and RT-qPCR were used to detect the expression of Collagen I and α-SMA in the granulation tissue of wound. Results No serious complications occurred in 52 patients after treatment. The content of IL-6 and TNF-α in wound exudation in the urokinase group were lower than that in the saline group(P all<0.05). The improvement of granulation tissue in the urokinase group was better than that in the saline group(P<0.05). The results of HE staining of the granulation tissue showed that the number of new blood vessels in the granulation tissue of the wound in the urokinase group was higher than that in the saline group(P<0.05). The results of Masson staining showed that the collagen in the granulation tissue of the wound in the urokinase group was arranged neatly,while the collagen in the saline group was arranged disorderly,and the collagen content in the urokinase group was higher than that in the saline group(P<0.05). The results of immunohistochemistry indicated that the contents of VEGF and TGF-βin the wound granulation tissue in the urokinase group were higher than those in the saline group(P all<0.05).The results of Western blot and RT-qPCR showed that the expression of Collagen I and α-SMA in urokinase group was significantly increased(P all<0.05). Conclusion Urokinase can reduce the inflammatory reaction of chronic wounds and increase the number of new blood vessels and collagen content in granulation tissue,increase levels of VEGF and TGF-β,Collagen I and α-SMA,improve the wound condition,and it is safe and reliable for clinical application.更多还原