Effects of temperature-sensitive hydroxybutyl chitosan hydrogel on wound healing of full-thickness skin defect in rats
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摘要:
目的 探讨温敏性羟丁基壳聚糖水凝胶对大鼠全层皮肤缺损创面愈合的作用。 方法 采用实验研究方法。取51只7~10周龄SD大鼠，雌雄不限，在大鼠背部距脊柱约1.0 cm处，制造2个直径2 cm的全层皮肤缺损圆形创面。将大鼠按随机数字表法分为温敏性水凝胶组、凝胶组和空白对照组，每组17只大鼠（34个创面），前2组大鼠创面伤后即刻分别涂抹0.3 mL温敏性羟丁基壳聚糖水凝胶和羧甲基壳聚糖凝胶，空白对照组大鼠创面不行任何处理，3组大鼠创面均外用凡士林油纱。每天换药时观察温敏性水凝胶组大鼠创面温敏性羟丁基壳聚糖水凝胶及凝胶组大鼠创面羧甲基壳聚糖凝胶状态，记录去除凡士林油纱的难易程度。伤后3、7、10、14、21 d，观察3组大鼠创面愈合情况，并计算创面愈合率。伤后3、7、10、14、21 d，每组各取2只大鼠的4个创面组织，行苏木精-伊红染色观察炎症细胞浸润、血管新生、再上皮化情况；Masson染色观察胶原纤维再生和重塑情况，并计算胶原容积分数；酶联免疫吸附测定法检测白细胞介素6（IL-6）、转化生长因子β1（TGF-β1）、基质金属蛋白酶1 （MMP-1）的表达。对数据行析因设计方差分析、单因素方差分析及Bonferroni检验。 结果 伤后换药时，凝胶组大鼠创面羧甲基壳聚糖凝胶呈液态凝胶状，可随体位流动；而温敏性水凝胶组大鼠创面温敏性羟丁基壳聚糖水凝胶呈固态凝胶状，不随体位变化而流动，且分布更均匀；温敏性水凝胶组大鼠创面凡士林油纱较易去除，而其余2组凡士林油纱不易去除。伤后3、7、10、14、21 d，温敏性水凝胶组和凝胶组大鼠创面肉芽组织生长好，未见明显感染；空白对照组伤后3、5 d各有1只大鼠因创面感染而死亡。伤后7、10、14、21 d，温敏性水凝胶组和凝胶组大鼠创面愈合率明显高于空白对照组（P<0.01）；伤后10 d，温敏性水凝胶组大鼠创面愈合率明显高于凝胶组（P<0.05）。伤后3 d，3组大鼠创面均有大量中性粒细胞和淋巴细胞浸润。伤后7~21 d，温敏性水凝胶组和凝胶组大鼠创面炎症细胞浸润逐渐减少，创面逐渐愈合，可见表皮层和真皮层，未见毛囊等皮肤附件；空白对照组大鼠创面伤后21 d未完全愈合。伤后3~10 d，3组大鼠创面新生胶原纤维组织逐渐增多；伤后14、21 d，与空白对照组比较，温敏性水凝胶组和凝胶组大鼠创面胶原纤维更加致密，排列整齐有序。伤后10、14、21 d，温敏性水凝胶组和凝胶组大鼠创面胶原容积分数显著高于空白对照组（P<0.01）；伤后14 d，温敏性水凝胶组大鼠创面胶原容积分数显著高于凝胶组（P<0.01）。伤后3、7、10 d，温敏性水凝胶组大鼠创面IL-6的表达显著高于凝胶组和空白对照组（P<0.01），凝胶组大鼠创面IL-6的表达显著低于空白对照组（P<0.01）。伤后3、7、10 d，温敏性水凝胶组大鼠创面TGF-β1的表达显著高于凝胶组及空白对照组（P<0.01）；伤后3、7 d，凝胶组大鼠创面TGF-β1的表达显著低于空白对照组（P<0.01）；伤后10 d，凝胶组大鼠创面TGF-β1的表达显著高于空白对照组（P<0.01）；伤后14 d，凝胶组大鼠创面TGF-β1的表达明显高于温敏性水凝胶组和空白对照组（P<0.01）；伤后21 d，温敏性水凝胶组大鼠创面TGF-β1的表达显著低于凝胶组和空白对照组（P<0.01），凝胶组大鼠创面TGF-β1的表达显著低于空白对照组（P<0.01）。伤后7 d，凝胶组大鼠创面MMP-1的表达显著高于温敏性水凝胶组和空白对照组（P<0.01）；伤后10、14、21 d，温敏性水凝胶组大鼠创面MMP-1的表达显著高于凝胶组及空白对照组（P<0.01）；伤后10 d，凝胶组大鼠创面MMP-1的表达显著低于空白对照组（P<0.01）；伤后14、21 d，凝胶组大鼠创面MMP-1的表达显著高于空白对照组（P<0.01）。 结论 温敏性羟丁基壳聚糖水凝胶可通过增加IL-6、TGF-β1和MMP-1的表达，调节创面愈合环境，抑制炎症反应，提高组织修复强度，促进胶原的合成/分解，从而促进大鼠全层皮肤缺损创面的愈合。 Abstract:Objective To investigate the effects of temperature-sensitive hydroxybutyl chitosan hydrogel on wound healing of full-thickness skin defect in rats. Methods The experimental research method was used. Fifty-one no matter male or female Sprague-Dawley rats aged 7-10 weeks were selected, and two round full-thickness skin defect wounds with a diameter of 2 cm were created on the back of each rat at a distance about 1.0 cm to the spine. The rats were divided into temperature-sensitive hydrogel group, gel group, and blank control group according to the random number table, with 17 rats and 34 wounds in each group. Wounds of rats in the first two groups were applied respectively with 0.3 mL temperature-sensitive hydroxybutyl chitosan hydrogel and carboxymethyl chitosan hydrogel immediately after injury, and the wounds of rats in blank control group received no treatment. The wounds of rats in the three groups were all covered with vaseline oil gauze. The states of temperature-sensitive hydroxybutyl chitosan hydrogel in wounds of rats in temperature-sensitive hydrogel group and carboxymethyl chitosan hydrogel in wounds of rats in gel group were observed every day when the dressings were changed, and the difficulty of vaseline oil gauze removal was recorded. On the 3rd, 7th, 10th, 14th, and 21st day after injury, the wound healing of rats in the three groups was observed and the wound healing rates were calculated. On the 3rd, 7th, 10th, 14th, and 21st day after injury, tissue from 4 wounds of 2 rats in each group was collected for the following observation and detection. The infiltration of inflammatory cells, angiogenesis, and re-epithelialization were observed by hematoxylin eosin staining. The regeneration and remodeling of collagen fibers were observed by Masson staining, and the collagen volume fraction was calculated. The expressions of interleukin-6 (IL-6), transforming growth factor β1 (TGF-β1), and matrix metalloproteinase-1 (MMP-1) were detected by enzyme-linked immunosorbent assay method. Data were statistically analyzed with analysis of variance for factorial design, one-way analysis of variance, and Bonferroni test. Results The carboxymethyl chitosan gel in wounds of rats in gel group was liquid gel and could flow with the body position, while the temperature-sensitive hydroxybutyl chitosan hydrogel in wounds of rats in temperature-sensitive hydrogel group was solid gel and could not flow with the body position, and the distribution of the latter was more uniform. The vaseline oil gauzes were easily removed in wounds of rats in temperature-sensitive hydrogel group, while the vaseline oil gauzes were difficult to remove in the other two groups. On the 3rd, 7th, 10th, 14th, and 21st day after injury, the wound granulation tissue of rats grew well in temperature-sensitive hydrogel group and gel group, with no obvious infection, and two rats in blank control group died of wound infection on the 3rd and 5th day after injury. On the 7th, 10th, 14th, and 21st day after injury, the wound healing rates of rats in temperature-sensitive hydrogel group and gel group were significantly higher than that in blank control group (P<0.01). On the 10th day after injury, the wound healing rate of rats in temperature-sensitive hydrogel group was significantly higher than that in gel group (P<0.05). A large number of neutrophils and lymphocytes infiltrated into the wounds of rats in the three groups on the 3rd day after injury. The infiltration of inflammatory cells was gradually reduced and the wound healed gradually in rats of temperature-sensitive hydrogel group and gel group from the 7th to 21st day after injury, and the epidermis and dermis could be seen, without hair follicles and other skin appendages. The wounds of rats in blank control group did not heal completely on 21st day after injury. From the 3rd to 10th day after injury, the newly formed collagen fibers increased gradually in the wounds of rats in the three groups. On the 14th and 21st day after injury, the collagen fibers in the wounds of rats in temperature-sensitive hydrogel group and gel group were denser and more orderly than those in blank control group. On the 10th, 14th, and 21st day after injury, the collagen volume fraction of wounds of rats in temperature-sensitive hydrogel group and gel group was significantly higher than that in blank control group (P<0.01). On the 14th day after injury, the collagen volume fraction of wounds of rats in temperature-sensitive hydrogel group was significantly higher than that in gel group (P<0.01). On the 3rd, 7th, and 10th day after injury, the expressions of IL-6 in wounds of rats in temperature-sensitive hydrogel group were significantly higher than those in gel group and blank control group (P<0.01), and the expressions of IL-6 in wounds of rats in gel group were significantly lower than those in blank control group (P<0.01). On the 3rd, 7th, and 10th day after injury, the expressions of TGF-β1 in wounds of rats in temperature-sensitive hydrogel group were significantly higher than those in gel group and blank control group (P<0.01). The expressions of TGF-β1 in wounds of rats in gel group were significantly lower than those in blank control group on the 3rd and 7th day after injury (P<0.01), and the expression of TGF-β1 in wounds of rats in gel group was significantly higher than that in blank control group on the 10th day after injury (P<0.01). On the 14th day after injury, the expression of TGF-β1 in wounds of rats in gel group was significantly higher than that in temperature-sensitive hydrogel group and blank control group (P<0.01). On the 21st day after injury, the expression of TGF-β1 in wounds of rats in temperature-sensitive hydrogel group was significantly lower than that in gel group and blank control group (P<0.01), and the expression of TGF-β1 in wounds of rats in gel group was significantly lower than that in blank control group (P<0.01). On the 7th day after injury, the expression of MMP-1 in wounds of rats in gel group was significantly higher than that in temperature-sensitive hydrogel group and blank control group (P<0.01). On the 10th, 14th, and 21st day after injury, the expressions of MMP-1 in wounds of rats in temperature-sensitive hydrogel group were significantly higher than those in gel group and blank control group (P<0.01). On the 10th day after injury, the expression of MMP-1 in wounds of rats in gel group was significantly lower than that in blank control group (P<0.01). On the 14th and 21st day after injury, the expressions of MMP-1 in wounds of rats in gel group were significantly higher than those in blank control group (P<0.01). Conclusions Temperature-sensitive hydroxybutyl chitosan hydrogel can promote the healing of full-thickness skin defect wounds in rats by increasing the expressions of IL-6, TGF-β1, and MMP-1, regulating the wound healing environment, inhibiting inflammatory reaction, improving the strength of tissue repair, and promoting collagen synthesis or decomposition -
Key words:
- Wound healing /
- Biological dressings /
- Hydrogel /
- Thermosensitive chitosan hydrogel /
- Cytokine
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所有作者均声明不存在利益冲突放射治疗在有效治疗肿瘤的同时，会引起组织缺氧，细胞和血管减少，进而导致皮肤坏死和溃疡等并发症。高压氧疗法可减少组织水肿，促进血管生成、Fb生长、胶原形成、再上皮化，并能提高白细胞的杀菌活性。创面局部喷洒血红蛋白溶液可快速提高氧饱和度，可用于糖尿病足溃疡、下肢静脉溃疡和术后创面的治疗。Granulox血红蛋白喷雾剂由德国Hälsa Pharma公司生产，为含猪血红蛋白的水性溶液，局部喷洒于创面可促进空气中氧气进入创面组织，有效改善创面氧饱和度。作者在进行文献综述后进一步通过病例报告，探讨了高压氧联合血红蛋白喷雾剂治疗放射性溃疡的效果。该病例为64岁头颈部肿瘤术后患者，放射治疗结束后6个月于右侧颈部出现难以愈合的深大创面，经常规换药和皮瓣治疗无效，对患者进行每日高压氧（2.4 ATA，每次90 min）联合Granulox血红蛋白喷雾剂喷洒治疗，泡沫敷料包扎，每日换药，持续30 d。治疗15 d后创面开始逐渐愈合，2个月后经刃厚皮片移植后创面封闭。该研究表明，短期应用高压氧联合血红蛋白喷雾剂治疗放射性溃疡有一定疗效，但还需要进一步的随机对照试验进行验证。孙佳辰,编译自《J Wound Care》,2020,29(8):452-456;申传安,审校
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1 2组全层皮肤缺损大鼠伤后3 d换药时创面羧甲基壳聚糖凝胶或温敏性羟丁基壳聚糖水凝胶状态。1A.凝胶组羧甲基壳聚糖凝胶呈液态凝胶状；1B.温敏性水凝胶组温敏性羟丁基壳聚糖水凝胶呈固态凝胶状
2 3组全层皮肤缺损大鼠伤后各时间点创面愈合情况。2A、2B、2C.分别为温敏性水凝胶组伤后0（即刻）、10、21 d创面情况，图2C创面完全愈合；2D、2E、2F.分别为凝胶组伤后0、10、21 d创面情况，图2E创面面积明显大于图2B，图2F创面基本愈合；2G、2H、2I.分别为空白对照组伤后0、10、21 d创面情况，图2H创面面积明显大于图2B，图2I仍可见残余创面
注：温敏性水凝胶组、凝胶组大鼠创面分别涂抹温敏性羟丁基壳聚糖水溶胶、羧甲基壳聚糖凝胶
3 3组全层皮肤缺损大鼠伤后3、7、14 d创面炎症细胞浸润、血管新生和再上皮化情况 苏木精-伊红×100。3A、3B、3C.分别为温敏性水凝胶组、凝胶组及空白对照组伤后3 d，创面均有大量中性粒细胞和淋巴细胞浸润；3D、3E、3F.分别为温敏性水凝胶组、凝胶组及空白对照组伤后7 d，炎症细胞分别较图3A、3B、3C减少，且图3D、3E炎症细胞均较图3F明显减少，3组同时可见毛细血管增生，创面边缘上皮开始移行修复；3G、3H、3I.分别为温敏性水凝胶组、凝胶组及空白对照组伤后14 d，图3G和3H创面炎症细胞浸润消失，并可见复层鳞状上皮结构已完整覆盖创面，图3I仍可见少量炎症细胞浸润且复层鳞状上皮结构不完整
注：温敏性水凝胶组、凝胶组大鼠创面分别涂抹温敏性羟丁基壳聚糖水溶胶、羧甲基壳聚糖凝胶
4 3组全层皮肤缺损大鼠伤后3、14、21 d创面胶原纤维变化 Masson×100。4A、4B、4C.分别为温敏性水凝胶组、凝胶组及空白对照组伤后3 d，创面新生胶原纤维组织较少；4D、4E、4F.分别为温敏性水凝胶组、凝胶组及空白对照组伤后14 d，图4D、4E胶原纤维组织较图4F多且排列更整齐；4G、4H、4I.分别为温敏性水凝胶组、凝胶组及空白对照组伤后21 d，图4G、4H较图4I胶原纤维更加致密，且排列整齐有序
注：温敏性水凝胶组、凝胶组大鼠创面分别涂抹温敏性羟丁基壳聚糖水溶胶、羧甲基壳聚糖凝胶
5 3组全层皮肤缺损大鼠伤后各时间点创面胶原容积分数比较（
注：温敏性水凝胶组、凝胶组大鼠创面分别涂抹温敏性羟丁基壳聚糖水溶胶、羧甲基壳聚糖凝胶;处理因素主效应，F=22.46，P<0.01；时间因素主效应，F=15.78，P<0.01；两者交互作用，F=2.67，P=0.23；伤后3、7 d，组间总体比较，差异无统计学意义（F=1.87、3.66，P=0.15、0.08）；伤后10、14、21 d，组间总体比较，差异有统计学意义（F=8.56、20.40、40.38，P=0.03、<0.01、<0.01）；与温敏性水凝胶组比较，aP<0.01；与凝胶组比较，bP<0.01
6 3组全层皮肤缺损大鼠伤后各时间点创面白细胞介素6的表达比较（
注：温敏性水凝胶组、凝胶组大鼠创面分别涂抹温敏性羟丁基壳聚糖水溶胶、羧甲基壳聚糖凝胶；处理因素主效应，F=35.89，P<0.01；时间因素主效应，F=19.76，P<0.01；两者交互作用，F=15.95，P<0.01；伤后3、7、10 d，组间总体比较，差异有统计学意义（F=9.56、48.40、30.82，P<0.01、<0.01、<0.01）；伤后14、21 d，组间总体比较，差异无统计学意义（F=5.78、3.38，P=0.57、0.08）；与温敏性水凝胶组比较，aP<0.01；与凝胶组比较，bP<0.01
7 3组全层皮肤缺损大鼠伤后各时间点创面转化生长因子β1的表达比较（
注：温敏性水凝胶组、凝胶组大鼠创面分别涂抹温敏性羟丁基壳聚糖水溶胶、羧甲基壳聚糖凝胶；处理因素主效应，F=56.33，P<0.01；时间因素主效应，F=27.98，P<0.01；两者交互作用，F=12.67，P<0.01；伤后3、7、10、14、21 d，组间总体比较，差异有统计学意义（F=6.04、16.22、22.63、48.38、36.83，P<0.05、<0.01、<0.01、<0.01、<0.01）；与温敏性水凝胶组比较，aP<0.01；与凝胶组比较，bP<0.01
8 3组全层皮肤缺损大鼠伤后各时间点创面基质金属蛋白酶1的表达（
注：温敏性水凝胶组、凝胶组大鼠创面分别涂抹温敏性羟丁基壳聚糖水溶胶、羧甲基壳聚糖凝胶;处理因素主效应，F=31.35，P<0.01；时间因素主效应，F=29.46，P<0.01；两者交互作用，F=17.86，P<0.01；伤后3 d，组间总体比较，差异无统计学意义（F=17.53，P=0.06）；伤后7、10、14、21 d，组间总体比较，差异有统计学意义（F=38.27、79.26、10.44、20.68，P=0.03、<0.01、0.02、<0.01）；与温敏性水凝胶组比较，aP<0.01；与凝胶组比较，bP<0.01
表1 3组全层皮肤缺损大鼠伤后各时间点创面愈合率比较（%，
组别 3 d 7 d 10 d 14 d 21 d 温敏性水凝胶组 13.95±3.12 61.99±9.15 84.70±3.84 95.80±2.04 99.97±0.10 凝胶组 13.32±1.04 59.82±11.10 82.33±5.87c 93.02±3.72 99.24±1.30 空白对照组 13.06±0.85 38.13±16.40ab 48.16± 2.79ab 81.25± 6.75ab 97.51± 1.36ab F值 0.87 8.38 10.78 9.56 11.95 P值 0.05 0.02 <0.01 <0.01 <0.01 注：温敏性水凝胶组、凝胶组大鼠创面分别涂抹温敏性羟丁基壳聚糖水溶胶、羧甲基壳聚糖凝胶；伤后3、7、10、14、21 d，温敏性水凝胶组和凝胶组创面数分别为34、30、26、22、18个，空白对照组（伤后3、5 d各有1只大鼠死亡）创面数分别为32、26、22、18、14个；与温敏性水凝胶组比较，aP<0.01，cP<0.05；与凝胶组比较，bP<0.01 
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