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目的:观察烧伤后残余创面联合应用rhGM-CSF、莫匹罗星的疗效及局部不良反应。方法:选择2014年4月–2015年4月收治的60例烧伤后残余创面患者,采用同体对照的研究方法,每例患者选取2处烧伤后残余创面,随机分为联合治疗组(n=60)和对照组(n=60),2组受试创面面积比较差异无统计学意义(P>0.05),具有可比性。联合治疗组创面外用rhGM-CSF凝胶剂及莫匹罗星软膏,对照组创面外用莫匹罗星软膏。观察两组创面分泌物、炎症反应、肉芽组织的变化及局部不良反应。观察治疗后7,14d的创面细菌清除率及创面愈合率,记录创面愈合时间。选择10例患者于治疗前及治疗后7,14d切取创面边缘组织标本,免疫组化法检测TNF-α、IL-1β的表达水平。结果:与对照组相比较,联合治疗组创面分泌物明显减少,炎症反应减轻,肉芽组织较为鲜红。未观察到明显局部不良反应。治疗7,14d后的创面细菌清除率联合治疗组为(45±11)%、(92±9)%,均高于对照组[(28±12)%、(70±11)%,P<0.05]。联合治疗组创面愈合率分别为(68±14)%、(97±10)%,均高于对照组[(53±12)%、(89±13)%,P<0.05]。联合治疗组创面平均愈合时间为(12±2)d,明显短于对照组[(14±3)d,P<0.001]。治疗前2组创面TNF-α、IL-1β积分光密度(IOD值)均无显著差异(P>0.05)。治疗后7,14d联合治疗组创面TNF-α和IL-1βIOD值分别为2 740±248,1 385±116和7 876±596,4 185±399,均低于对照组(3 419±178,2 112±297和9 912±578,6 657±412,P<0.001)。结论:联合应用rhGM-CSF、莫匹罗星能促进烧伤后残余创面愈合,可能与其抑制细菌生长及创面TNF-α、IL-1β的过度表达有关。
Objective: To observe the curative effect and local adverse reactions of rhGM-CSF and mupirocin combined with residual wound after burns. Methods: Sixty patients with post-burn residual wounds who were treated in April 2014-April 2015 were enrolled in the study. All patients were divided into two groups randomly (n = 60) ) And control group (n = 60). There was no significant difference between the two groups in wound area (P> 0.05), which was comparable. Combination therapy group wounds with rhGM-CSF gel and mupirocin ointment, the control group of external use mupirocin ointment. The wound secretions, inflammation, changes of granulation tissue and local adverse reactions in both groups were observed. The wound bacterial clearance rate and wound healing rate were observed at 7 and 14 days after treatment, and wound healing time was recorded. Ten patients were selected before treatment and 7,14 days after treatment to cut the edge of the wound tissue specimens, immunohistochemical detection of TNF-α, IL-1β expression levels. Results: Compared with the control group, the wound healing in the combination group was significantly reduced, the inflammatory response was relieved, and the granulation tissue was bright red. No obvious local adverse reactions were observed. The bacterial clearance of the wounds after treatment for 7 and 14 days were (45 ± 11)% and (92 ± 9)%, respectively, which were significantly higher than those in the control group (28 ± 12% and 70 ± 11%, P < 0.05]. The wound healing rates in the combined treatment group were (68 ± 14)% and (97 ± 10)%, respectively, higher than those in the control group (53 ± 12% and 89 ± 13%, P <0.05, respectively). The wound healing time was 12 ± 2 days in the combined treatment group, which was significantly shorter than that in the control group (14 ± 3 days, P <0.001). The integral optical density (IOD) of TNF-α and IL-1β in the two groups before treatment had no significant difference (P> 0.05). The IOD values of TNF-α and IL-1β in the wounds of the combination therapy group at 7 and 14 days after treatment were 2 740 ± 248, 1 385 ± 116 and 7 876 ± 596 and 4 185 ± 399, respectively, which were lower than those in the control group (3 419 ± 178, 2 112 ± 297 and 9 912 ± 578, 6 657 ± 412, P <0.001). CONCLUSION: Combined application of rhGM-CSF and mupirocin can promote the healing of residual wounds after burn, which may be related to the inhibition of bacterial growth and the overexpression of TNF-α and IL-1β.