目的 探讨腔镜深筋膜下交通支结扎（SEPS）+溃疡周围环缝术联合治疗慢性下肢静脉性溃疡的临床疗效。方法 2004年3月至2006年9月对23例慢性下肢静脉性溃疡患者实施SEPS+溃疡周围环缝术（联合治疗组）。另有SEPS组(19例)和溃疡周围环缝组(30例)作对照。所有病例均行常规大隐静脉高位结扎+剥脱术。结果 联合治疗组溃疡于术后12~60 d愈合，平均25.7 d； SEPS组于术后18~90 d愈合，平均35.1 d; 溃疡周围环缝组于术后21~90 d愈合，平均47.3 d，各组间差异均有统计学意义（P＜0.05）。3组间复发率比较，差异无统计学意义（Pgt;0.05）。结论 SEPS+溃疡周围环缝术能够有效地治疗慢性下肢静脉性溃疡，2个术式联合应用其溃疡愈合时间较单独应用缩短。
Objective To study efficacy of ligation and stripping of great saphenous vein in combination with foam sclerotherapy and foam sclerotherapy alone in treatment of venous leg ulcer. Method Fifty-seven patients with venous leg ulcers from January 2015 to December 2016 in the West China Hospital of Sichuan University were collected, then were designed to ligation and stripping of great saphenous vein in combination with foam sclerotherapy group (abbreviated as combination therapy group, n=33) and foam sclerotherapy alone group (n=24). Results The baseline data such as the age, gender, disease duration, and ulcer size had no significant differences in these two groups (P>0.05). All the patients received operation successfully. The median operative time was shorter, the average intraoperative blood loss was less, and the time of ulcer healing after surgery was longer in the foam sclerotherapy alone group as compared with the combination therapy group [14 minversus 40 min, P<0.001; (12.3±3.2) mLversus (35.5±10.0) mL, P<0.001; (22.0±4.5) dversus (13.7±4.0) d, P<0.001]. The rates of the wound infection, local pigmentation, and ulcer recurrence had no significant differences between the foam sclerotherapy alone group and the combination therapy group (4.2%versus 9.1%, P=0.472; 25.0% versus 15.2%, P=0.352; 20.8% versus 9.1%, P=0.208). The foam sclerotherapy alone group was obviously superior to the combination therapy group in the time and cost of hospitalization (4 d versus 13 d, P<0.001; 3 000 yuanversus 8 590 yuan, P<0.001). There was no large area of tissue necrosis, the deep vein thrombosis, or the other serious complications in these two groups. Conclusion Ligation and stripping of great saphenous vein in combination with foam sclerotherapy in treatment of venous leg ulcer can accelerate ulcer healing than foam sclerotherapy alone, but there is no significant difference between these two groups in complications and recurrence rate, the foam sclerotherapy alone group is superior in time and cost of hospitalization, appropriate treatment plan should be formulated according to specific situation of patient.
ObjectiveTo explore the differentially expressed genes (DEGs) in venous leg ulcer (VLU) by bioinformatics, and further explore the molecular mechanism of the disease, predict early diagnostic markers and treatment targets.MethodsThe expression profiles of VLU were downloaded from the gene expression omnibus (GEO) database, the DEGs of VLU and inflammatory phase of normal skin healing were identified by R software and used to perform gene ontology (GO) and KEGG pathway enrichment analysis, obtaining the key genes of the pathway. We analyzed the proteins of protein interaction (PPI) network by STRING database and Cytoscape 3.2.1 software to obtain hub genes.ResultsA total of 409 DEGs were obtained, including 173 upregulted genes and 236 downregulted genes. The GO analysis showed that the upregulated DEGs mainly distributed in collagen-containing extracellular matrix (ECM), cornified envelope and collagen trimer, involved in biological processes such as skin development, keratinocyte differentiation and cornification, which mediated molecular functions such as ECM structural constituent, ECM structural constituent conferring tensile strength and integrin binding. The downregulated DEGs mainly distributed in tertiary granule, secretory granule membrane and tertiary granule membrane cornification, involved in biological processes such as response to chemokine, leukocyte migration and neutrophil chemotaxis, which mediated molecular functions such as chemokine activity, chemokine receptor binding and cytokine activity. KEGG pathway enrichment analysis results showed that the upregulated DEGs were mainly enriched in ECM-receptor interaction and protein digestion and absorption pathways, collagen type Ⅰ alpha1 chain (COL1A1), collagen type Ⅰ alpha2 chain (COL1A2), and collagen type Ⅵ alpha 6 chain (COL6A6) were the key genes of pathway; the downregulated DEGs were mainly enriched in Staphylococcus aureus infection, Toll-like receptor signaling pathway and leukocyte transendothelial migration pathways, interleukin (IL)-1β, C-X-C motif chemokine ligand 8 (CXCL8), IL-10, matrix metalloproteinase (MMP)1, and MMP9 were the key genes of pathway. The hub core genes of the PPI network were formyl peptide receptor (FPR)1, FPR2, IL-1β, IL-10, and CXCL8.ConclusionsThe results of this study indicate that the genes and signaling pathways involved in COL1A1, COL1A2, COL6A6, IL-1β, CXCL8, IL-10, MMP1, and MMP9 affect the healing of VLU. FPR1, FPR2, IL-1β, IL-10, and CXCL8 can be used as potential therapeutic targets.
ObjectiveTo investigate the relationship between the nucleotide binding oligomerization domain like receptor protein 3 (NLRP3) inflammasome and inflammatory reaction of venous ulcer of lower extremity.MethodsTwenty-four patients with active venous ulcer of lower extremity (active ulcer group), 24 patients with non exudative venous ulcer of lower extremity as positive control (non-active ulcer group), and 24 patients with traumatic wound as negative control (traumatic-wound group) were enrolled. The clinical data of the three groups were compared, the tissue samples around the wound were harvested, and the expressions of NLRP3 protein were detected by immunohistochemistry among the three groups. Enzyme linked immunosorbent assay (ELISA) was used to detect the IL-1β and IL-18 protein levels, RT-PCR was used to detect the mRNA expressions of apoptosis associated speck like protein containing CARD (ASC), caspase-1, c-Jun N-terminal kinase (JNK), p38, nuclear factor (NF)-κB p65 and NF-κB inhibitor alpha (NF-κB IkBα), and Western blotting was performed to evaluate the level of NLRP3 inflammasome in wound tissues.ResultsThe inflammatory response in the non-active ulcer group and trauma-wound group were milder than that in the active ulcer group. The levels of IL-1β and IL-18 proteins in the active ulcer group were higher than those in the non-active ulcer group and the traumatic-wound group [IL-1β: (146.621±11.597) ng/L vs. (80.967±14.213) ng/L vs. (84.962±19.484) ng/L, F=136.200, P<0.001; IL-18: (119.814±12.788) ng/L vs. (72.899±17.220) ng/L vs. (48.131±10.407) ng/L, F=167.910, P<0.001]. The results of RT-PCR showed that the mRNA expressions of ASC [(0.030±0.012) ng/L vs. (0.021±0.005) ng/L vs. (0.016±0.004) ng/L, F=18.106, P<0.001], caspase-1 [(0.054±0.012) ng/L vs. (0.013±0.009) ng/L vs. (0.018±0.006) ng/L, F=130.372, P<0.001], NF-κB p65 [(0.093±0.015) ng/L vs. (0.038±0.013) ng/L vs. (0.043±0.014) ng/L, F=110.950, P<0.001], NF-κB IkB-α [(0.085±0.015) ng/L vs. (0.078±0.015) ng/L vs. (0.041±0.016) ng/L, F=53.070, P<0.001], and JNK [(0.075±0.018) ng/L vs. (0.042±0.013) ng/L vs. (0.039±0.014) ng/L, F=41.271, P<0.001] in the wound tissues of the active ulcer group were higher than those in the non-active ulcer group and the traumatic-wound group. And the mRNA expression of p38 in the wound tissues of the active ulcer group was lower than that in the non-active ulcer group [(0.050±0.008) ng/L vs. (0.064±0.014) ng/L, P<0.05]. The result of Western blotting showed that the relative expression level of NLRP3 protein in the wound tissues of the active ulcer group was higher than that in the trauma-wound group and non-active ulcer group (0.767±0.272 vs. 0.605±0.212 vs. 0.556±0.183, F=4.804, P=0.012).ConclusionNLRP3 inflammasome is closely related to the wound in venous ulcer of lower extremity and provides a new target to the therapy of venous ulcer of lower extremity.