EPO、IL-1β、MMP-9/TIMP-1與燒傷患者瘢痕評分、創(chuàng)面愈合時間關(guān)系及對創(chuàng)面愈合質(zhì)量的預測價值

王之學，肖繼州，于強，楊書培，郭延民

[摘要]目的：探討促紅細胞生成素（Erythropoietin，EPO）、白介素-1β（Interleukin-1β，IL-1β）、基質(zhì)金屬蛋白酶-9/基質(zhì)金屬蛋白酶抑制劑-1（Matrix metalloproteinase-9/Tissue inhibitor of metalloproteinase-1，MMP-9/TIMP-1）與燒傷患者瘢痕評分、創(chuàng)面愈合時間關(guān)系及對創(chuàng)面愈合質(zhì)量的預測價值。方法：選取2018年5月-2021年1月筆者科室收治的113例深Ⅱ度燒傷患者，采用削痂植皮聯(lián)合外用重組人粒細胞-巨噬細胞刺激因子治療，根據(jù)創(chuàng)面愈合質(zhì)量分為良好組（n=88）、不良組（n=25），比較兩組基線資料及治療前、治療5 d、10 d后EPO、IL-1β、MMP-9/TIMP-1，應(yīng)用Pearson分析治療5 d、10 d后EPO、IL-1β、MMP-9/TIMP-1與溫哥華瘢痕量表（Vancouver scar scale，VSS）、創(chuàng)面愈合時間關(guān)系，采用多因素Logistic回歸方程分析創(chuàng)面愈合質(zhì)量的相關(guān)影響因素，采用受試者工作特征曲線（Receiver operating characteristic，ROC）及ROC下面積（Area under the curve，AUC）分析治療5 d、10 d后EPO、IL-1β、MMP-9/TIMP-1，預測創(chuàng)面愈合質(zhì)量價值。結(jié)果：不良組創(chuàng)面愈合時間、VSS評分數(shù)值均高于良好組（P＜0.05）；不良組治療5 d、10 d后EPO低于良好組，IL-1β、MMP-9/TIMP-1高于良好組，差異均有統(tǒng)計學意義（P＜0.05）；治療5 d、10 d后EPO與VSS評分、創(chuàng)面愈合時間呈負相關(guān)（P＜0.05）；治療5 d、10 d后IL-1β、MMP-9/TIMP-1與VSS評分、創(chuàng)面愈合時間呈正相關(guān)（P＜0.05）；將創(chuàng)面愈合時間、VSS評分控制后，治療5 d、10 d后EPO、IL-1β、MMP-9/TIMP-1仍與創(chuàng)面愈合質(zhì)量相關(guān)（P＜0.05）；治療10 d后EPO、IL-1β、MMP-9/TIMP-1的AUC大于治療5 d后，且EPO、IL-1β聯(lián)合MMP-9/TIMP-1的AUC大于任一單一指標。結(jié)論：EPO、IL-1β、MMP-9/TIMP-1與燒傷患者瘢痕評分、創(chuàng)面愈合時間、創(chuàng)面愈合質(zhì)量有關(guān)，聯(lián)合檢測能為臨床預測創(chuàng)面質(zhì)量提供有效參考，并有望成為促進創(chuàng)面愈合、提高愈合質(zhì)量的一個干預靶點。

[關(guān)鍵詞]EPO；IL-1β；MMP-9/TIMP-1；燒傷；VSS評分；創(chuàng)面愈合時間；創(chuàng)面愈合質(zhì)量

[中圖分類號]R622? ? [文獻標志碼]A? ? [文章編號]1008-6455（2023）04-0012-05

The Relationship of EPO，IL-1β，MMP-9/TIMP-1 with Scar Score，Wound Healing Time and Predictive Value of Wound Healing Quality in Burn Patients

WANG Zhixue，XIAO Jizhou，YU Qiang，YANG Shupei，GUO Yanmin

（Department of Burn Surgery，Liaocheng Second People's Hospital，Liaocheng 252600，Shandong，China）

Abstract： Objective? To investigate the relationship between erythropoietin （EPO），interleukin-1β （IL-1β），matrix metalloproteinase-9/matrix metalloproteinase inhibitor-1 （MMP-9/TIMP-1） and scar scores of burn patients and the relationship between wound healing time and the predictive value of wound healing quality. Methods? A total of 113 patients with deep second-degree burns admitted to our hospital from May 2018 to January 2021 were selected and treated with scab skin grafting combined with topical recombinant human granulocyte-macrophage stimulating factor.They were divided into good groups according to the quality of wound healing （n=88），poor group （n=25），compare the baseline data of the two groups，before treatment，5 days after treatment，and 10 days after treatment for EPO，IL-1β，MMP-9/TIMP-1，and Pearson analysis treatment 5 The relationship between EPO，IL-1β，MMP-9/TIMP-1 and Vancouver Scar Scale （VSS），wound healing time after 10 days of treatment，and the related influencing factors of wound healing quality analyzed by multivariate logistic regression equation.The receiver operating characteristic curve （ROC） and the area under the ROC （AUC） were used to analyze the value of EPO，IL-1β，MMP-9/TIMP-1 in predicting the quality of wound healing after 5 days of treatment and 10 days after treatment. Results? The wound healing time and VSS score of the bad group were higher than those of the good group （P＜0.05）; the EPO of the bad group was lower than that of the good group after 5 days of treatment and 10 days after treatment，and IL-1β and MMP-9/TIMP-1 were higher than the good group，the differences were statistically significant （P＜0.05）; EPO was negatively correlated with VSS score and wound healing time after 5 days of treatment and 10 days of treatment （P＜0.05）; IL-1β，MMP-9/ TIMP-1 was positively correlated with VSS score and wound healing time （P＜0.05）; after controlling the wound healing time and VSS score，EPO，IL-1β，MMP-9/TIMP-1 after 5 days of treatment and 10 days after treatment It is still related to the quality of wound healing （P＜0.05）; the AUC of EPO，IL-1β，MMP-9/TIMP-1 after 10 days of treatment is greater than that of 5 days after treatment，and EPO，IL-1β combined with MMP-9/TIMP- The AUC of 1 is greater than any single index. Conclusion? EPO，IL-1β，MMP-9/TIMP-1 are related to the scar score，wound healing time，and wound healing quality of burn patients.The combined detection can provide an effective reference for clinical prediction of wound quality，and is expected to promote wound healing and improve healing an intervention target for quality.

Key words： erythropoietin; interleukin-1β; matrix metalloproteinase-9/Tissue inhibitor of metalloproteinase-1; burns; vancouver scar scale; wound healing time; wound healing quality

燒傷創(chuàng)面愈合時間、愈合質(zhì)量與患者住院時間、住院費用及出院后心理壓力、生活質(zhì)量等密切相關(guān)，故研究燒傷創(chuàng)面愈合質(zhì)量、愈合時間的相關(guān)機制，早期預測創(chuàng)面愈合質(zhì)量意義重大[1]。……