| Objective: To observe and evaluate the effect of adipose-derived stem cells/extracellular matrix complex(ECM/SVF gel)on chronic wound treatment through clinical trials,and to study the mechanism of ECM/SVF gel from paracrine and regulate local matrix metalloproteinases(MMPs)by relevant basic methods.To influence the healing of chronic wounds,it aims to provide a richer theoretical basis and treatment for the clinical treatment of chronic wounds.Methods: 1.Part one study: Chronic wound patients who were hospitalized during the period from August 2017 to January 2019 in the Department of Burn and Plastic Surgery,Affiliated Hospital of North Sichuan Medical College,were randomly divided into two groups,each group of 15 example.After the wound was thoroughly debrided,the experimental group: ECM/SVF gel was treated with local injection.Control group: treated with conventional vacuum sealing drainage(VSD).VAS pain scores were taken before treatment and on the seventh day after treatment.Wound healing was observed on the seventh,tenth and fourteenth days after treatment.The wound healing rate was measured and calculated,and the growth of granulation tissue was observed and scored.2.Part two study: Observing the expression of vascular endothelial growth factor(VEGF),matrix metalloproteinases(MMPs)and their inhibitors(TIMPs): a small amount of granulation tissue was taken from the same site before the wound treatment and on the seventh day after treatment.The expression of VEGF,matrix metalloproteinase-1(MMP-1)and matrix metalloproteinase inhibitor-1(TIMP-1)in the experimental group and the control group were detected.Data analysis was performed using SPSS20.0 statistical software,P<0.05 was statistically significant.Result: 1.The two groups of patients were generally in good condition after treatment,no complications were found at the treatment site,and no adverse reactions occurred during the treatment.After treatment,the wounds of both groups had a tendency to heal.On the seventh day after treatment,the healing rate of the two groups was different.The healing rate of ECM/SVF gel group(39.98±19.92%)was higher than that of VSD group(11.44±11.80%).On the tenth day after treatment,the healing rates of ECM/SVF gel group and VSD group were also different.The healing rate of ECM/SVF gel group(47.53±15.34%)was higher than that of VSD group(15.34±6.96%).The difference was statistically significant.(P<0.05).On the 14 th day after treatment,the healing rate of the two groups was also significantly different(P<0.05),and the healing rate of ECM/SVF gel group(58.54±20.62%)was significantly higher than that of VSD group(19.81±8.09%).2.After treatment,the patients in the ECM/SVF gel group and the VSD group had a certain degree of pain relief compared with before treatment,and the VAS scores were different(P<0.05),which was statistically significant.On the seventh day after treatment,the ECM/SVF gel group scores(1.88±0.83)were significantly lower than those in the VSD group(4.50±0.76),and the difference was statistically significant(P<0.05).The granulation tissue growth of the two groups was significantly increased on the seventh day after treatment(P<0.05),but there was no difference between the two groups(P>0.05).On the tenth day,there was a difference in the growth of granulation tissue between the two groups(P<0.05).The granulation tissue growth score of the ECM/SVF gel group(2.87±0.24)was better than that of the VSD group(2.32±0.26).On the fourteenth day,there was also a statistically significant difference between the two groups(P<0.05),and the ECM/SVF gel group score(4.12±0.36)was significantly higher than the VSD group(2.98±0.29).3.The results of immunohistochemistry showed that the levels of VEGF in the two groups increased significantly after treatment for seven days,which was significantly different from that before surgery(P<0.05),but the relative expression of VEGF in VSD group(0.0689±0.0240)was higher than that of ECM/SVF gel.The group(0.0529±0.0141),the difference was statistically significant(P<0.05).After 7 days of treatment,the levels of MMP-1 in the two groups decreased,and there was significant difference between the two groups(P<0.05),but there was no significant difference between the two groups(P>0.05).After 7 days of treatment,the content of TIMP-1 in the ECM/SVF gel group(0.2112±0.1173)increased significantly,and the content of TIMP-1 in the VSD group(0.0138±0.0102)increased.There was significant difference between the two groups(P<0.05).Conclusion: 1.ECM/SVF gel is effective in treating chronic wounds,promotes wound healing,relieves pain and promotes granulation tissue growth,and has good prognosis and no adverse reactions.It is a safe and effective treatment.2.ECM/SVF gel promotes the growth of wound granulation tissue and accelerates wound healing under the interaction of increasing the concentration of wound growth factor,inhibiting local inflammation and controlling infection.ECM/SVF gel increases the local VEGF concentration by paracrine,promotes the regeneration of fibroblasts and endothelial cells,and provides conditions for angiogenesis.ECM/SVF gel down-regulates MMP-1 and increases TIMP-1.This mechanism may be used to regulate collagen deposition and local inflammation in chronic wounds to promote wound healing. |
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