Two Polarization Type Macrophages In The Treatment Of Refractory Wounds Differential Expression

Objective To explore the differential expression of different polarization types of macrophages in wound tissue during surgical treatment of diabetic foot refractory wounds,and to analyze the clinical significance of macrophages in inflammatory and repair of refractory wounds.Methods Twenty patients with severe diabetic foot who underwent surgical treatment of burn and plastic surgery at the First Affiliated Hospital of Soochow University from December 2017 to January 2019 were enrolled in this study.After seeking patient consent and obtaining permission from the ethics committee,debridement combined with negative pressure closed drainage technique was used to treat the patient.Before the treatment and 2 weeks after treatment,the patient’s wounds were observed.The tissue sections at the edge of the wound were divided into three groups:A,B,and C.The group A was stained with HE and the pathological changes of the wound were observed by microscope.Group B And group C used immunohistochemical techniques to observe the expression of two activated types of macrophages.Group B used CD86 monoclonal antibody to label M1 macrophages in wound tissue;group C specifically labeled M2 macrophages with CD206 monoclonal antibody.After staining,the positive cells were counted under the high power microscope field and recorded as M1 and M2.The image-Pro Plus 6.0 image analysis software was used to obtain M1 and M2 counts,and the ratio of M1/M2 was calculated.The differences between the two types of polarized macrophages before and after surgery were compared.Results The wounds were observed 2 weeks after the operation,and the wounds were smooth,the edges were clear,the granulation was fresh,the inflammatory reaction was light,the swelling and exudation were weaker than before,wound tends to converge and heal.Under the microscope of group A,the degree of inflammatory reaction at the time of wound healing was lighter than that before operation,and the number of new capillary,fibroblast,collagen and epithelial cells was significantly better than that before surgery.Group B and C patients had CD86 and CD206 positive cell counts before treatment,with M1 count of 180.40±32.43 and M2 count of 54.13±5.43.In the 2 weeks after surgical treatment,the M1 count was 85.73±17.10,and the M2 count was 44.87±4.91.The number of CD86 and CD206 positive cells in the wounds decreased 2 weeks after surgery(P<0.01).The difference was statistically significant.After 2 weeks of surgical treatment,the M1/M2 ratio of wounds was significantly lower than that before treatment.(P<0.01),the difference was statistically significant.Conclusion Debridement combined with negative pressure closed drainage technique can be applied to diabetic foot wounds,which can improve local pathological changes and promote the decrease of macrophage numbers.At the same time,macrophages are induced to polarize into M2 macrophages.Thereby alleviating M1 macrophage-mediated chronic wound inflammation in diabetic foot and promoting healing;in clinical work,interventions for reducing the proportion of Ml macrophages and increasing the proportion of M2 macrophages in chronic refractory wounds are beneficial to wounds Heal.