壳聚糖及其复合物在治疗下肢慢性溃疡中的研究进展
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张喜成, Email: zhangxicheng163@163.com

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Research progresses of chitosan and its derivatives in treatment chronic leg ulcer 
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    摘要:

    下肢慢性溃疡(CLU)是一种常见的外科疾病。在人群中发病率为0.12%~1.1%,其中60岁以上发病率为0.5%~3%,80岁以上则高达5%。根据溃疡病因,可将其分为血管源性溃疡、糖尿病足溃疡、压力性溃疡、创伤性溃疡、神经营养性溃疡、恶性溃疡等。伤口的愈合包括炎症反应期、增生期和修复期,适当的微环境能促进细胞的增殖和迁移,有利于早期伤口愈合,防止炎症和疤痕产生。溃疡创面的处理对愈合过程有着至关重要的作用。目前针对CLU的治疗主要包括清创、植皮、负压封闭引流、抗感染、局部活性因子、干细胞移植及敷料覆盖等。选择合适的伤口敷料对促进CLU创面的愈合起至关重要的作用,这类敷料除具有良好的吸收伤口渗液能力外,还应保持伤口的适宜的微环境、抑菌、止血、镇痛等能力和促进伤口愈合能力。壳聚糖化是甲壳素经强碱作用脱去部分乙酰基的产物。其具有抗感染、止血、免疫调节、诱导组织修复和细胞增殖,以及良好的生物相容性和生物降解性。同时壳聚糖对白细胞和巨噬细胞具有趋化作用,增强巨噬细胞吞噬作用,其可刺激中性粒细胞及巨噬细胞分泌白细胞介素和肿瘤坏死因子,进而促进创面进行“自净”。壳聚糖在治疗CLU中的良好前景。

    Abstract:

    Chronic leg ulcer (CLU) is a common surgical disease. Its prevalence is 0.12 to 1.1% in the general population, is 0.5% to 3% in people older than 60, and reaches 5% in those over 80 years of age. According to the pathogenesis, it can be divided into vascular ulcer, diabetic foot ulcer, pressure ulcer, traumatic ulcer, neurotrophic ulcer, and malignant ulcer, etc. The wound healing stages include inflammatory response phase, hyperplasia phase and repair phase. Proper microenvironmental conditions can promote cell proliferation and migration, which is helpful for early wound healing and preventing inflammation and scar tissue generation. Ulcer wound treatment has a vital role in the wound healing process. At present time, the treatment for CLU mainly includes debridement and skin grafting, vacuum sealing drainage, anti-infection, local active factors, stem cell transplantation and dressing coverage, etc. The selection of appropriate wound dressings plays a crucial role in accelerating the wound healing of CLU. In addition to the good ability to absorb wound exudate, these dressings should also have the abilities of maintaining appropriate microenvironment, anti-bacteria, hemostasis, analgesia and other abilities for promoting wound healing. Chitosan is the product of partial deacetylation of chitin by the action of strong alkali. It possesses the characteristics of infection resistance, hemostasis, immune regulation, inducing tissue repair and cell proliferation, as well as good biocompatibility and biodegradability. At the same time, chitosan has effect on white blood cells and macrophages chemotaxis, enhancing macrophage phagocytosis, and stimulating neutrophils and macrophages to secrete interleukins and tumor necrosis factor, and thereby promoting "self-purification" of the wound surface. Chitosan has a good prospect in the treatment of CLU. 

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刘佳鑫, , 张喜成, 高启航, 韦利, 李观强.壳聚糖及其复合物在治疗下肢慢性溃疡中的研究进展[J].中国普通外科杂志,2020,29(6):752-758.
DOI:10.7659/j. issn.1005-6947.2020.06.017

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  • 收稿日期:2019-12-04
  • 最后修改日期:2020-05-13
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  • 在线发布日期: 2020-06-25