以小鼠模型研究糖尿病傷口進程之療傷環境與癒合反應

Study of Healing Environment and Healing Reaction of Diabetic Wound Process in Mouse Model

方培燊(Pei-Sen Fang)

指導教授 ： 周涵怡

國立臺灣大學/醫學院/口腔生物科學研究所/碩士(2019年)

https://doi.org/10.6342/NTU201900253

摘要

從世界糖尿病聯盟（IDF）得知，在2017年時全球罹患糖尿病的病患就高達四億兩千五百萬人，並且推估在2045年時罹患糖尿病的人數會成長到六億兩千九百萬人，而糖尿病的族群主要以第一型和第二型糖尿病占多數，第一型糖尿病主要是因為基因或由於自體免疫系統破壞產生胰島素的胰島β細胞所引起疾病，而第二型糖尿病是因為飲食或生活型態異常所導致的胰島素抵抗作用異常所引起的疾病，其中第二型糖尿病的病患人數則占了高達90%左右，但是不論罹患哪一種的糖尿病，如果沒有去進行治療便會引發其他複雜的併發症，其中一個併發症就是所謂的慢性傷口。而在日常生活中難免會產生傷口，當糖尿病病患產生傷口時，會因為體內血糖濃度的居高不下而導致血管新生能力下降，以及傷口神經末端受損而造成的感知敏銳度降低。所以當受傷患者患有糖尿病時，傷口會較緩慢的癒合但會快速的惡化，因此需要密切的監視傷口狀況和給予一個良好的環境來進行傷口癒合。而讓傷口處於濕潤的環境是已經被證明可以增加整體傷口的癒合速度，目前已經開發出具有保濕、高吸收率、延展性佳、防水且透氣的薄型水凝膠敷料，但是這些條件都還不足以給予慢性傷口所需的照護環境。為此，本研究是以國內正積極發展中具有高度抵擋外界細菌入侵的結構；同時也具有濕潤環境以及抗沾黏能力的雙離子水凝膠敷料來進行研究，以釐清幫助傷口修復的機制並且期待開發出更好的產品來改善慢性傷口的照護環境。
　　而本研究中主要是使用以飲食誘導的第二型糖尿病C57BL/6公鼠來模擬人類的第二型糖尿病，然後在同一隻老鼠的背上進行手術開創出兩個相同大小的圓形傷口，並且使用雙離子水膠和市售的敷料來給予不同的傷口照護環境，在經過觀察數天的傷口表面狀況和不同敷料本體的實際變化後，在病理組織切片的分析中得到，新型敷料不管是在癒合的中期還是後期都讓慢性傷口得到超越市售敷料的癒合效果。

關鍵字

糖尿病 ； 慢性傷口 ； 血液供給 ； 神經 ； 濕潤環境 ； 傷口照護 ； 病理組織切片

並列摘要

According to the International Diabetes Federation (IDF), there were 425 million people worldwide suffering from diabetes in 2017, and it is estimated that people with diabetes will grow to 629 million people by 2045. The majority of people with diabetes are predominantly type 1 and type 2 diabetes, and type 1 diabetes is mainly caused by congenital genes or autoimmune system to damage insulin-producing islet beta cells, and type 2 diabetes is caused by abnormal diet or lifestyle lead to abnormal insulin resistance. Then the number of patients with type 2 diabetes accounted for up to 90%, but whether suffering any type of diabetes, if you don’t go to treatment, it will cause other complicated complication, and one of the complications is chronic wound. Inevitably, wound will occur in daily life, so when the diabetic patient has a wound, and it will because the blood glucose level in the body is too high, which leads to decrease the angiogensis ability, and the perceived acuity reduction caused by damage to the nerve endings of the wound. Therefore, when an injured patient has diabetes, the wound will heal slowly but it will deteriorate quickly at the same time, so it is demands to monitor closely the wound condition and give a good environment for wound healing. In the advancement of medical concepts, keeping the wound in the moist environment has been confirmed to increase the healing rate of the overall wound and has been developed to have thin hydrogel dressing with moisturizing, high absorptivity, good ductility, waterproof and air permeability, but these conditions are not enough to give the care environment for chronic wounds. To this end, this study is based on a structure that is actively developing in the country and is highly resistant to external bacterial invasion. It also has a moist environment and Zwitterionic hydrogel dressing that resists adhesion. To clarify the mechanisms that help wound repair and look forward to developing better products to improve the care environment for chronic wounds.
In this study, it is mainly using diet-induced type 2 diabetes C57BL/6 male mice to simulate human type 2 diabetes, then surgery on the back of the same mouse to create two circular wounds of the same size, and use Zwitterionic hydrogel dressing and commercially available dressing to give different wound care environments. After several days of observation and recording of the wound surface condition and actual changes of different dressings, obtained in the analysis of pathological tissue sections, new dressing give chronic wound better healing than commercially available dressing, no matter both in the middle and late stages of healing.

並列關鍵字

Diabetes ； Chronic wounds ； Blood supply ； Nervous system ； Moist environment ； Wound care environments ； Pathological tissue section

參考文獻

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