Treatment differences and mechanism of diabetes mellitus patients and non-diabetes mellitus patients with lower extremity burns

Abstract

Objective To discuss on lower extremity wound healing of burn patients with diabetes mellitus and its possible mechanism. Methods With the method of case-control study, 47 cases of diabetic patients with lower extremity burns were set as the diabetic group, 60 cases of non-diabetic lower limb burn patients were set as non-diabetic group. Two groups of the patients were admitted to the department of burns and plastics surgery, the second People′s hospital of Shantou from July 2013 to September 2010. Two groups of patients were treated with conventional therapy such as wound treatment, anti infection, gene recombinant basic fibroblast growth factor (bFGF) treatment and so on. In addition, the patients of diabetes group were treated with hypoglycemic therapy. The protein and mRNA expression levels of the fibroblast growth factor 2 (FGF2), vascular endothelial growth factor (VEGF) were measured with the enzyme linked immunosorbent assay (ELISA) in two groups of patients at the time of 7 days after treatment. Tissue microvessel density (MVD) was detected by immunohistochemistry. Isolation treatment time, total length of stay, incidence of complications and treatment outcome were compared between the two groups. The data were compared with the t test, the Chi square test and the Fisher exact probability test. Results Treatment after 7 days, the expression levels of FGF2 protein, VEGF protein in diabetes group (87.4±7.8) ng/mL, (106.3±14.2) ng/mL were significantly higher than the non-diabetes group (61.3±9.2) ng/mL, (68.8±13.1) ng/mL, the differences were statistically significant (t=15.55, 19.88, P values were less than 0.01). The expression levels of FGF2 mRNA, VEGF mRNA in diabetes group (11.5±4.7)×104 copies, (8.7±3.9)×104 copies were significantly higher than the non-diabetes group(4.9±2.6)×104 copies, (2.8±1.7)×104 copies, the differences were statistically significant (t=9.23, 10.52, P values were less than 0.01). The wound tissue MVD in diabetes group (14.6±2.5)/vision were less than the non-diabetes group (23.9±5.4)/vision, the difference was statistically significant (t=11.83, P value was less than 0.01). There was no significant difference (P value was more than 0.05) in the isolation treatment time between the diabetes group (8.9±7.2) d and non-diabetes group (8.6±6.5)d. There was significant difference (P value was more than 0.05) in total length of stay between the diabetes group (16.3±5.5)d and non-diabetes group(10.8±4.8)d. The incidence of complications in the diabetic group (31.9%) was higher than that in the non-diabetic group(13.3%), and the difference was statistically significant (P value was less than 0.05). The proportion of family care, community treatment and rehabilitation facilities in the diabetes group was higher than that in the non-diabetic group, and the difference was statistically significant (P value was less than 0.05). Conclusions The wound tissue in diabetic patients with lower extremity burns in the low expression of MVD showed that wound healing angiogenesis had been inhibited, which may be one of the causes of delayed wound healing in diabetes. While diabetes will increase the complications of patients, which have adverse effects on the recovery of burn patients. Key words: Diabetes mellitus; Lower extremity; Burns; Microvessels; Fibroblast growth factor 2; Vascular endothelial growth factors; Treatment outcome; Complications