Jaschke E, Zabernigg A, Gattringer C
Department of Internal Medicine, General Hospital, Kufstein, Austria.
Int J Dermatol. 1999 May;38(5):380-6. doi: 10.1046/j.1365-4362.1999.00665.x.
Chronic venous leg ulcers have a major medical and economic impact on the elderly worldwide. Healing of the large ulcers (>10 cm2) occurs only in two-thirds of the patients and reulceration of healed ulcers recurs in one-third within 1 year. Because both healing and relapse rate influence greatly a patient's quality of life and the overall cost of treatment, every effort should be made to improve these two parameters.
To determine the safety and efficacy of topical low-dose recombinant human granulocyte-macrophage colony-stimulating factor (rhu GM-CSF) for the treatment of venous ulcers, and to document any improvement in healing rates.
Thirty-eight patients (29 women, 9 men; median age, 74 years) with chronic venous insufficiency were treated with topical rhu GM-CSF (5 microg/mL 0.9% sodium chloride solution), followed by application of a compression dressing. All subjects were treated as outpatients.
Complete healing was observed in 47 of the 52 ulcers (90.4%). The average healing time was 19 weeks. No systemic or local side-effects from the therapy were observed. Nine chronic ulcers, previously refractory to conventional treatment (pretreatment for more than 46 weeks), showed the same response rate (9/8, or 88.9%) and healing time (mean, 19 weeks). After 40 months, no reulceration of the healed ulcers was observed, but two patients developed new ulcers on the same leg. Healing remained stable, with excellent cosmetic results.
In this first study, topically applied low-dose rhu GM-CSF was a safe treatment for chronic venous leg ulcers. Healing rates were significantly increased and relapse rates were minimal.
慢性下肢静脉溃疡对全球老年人产生了重大的医学和经济影响。大溃疡（面积>10平方厘米）仅有三分之二的患者能够愈合，且愈合后的溃疡有三分之一在1年内复发。由于愈合率和复发率都极大地影响患者的生活质量和总体治疗成本，因此应尽一切努力改善这两个参数。
确定局部应用低剂量重组人粒细胞巨噬细胞集落刺激因子（rhu GM-CSF）治疗静脉溃疡的安全性和有效性，并记录愈合率的任何改善情况。
38例慢性静脉功能不全患者（29例女性，9例男性；中位年龄74岁）接受局部rhu GM-CSF（5微克/毫升的0.9%氯化钠溶液）治疗，随后应用加压敷料。所有受试者均作为门诊患者进行治疗。
52处溃疡中有47处（90.4%）完全愈合。平均愈合时间为19周。未观察到该治疗的全身或局部副作用。9处先前对传统治疗无效（预处理超过46周）的慢性溃疡，显示出相同的缓解率（9/8，即88.9%）和愈合时间（平均19周）。40个月后，未观察到愈合溃疡复发，但有2例患者在同一条腿上出现了新的溃疡。愈合情况保持稳定，美容效果极佳。
在这项首次研究中，局部应用低剂量rhu GM-CSF是治疗慢性下肢静脉溃疡的一种安全疗法。愈合率显著提高，复发率极低。
