Groves R W, Schmidt-Lucke J A
Department of Medicine, University College London, UK.
Adv Skin Wound Care. 2000 May-Jun;13(3 Pt 1):107-12.
Although most wounds heal rapidly, impaired or delayed tissue repair represents a major clinical challenge. Current therapy is directed at providing a wound with the most favorable environment in which to heal, rather than aiming to increase the rate of healing pharmacologically. Recent studies have suggested that a number of drugs may act specifically to increase healing rates. In vivo studies have demonstrated that recombinant human granulocyte-macrophage colony-stimulating factor facilitates wound contraction, causes local recruitment of inflammatory cells, and induces keratinocyte proliferation. It also activates mononuclear phagocytes, promotes migration of epithelial cells, and further regulates cytokine production. In 2 recent placebo-controlled studies involving venous leg ulceration, subcutaneous perilesional injections of recombinant human granulocyte-macrophage colony-stimulating factor were found to be significantly better than placebo in the time to complete wound healing. In other studies, recombinant human granulocyte-macrophage colony-stimulating factor was administered topically to wounds. Several case reports have also demonstrated the use of recombinant human granulocyte-macrophage colony-stimulating factor for postsurgical wounds, chronic leg ulcers of sickle cell anemia patients, and refractory pyoderma gangrenosum. Despite proper attention to wound care, some wounds fail to heal in an appropriate fashion and may become chronic. Studies of wound physiology as well as experimental and clinical evidence suggest that recombinant human granulocyte-macrophage colony-stimulating factor may promote healing of these lesions.
尽管大多数伤口愈合迅速，但组织修复受损或延迟仍是一项重大的临床挑战。目前的治疗方法旨在为伤口提供最有利于愈合的环境，而非从药理学角度提高愈合速度。最近的研究表明，一些药物可能具有特异性提高愈合速度的作用。体内研究已证明，重组人粒细胞巨噬细胞集落刺激因子可促进伤口收缩，引起炎症细胞的局部募集，并诱导角质形成细胞增殖。它还能激活单核吞噬细胞，促进上皮细胞迁移，并进一步调节细胞因子的产生。在最近两项涉及下肢静脉溃疡的安慰剂对照研究中，发现皮下病灶周围注射重组人粒细胞巨噬细胞集落刺激因子在伤口完全愈合时间方面明显优于安慰剂。在其他研究中，重组人粒细胞巨噬细胞集落刺激因子被局部应用于伤口。一些病例报告也证明了重组人粒细胞巨噬细胞集落刺激因子可用于术后伤口、镰状细胞贫血患者的慢性腿部溃疡以及难治性坏疽性脓皮病。尽管对伤口护理给予了适当关注，但一些伤口仍无法以适当方式愈合，可能会变成慢性伤口。伤口生理学研究以及实验和临床证据表明，重组人粒细胞巨噬细胞集落刺激因子可能促进这些损伤的愈合。
