Department of Endocrinology, The NO. 1 Central Hospital of Baoding City, 320 North Greatwall Street, Baoding, 071000, China.
J Diabetes Complications. 2013 Jul-Aug;27(4):380-2. doi: 10.1016/j.jdiacomp.2012.12.007. Epub 2013 Jan 26.
Little is known about serum concentrations of Matrix Metalloproteinase-9 (MMP-9), MMP-2, TIMP-1 and TIMP-2 in diabetic patients with foot ulcers. This study demonstrates their relationship with wound healing.
Ninety-four patients with diabetic foot ulcers were recruited in the study. Serum MMP-9, MMP-2, TIMP-1 and TIMP-2 were measured at the first clinic visit and the end of 4-week treatment and followed up till 12 weeks. According to the decreasing rate of ulcer healing area at the fourth week, we divided those cases into good and poor healers. Through analyses, we explore the possible relationship among those factors and degree of wound healing.
The median level of serum MMP-9 in good healers was lower than poor healers at first visit (124.2 μg/L vs 374.6 μg/L, p<0.05), and after 4-week therapy it decreased 5-fold approximately. In contrast, the change in MMP-9 concentration did not reach statistical significance in poor healers. MMP-2, TIMP-1 and TIMP-2 varied slightly in both good healers and poor healers. The MMP-9/TIMP-1 ratio better reflected the healing than MMP-9 alone before therapy and after 4 week treatment (r = -0.6475 vs -0.3251, r = -0.7096 vs -0.1231, respectively). Receiver Operator Curve (ROC) showed that the cutoff for MMP-9/TIMP-1 ratio at <0.395 best predicted a reduction in wound area of 82% at the end of 4-week treatment with a sensitivity of 63.6% and a specificity of 58.6% (area under the curve 0.658, p < 0.001).
Detecting serum MMP-9/TIMP-1 ratio on admission might be a predictor of healing and might provide a novel target for the future therapy in diabetic foot ulcers.
糖尿病足溃疡患者的血清基质金属蛋白酶 9（MMP-9）、MMP-2、TIMP-1 和 TIMP-2 浓度知之甚少。本研究旨在探讨它们与伤口愈合的关系。
本研究共纳入 94 例糖尿病足溃疡患者。在首次就诊时和 4 周治疗结束时测量血清 MMP-9、MMP-2、TIMP-1 和 TIMP-2，并随访至 12 周。根据第 4 周时溃疡愈合面积的减少率，将这些病例分为愈合良好和愈合不良的患者。通过分析，我们探讨了这些因素与伤口愈合程度之间的可能关系。
愈合良好的患者初次就诊时血清 MMP-9 中位数水平低于愈合不良的患者（124.2 μg/L 比 374.6 μg/L，p<0.05），且在 4 周治疗后下降约 5 倍。相比之下，愈合不良的患者 MMP-9 浓度的变化没有达到统计学意义。在愈合良好和愈合不良的患者中，MMP-2、TIMP-1 和 TIMP-2 变化不大。在治疗前和 4 周治疗后，MMP-9/TIMP-1 比值比 MMP-9 更能反映愈合情况（r = -0.6475 比 -0.3251，r = -0.7096 比 -0.1231）。受试者工作特征曲线（ROC）显示，MMP-9/TIMP-1 比值<0.395 时，4 周治疗结束时伤口面积减少 82%的最佳预测值，其灵敏度为 63.6%，特异性为 58.6%（曲线下面积 0.658，p<0.001）。
入院时检测血清 MMP-9/TIMP-1 比值可能是愈合的预测指标，并可能为糖尿病足溃疡的未来治疗提供新的靶点。
