Department of Dermatology, Venerology and Allergology, University-Hospital Essen, University of Duisburg-Essen, Essen, Germany.
FUJIFILM VisualSonics Inc., Amsterdam, The Netherlands.
Mol Imaging Biol. 2018 Feb;20(1):124-130. doi: 10.1007/s11307-017-1103-9.
Chronic leg ulcers can be a challenge to treat and long-term therapy a significant cost factor in western public health budgets. Objective wound assessment assays enabling selection of appropriate wound therapy regimes would be desirable. Oxygenation status in ulcer tissue has obtained increased attention as a relevant factor in wound healing. To increase oxygenation in wounds, a topical hemoglobin spray was developed. Although favorable results have been noted, the link between clinical efficacy and the mode of action has not been demonstrated. The aims were to determine if changes in tissue oxygenation can be measured after topical application of hemoglobin on chronic wounds and to evaluate the findings in terms of therapy strategies.
Photoacoustic imaging was used to measure the local oxygen saturation (StO) in leg ulcers before and after hemoglobin spray treatment. Sclerosis of the leg ulcers was histopathologically graded and the change in wound size was documented in a follow-up examination.
Measuring 49 patients, an increase in StO after topical hemoglobin application from on average 66.1 to 71 % (p = 0.017) after 20 min was observed. Depending on the increase in StO (>10 % or <10 %) patients were stratified into a Responder and a Non-Responder group. Wound size significantly decreased in the Responder Group (p = 0.001), while no significant difference in the Non-Responder group (p = 0.950) was noted.
Our findings suggest that the likelihood of wound healing under conservative therapy can be predicted by measuring changes in StO after topical hemoglobin application. This assay may reduce treatment time and costs by avoiding ineffective conservative long-term therapy.
German Clinical Trials Register: DRKS00005993.
慢性腿部溃疡的治疗具有挑战性，长期治疗是西方公共卫生预算的一个重要成本因素。如果能够选择合适的伤口治疗方案，对伤口进行客观评估将是非常理想的。组织中的氧合状态作为伤口愈合的一个相关因素，已经引起了越来越多的关注。为了增加伤口的氧合，开发了一种局部血红蛋白喷雾。尽管已经注意到了有利的结果，但临床疗效与作用机制之间的联系尚未得到证明。本研究旨在确定局部应用血红蛋白后是否可以测量慢性伤口的组织氧合变化，并根据治疗策略评估这些发现。
使用光声成像技术测量血红蛋白喷雾治疗前后腿部溃疡的局部氧饱和度（StO）。腿部溃疡的硬化程度通过组织病理学分级，并在随访检查中记录伤口大小的变化。
对 49 名患者进行测量，观察到局部血红蛋白应用后 StO 从平均 66.1%增加到 71%（p=0.017），20 分钟后增加。根据 StO 的增加（>10%或<10%），患者被分为应答者和非应答者组。应答组的伤口大小显著减小（p=0.001），而非应答组则没有显著差异（p=0.950）。
我们的研究结果表明，通过测量局部血红蛋白应用后 StO 的变化，可以预测保守治疗下的伤口愈合可能性。该检测方法可能通过避免无效的长期保守治疗，减少治疗时间和成本。
德国临床试验注册中心：DRKS00005993。
