检测升高的蛋白酶活性：160例伤口的前瞻性分析

Testing Elevated Protease Activity: Prospective Analysis of 160 Wounds.

作者信息

Lockmann Anike, Schill Tillmann, Hartmann Franziska, Grönemeyer Lisa-Lena, Holzkamp Ricarda, Schön Michael P, Thoms Kai-Martin

机构信息

In the Department of Dermatology, Venereology, and Allergology at University Medical Center Göttingen, Germany, Anike Lockmann, MD, is an Assistant Physician; Tillmann Schill, MD, is a Specialist Physician; Franziska Hartmann, MD, is an Assistant Physician; Lisa-Lena Grönemeyer, MD, is an Assistant Physician; Michael P. Schön, MD, is Professor and Chairman; and Kai-Martin Thoms, MD, is a Senior Physician. Ricarda Holzkamp, MD, is a Specialist Physician, Dermatology Practice, Osterode, Germany. Acknowledgments: Kai-Martin Thoms has disclosed speaker's fees from Systagenix Wound Management. Woundchek Protease Status was purchased at a reduced price for the purpose of this study. The authors have disclosed no other conflicts of interest regarding this article. Submitted December 21, 2016; accepted in revised form June 21, 2017.

出版信息

Adv Skin Wound Care. 2018 Feb;31(2):82-88. doi: 10.1097/01.ASW.0000527965.64870.03.

DOI:10.1097/01.ASW.0000527965.64870.03

PMID:29346149

Abstract

OBJECTIVE

Given that local elevated protease activity (EPA) has been implicated in impaired wound healing, a prospective single-center study was conducted to assess protease activity in various wound types.

METHODS

Protease activity was determined using an easy-to-use test system (Woundchek Protease Status Test Kit; Systagenix, Gatwick, United Kingdom) in 160 wounds in 143 patients. The assay detects the combined activity of inflammatory proteases, mainly matrix metalloproteinases 8 and 9 and human neutrophil elastase.

RESULTS

Local EPA was detected in 29 of 153 validly tested wounds (18.95%). No difference was detected between acute and chronic wounds, regardless of associated or causative conditions, with the sole exception of surgical wounds. Surgical wounds showed EPA significantly less frequently than nonsurgical wounds. Among nonsurgical wounds, EPA was detected more frequently in acute compared with chronic wounds. Wounds with signs of unimpeded healing (granulation or epithelialization) showed EPA less often than wounds covered with necrotic tissue or a fibrin layer. However, 14% of wounds with epithelialization or granulation exhibited EPA potentially impeding wound healing. Wounds treated with moisture-retentive wound dressings showed EPA significantly less frequently compared with wounds bandaged with dressings with less moisture-retentive properties. Remarkably, none of the wounds treated with collagen/oxidized regenerated cellulose/silver, which is a protease-modulating dressing, showed EPA.

CONCLUSIONS

To the study authors' knowledge, this is the largest study assessing EPA in various wound types. The convenient applicability of the test system provides a basis for future studies assessing the pathophysiologic relevance of EPA. In some unsuspicious wounds, early detection of EPA might precede impaired healing and prompt protease-modulating treatment before failure to heal becomes apparent.

摘要

目的

鉴于局部蛋白酶活性升高（EPA）与伤口愈合受损有关，开展了一项前瞻性单中心研究，以评估不同类型伤口中的蛋白酶活性。

方法

使用一种易于使用的检测系统（伤口蛋白酶状态检测试剂盒；Systagenix，英国盖特威克）测定了143例患者160处伤口的蛋白酶活性。该检测方法可检测炎症蛋白酶的综合活性，主要是基质金属蛋白酶8和9以及人类中性粒细胞弹性蛋白酶。

结果

在153处有效检测的伤口中，有29处检测到局部EPA（18.95%）。急性伤口和慢性伤口之间未检测到差异，无论其相关或致病情况如何，但手术伤口除外。手术伤口出现EPA的频率明显低于非手术伤口。在非手术伤口中，与慢性伤口相比，急性伤口中EPA的检测频率更高。具有愈合不受阻碍迹象（肉芽形成或上皮形成）的伤口出现EPA的频率低于覆盖有坏死组织或纤维蛋白层的伤口。然而，14%具有上皮形成或肉芽形成的伤口表现出可能阻碍伤口愈合的EPA。与使用保湿性较差的敷料包扎的伤口相比，使用保湿伤口敷料治疗的伤口出现EPA的频率明显更低。值得注意的是，使用胶原蛋白/氧化再生纤维素/银（一种蛋白酶调节敷料）治疗的伤口均未检测到EPA。