Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria.
Institute of Pathology, Medical University of Graz, Graz, Austria.
Sci Rep. 2018 Jan 18;8(1):1132. doi: 10.1038/s41598-017-18790-0.
Continuous subcutaneous insulin infusion (CSII) catheters are considered the weak link of insulin pump therapy. Wear-time considerably varies between patients and the choice of catheter material is based on personal preferences rather than scientific facts. Therefore, we systematically assessed and quantified the inflammatory tissue response to steel versus Teflon CSII catheters over a maximum wear-time of 7 days in swine. Tissue surrounding catheters was analysed using histopathology and quantitative real-time PCR. The area of inflammation increased significantly over time independent of material which was confirmed by an increase in CD68 expression and an increase in mononuclear and neutrophil cell infiltrate around the catheters. We observed substantially higher fibrin deposition (p < 0.05) around steel on day 4 of wear-time. IL-6 gene expression increased within 24 hours after insertion, returned to normal levels around Teflon (p < 0.05) but remained high around steel (p < 0.05). IL-10 and TGF-β levels did not resolve over time, indicating impaired wound healing. In conclusion, there was a major temporal effect in the acute inflammatory response to CSII catheters but we found little difference between materials. This study setup presents a robust tool for the systematic analysis of the tissue response to CSII catheters.
持续皮下胰岛素输注 (CSII) 导管被认为是胰岛素泵治疗的薄弱环节。患者之间的佩戴时间差异很大，导管材料的选择基于个人喜好，而不是科学事实。因此，我们在猪身上系统评估和量化了钢质与特氟龙 CSII 导管在最长 7 天佩戴时间内的炎症组织反应。使用组织病理学和定量实时 PCR 分析导管周围的组织。无论材料如何，炎症面积随时间显著增加，这一点得到了 CD68 表达增加以及导管周围单核细胞和中性粒细胞浸润增加的证实。我们观察到在佩戴时间的第 4 天，钢质周围的纤维蛋白沉积明显更高（p<0.05）。IL-6 基因表达在插入后 24 小时内增加，在特氟龙周围恢复正常水平（p<0.05），但在钢质周围仍保持高水平（p<0.05）。IL-10 和 TGF-β 水平随时间没有恢复，表明伤口愈合受损。总之，CSII 导管的急性炎症反应存在主要的时间效应，但我们发现两种材料之间几乎没有差异。这种研究设置为 CSII 导管的组织反应的系统分析提供了一个强大的工具。
