Nakai Ayano, Minematsu Takeo, Tamai Nao, Sugama Junko, Urai Tamae, Sanada Hiromi
Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Japan.
Department of Skincare Science, Graduate School of Medicine, The University of Tokyo, Japan; Division of Care Innovation, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Japan.
J Tissue Viability. 2019 May;28(2):87-93. doi: 10.1016/j.jtv.2019.02.002. Epub 2019 Feb 8.
The prevention of progression of Category I pressure ulcers (PUs) to Category II or higher is important, as Category II or higher PUs are open wounds and have a higher infection risk. Prognosis prediction of Category I PUs is necessary to provide successful intensive care for PUs with impaired healing. We focused on skin blotting using plasminogen activator inhibitor 1 (PAI1), interleukin-1α (IL-1α), vascular endothelial growth factor C (VEGF-C), and heat shock protein 90α (HSP90α). This pilot study was conducted at long-term-care and general hospitals to examine the applicability of DESIGN-R and thermography; the feasibility of skin blotting technique; the biomarker candidates, PAI1, IL-1α, VEGF-C, and HSP90α; and sample size for prognosis prediction for Category I PUs. Patients aged >65 years underwent skin blotting, scoring for DESIGN-R, and took thermography images of their Category I PU site. Albumin signals were not detected in one out of three participants. PAI1, IL-1α, VEGF-C, and HSP90α were detected in 19 participants, among whom 11 participants could be followed up after one week. There was no difference in DESIGN-R score and skin surface temperature between normal and impaired healing groups, and the sample size was calculated as 16. In conclusion, the feasibility of skin blotting was confirmed. PAI1, IL-1α, VEGF-C, and HSP90α could be biomarker candidates for prognosis prediction for Category I PU and the combination of VEGF-C and HSP90α could be associated with the prognosis of Category I PU. We need to investigate 842 patients in a future study.
预防Ⅰ期压疮（PU）进展为Ⅱ期或更高级别很重要，因为Ⅱ期或更高级别的PU为开放性伤口，感染风险更高。对Ⅰ期PU进行预后预测对于为愈合受损的PU提供成功的重症护理很有必要。我们重点研究了使用纤溶酶原激活物抑制剂1（PAI1）、白细胞介素-1α（IL-1α）、血管内皮生长因子C（VEGF-C）和热休克蛋白90α（HSP90α）进行皮肤印迹分析。这项初步研究在长期护理医院和综合医院开展，以检验DESIGN-R和热成像的适用性；皮肤印迹技术的可行性；生物标志物候选物PAI1、IL-1α、VEGF-C和HSP90α；以及Ⅰ期PU预后预测的样本量。年龄>65岁的患者接受了皮肤印迹分析、DESIGN-R评分，并对其Ⅰ期PU部位进行了热成像。三名参与者中有一名未检测到白蛋白信号。在19名参与者中检测到了PAI1、IL-1α、VEGF-C和HSP90α，其中11名参与者在一周后得到了随访。正常愈合组和愈合受损组之间的DESIGN-R评分和皮肤表面温度没有差异，样本量计算为16。总之，证实了皮肤印迹分析的可行性。PAI1、IL-1α、VEGF-C和HSP90α可能是Ⅰ期PU预后预测的生物标志物候选物，VEGF-C和HSP90α的组合可能与Ⅰ期PU的预后相关。我们需要在未来的研究中调查842名患者。
