Mekkes J R, Zeegelaar J E, Westerhof W
Department of Dermatology, Academic Medical Center, University of Amsterdam, The Netherlands.
Arch Dermatol Res. 1998 Mar;290(3):152-7. doi: 10.1007/s004030050281.
Proteolytic enzymes have been used for wound debridement for many years. The two enzymes most widely used in Europe are fibrinolysin/desoxyribonuclease and collagenase. Despite their frequent use, very few placebo-controlled studies comparing the enzymes with vehiculum only, or with each other, are available. In a specially developed necrotic ulcer animal model, combined with a computer image analysis technique to measure necrotic and total wound surface areas quantitatively, we assessed the wound-cleansing properties of fibrinolysin/DNase oleogel, collagenase ointment, saline-soaked gauze control treatment, and new galenic formulations of collagenase, including placebos. The average relative area of necrotic tissue present in the wound after 1 week was 31% for collagenase ointment and 56% for fibrinolysin/DNAse oleogel (P = 0.0037). Collagenase gel was significantly (P = 0.0007) better in removing necrosis than placebo (gel only). Fibrinolysin/DNAse was not significantly more effective than the three placebo or control treatments (placebo film, placebo gel, saline-soaked gauzes). We conclude that collagenase is a suitable enzyme for wound debridement, but we were not able to detect clinical efficacy of fibrinolysin/DNAse in this model.
蛋白水解酶用于伤口清创已有多年。在欧洲使用最广泛的两种酶是纤维蛋白溶酶/脱氧核糖核酸酶和胶原酶。尽管它们被频繁使用，但仅有极少数安慰剂对照研究将这些酶与仅使用赋形剂的情况进行比较，或者将这些酶相互比较。在一个专门开发的坏死性溃疡动物模型中，结合计算机图像分析技术来定量测量坏死和整个伤口的表面积，我们评估了纤维蛋白溶酶/脱氧核糖核酸酶油凝胶、胶原酶软膏、生理盐水浸湿纱布对照处理以及包括安慰剂在内的胶原酶新药剂型的伤口清洁特性。1周后伤口中坏死组织的平均相对面积，胶原酶软膏为31%，纤维蛋白溶酶/脱氧核糖核酸酶油凝胶为56%（P = 0.0037）。胶原酶凝胶在清除坏死组织方面显著优于安慰剂（仅凝胶）（P = 0.0007）。纤维蛋白溶酶/脱氧核糖核酸酶并不比三种安慰剂或对照处理（安慰剂薄膜、安慰剂凝胶、生理盐水浸湿纱布）更有效。我们得出结论，胶原酶是一种适合用于伤口清创的酶，但在该模型中我们未能检测到纤维蛋白溶酶/脱氧核糖核酸酶的临床疗效。
