| Part one:Therapeutic effect of epidermal growth factor combined with nano silver dressing on diabetic foot patients Objective:To investigate the clinical efficacy of epidermal growth factor combined with nano silver dressing in the treatment of diabetic foot wounds.Methods:A total of 120 patients with diabetic foot ulcers admitted to the Second Affiliated Hospital of Nanchang University from 2017-06 to 2020-06 were selected to participate in the experiment.A randomized method was used to randomly divide 120 patients into4 groups:30 in the epidermal growth factor group,30 in the nano-silver dressing group,30 in the combined group,and 30 in the saline control group(normal saline).Each group was given a dressing change every other day,and the time required for wound healing to each healing stage was observed.The healing rate of the wound surface and the growth degree of granulation tissue were graded in the healing stage.After 8 weeks of treatment,the wound exudate was cultured in bacteria.Results:There was no significant difference in the time between the four groups of patients reaching the effective phase of treatment(level 1).Compared with the control group,the epidermal growth factor group and the combined group achieved shorter wound healing time 2 and 3,and the difference was significant(p<0.05);and the combined group had shorter wound repair time than the epidermal growth factor group(p<0.05).The wound repair time of the nano-silver dressing group was shorter than that of the control group,but the difference was not significant(p>0.05).Conclusion:There is no significant difference in wound healing between the four groups during the clinically effective period.After this period,combined use of recombinant epidermis Growth factors and nano-silver dressings have a significant effect on promoting wound healing and can effectively prevent infection.Part two:Experimental study of epidermal growth factor combined with acidic fibroblast growth factor in the treatment of diabetic foot woundsObjective: To investigate the effect of epidermal growth factor and acidic fibroblast growth factor on the healing of diabetic foot wound.Methods: 80 patients with diabetic foot ulcer were treated with 2018.02-2020.02 from the First Affiliated Hospital of Nanchang University and The Jiujiang Affiliated Hospital of Nanchang University.The patients were all voluntarily signed the informed consent form.80 patients were randomly divided into four groups: recombinant human epidermal growth factor group,acidic fibroblast growth factor group with combination of the growth factors group,20 cases each,as well as 20 cases of Paulownia leaf burn oil control group(n = 4).In each group,the fasting blood glucose was controlled under 11.1mmol / L before treatment of the wound,and the infected patients were treated with antibiotics to control the infection completely.Combined treatment group were given each Recombinant Human Epidermal Growth Factor for External Use 40 IU / cm2,with acidic fibroblast growth factor 100 U / cm2,the treatment(using Paulownia leaf burn oil as a conventional treatment)is same with the control group;recombinant human epidermal growth factor in each group treated with Recombinant Human Epidermal Growth Factor for External Use 40 IU / cm2,the treatment(using Paulownia leaf burn oil as a conventional treatment)is same with the control group;acidic fibroblast growth factor group were given each external acidic fibroblast growth factor 100 U / cm2,the treatment(using Paulownia leaf burn oil as a conventional treatment)is same with the control group;Treating leaf burn oil control group with leaf burn wound oil wipe only.Each group was given a daily dressing change,to observe the wound healing to the time required for each stage of healing,the healing phase of wound healing rate and the degree of granulation tissue growth grading.Results: The experiment selected 80 cases of diabetic foot patients,all entered the result analysis.The wound healing was similar in the 4 groups(P>0.05)at the 3rd to 4th day after treatment,but the healing of the combined group was better than that of the control group(P<0.05)and the epidermal growth factor group was more similar to that of the combined group.The growth of granulation tissue was similar(P>0.05)on the 3-4 days after treatment,and the healing of the combined group was significantly better than that of the control group(P<0.05)and the epidermal growth factor group was more similar to that of the combined group.Conclusion: There was no significant difference in the effect of the two growth factors on promoting wound healing.After this period,epidermal growth factor or acid fibroblast growth factor was used alone.The combined use of recombinant epidermal growth factor and acid fibroblast growth factor had a good effect on wound healing.Part three: The role of epidermal growth factor and other growth factors in the management of diabetic foot ulcers: systematic evaluation and meta-analysis of clinical trialsObjective: Growth factors are an emerging therapy for diabetic foot ulcers.Although there have been clinical reports,there has not been a comprehensive and systematic evaluation of clinical evidence on the efficacy and safety of growth factors in diabetic foot ulcers.We solved this problem through a systematic review of randomized controlled trials(RCT),and explored the therapeutic effects of epidermal growth factor on diabetic foot ulcers through meta-analysis,and provided evidence-based medical evidence for its clinical use.Methods: Search Pub Med,Cochrane database,Scopus,Embase and Google Scholar databases,and select RCT research literature on growth factor treatment of ulcer wounds in diabetic patients.Literature search and evaluation were conducted by two independent reviewers.The methodological quality of the research was assessed using the Astec scale.We searched databases including Pub Med,EMBASE,Cochrane Library,Web of Science,EBSCOhost,Science Direct and Scopus(as of June 2020),screened research articles on epidermal growth factor and placebo in the treatment of diabetic foot ulcer wounds,and conducted literature quality assessment,So as to include high-quality literature.The cure rate of diabetic foot is used as a comparative indicator,and a stratified meta-analysis(local injection and local application)is carried out according to the type of administration route,and the accuracy of the research conclusion is determined by calculating the odds ratio(OR)and 95% confidence interval(95% CI)Sex.Results: We identified 18 RCTs of diabetic patients involved in diabetes and evaluated the effects of platelet-derived growth factor,epidermal growth factor,fibroblast growth factor,granulocyte colony stimulating factor,vascular endothelial growth factor,erythropoietin,and transforming growth factor Effectiveness.The main main outcome is complete healing,although different indicators are used to define this,such as wound closure,granulation tissue formation or complete re-epithelialization.Few studies have follow-up periods to report any recurrence and amputation rates.Due to the intervention,no adverse reactions were reported.A total of six studies were included in the meta-analysis,involving 530 patients who met the criteria for analysis.The combined OR(local injection and topical application)was 4.005(95% CI:(2.248;7.135),p<0.001).The intralesional injection and topical drug application were 3.599(95% CI:(1.213;10.677),p = 0.021)and 4.176(95% CI:(2.112;8.256),p<0.001),respectively.Statistical heterogeneity was not significant in the overall treatment and the two subgroups(I2: 24.56,p = 0.25,I2: 33.26,p = 0.213)(I2 = 15.17,p = 0.317).Conclusion: Overall,there is a greater consensus in literature analysis on the effect of EGF on diabetic ulcer healing,and the results of meta-analysis also support the use of epidermal growth factor to treat diabetic foot ulcers.However,because most growth factors have few trials and the available research methods are not the same,the effectiveness of other growth factors in treating diabetic foot wounds lacks clear evidence-based medical evidence. |
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