Dysregulated wound healing in the pathogenesis of urogynecologic mesh complications.

Dysregulated wound healing in the pathogenesis of urogynecologic mesh complications.
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DOI:
10.1038/s41598-023-48388-8
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发表时间:
2023-12-05
期刊:
影响因子:
4.6
通讯作者:
--
中科院分区:
综合性期刊3区
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--
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为了检验伤口愈合失调与泌尿妇科网状并发症相关的假设,我们在有(N = 39)和没有(N = 40)并发症的患者植入聚丙烯网后,使用阴道拭子收集阴道细胞分泌物。定制的多重免疫测定可测量炎症标记物(MCP-1、IGFBP-1、IL-2、IL-10、IL-17、PDGF-BB、bFGF、IL-1b、IL-6、IL-12p70、TNF-α)、神经炎症标记物(IL-1RA、TGF-β、IL-15、IL-18、IL-3、M-CSF)、血管生成 (VEGF) 和基质蛋白(纤连蛋白、tenasin c、血小板反应蛋白-2、lumican) 组间。出现并发症的患者更年轻、体重更重、植入网片的时间更长,而且更有可能是吸烟者。体重指数增加 5 kg/m2 和经常吸烟分别与并发症风险增加 2.4 倍和 6 倍相关。 bFGF、纤连蛋白、血小板反应蛋白-2、TNF-β或 VEGF 最高三分位的患者发生网状并发症的比值比 (OR) 为 11.8,而在控制年龄、BMI 和吸烟情况下,≥3 升高的 OR 为 237。 bFGF、血小板反应蛋白-2 和纤连蛋白的最高三分位数一起完美地指示了并发症(P < 0.0001)。高 bFGF、血小板反应蛋白-2 和纤连蛋白的接受者-操作者曲线显示并发症和对照之间具有良好的区分性(AUC 0.87)。这些数据提供了网片并发症中伤口愈合失调的证据。可修改的因素为患者咨询和干预提供了潜在的目标。
To test the hypothesis that dysregulated wound healing is associated with Urogynecologic mesh complications, we collected vaginal cell secretions using vaginal swabs after polypropylene mesh implantation in patients with (N = 39) and without (N = 40) complication. A customized multiplex immunoassay measured markers of inflammation (MCP-1, IGFBP-1, IL-2, IL-10, IL-17, PDGF-BB, bFGF, IL-1b, IL-6, IL-12p70, TNF-α), neuroinflammation (IL-1RA, TGF-β, IL-15, IL-18, IL-3, M-CSF), angiogenesis (VEGF), and matrix proteins (fibronectin, tenasin c, thrombospondin-2, lumican) between groups. Patients with complications were younger, heavier, implanted with mesh longer, and more likely to be ever smokers. A 5 kg/m2 BMI increase and ever-smoking were associated with a 2.4-fold and sixfold increased risk of complication, respectively. Patients with the highest tertile of bFGF, fibronectin, thrombospondin-2, TNF-β, or VEGF had an odds ratio (OR) of 11.8 for having a mesh complication while ≥ 3 elevated had an OR of 237 while controlling for age, BMI, and smoking. The highest tertile of bFGF, thrombospondin-2, and fibronectin together perfectly indicated a complication (P < 0.0001). A receiver-operator curve for high bFGF, thrombospondin-2, and fibronectin showed excellent discrimination between complications and controls (AUC 0.87). These data provide evidence of dysregulated wound healing in mesh complications. Modifiable factors provide potential targets for patient counseling and interventions.
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