目的 探討水蛭素調(diào)節(jié)斷指再植大鼠皮瓣成活、血管生成、炎癥因子表達(dá)的作用。方法 選取80只Wistar大鼠為研究對(duì)象，建立斷指再植模型后隨機(jī)分為兩組：模型組、水蛭素組，均40只。水蛭素組大鼠皮瓣局部sc天然水蛭素6 ATU/次，2次/d，模型組大鼠sc生理鹽水。術(shù)后7 d，觀察大鼠皮瓣存活率；制備皮瓣組織勻漿，提取總蛋白，采用ELISA雙抗體夾心法測(cè)定血管內(nèi)皮生長因子（VEGF）、白細(xì)胞介素-6（IL-6）、細(xì)胞間黏附分子-1（ICAM-1）、腫瘤壞死因子-α（TNF-α）表達(dá)情況；采用免疫印跡法測(cè)定皮瓣中細(xì)胞外調(diào)節(jié)蛋白激酶（ERK1/2）、Bcl-2、p38絲裂原活化蛋白激酶（p38 MAPK）表達(dá)；HE染色法測(cè)定皮瓣中炎癥介質(zhì)浸潤情況；CD34免疫組織化學(xué)染色法檢測(cè)血管密度值。結(jié)果 水蛭素組大鼠皮瓣存活率、血管密度值、VEGF水平、ERK1/2相對(duì)表達(dá)量均明顯高于模型組，而p38 MAPK、Bcl-2相對(duì)表達(dá)量，IL-6、ICAM-1、TNF-α水平明顯低于模型組，差異均具有統(tǒng)計(jì)學(xué)意義（P < 0.05）。結(jié)論 水蛭素在斷指再植模型大鼠中具有提高皮瓣成活率、促進(jìn)VEGF表達(dá)、抑制細(xì)胞凋亡、減少炎癥因子表達(dá)作用。

Objective To investigate the effect of hirudin on survival, angiogenesis and expression of inflammatory factors in replanted flaps of rats with finger replantation. Methods Totally 80 Wistar rates were selected to establish finger replantation model, and they were randomly divided into two groups with 40 cases in each group. Hirudin group was given local subdermal injection of six ATU natural hirudin, twice a day, and control group was given local subdermal injection of normal saline. After 7 d, rat skin flap survival rate was observed; Flap tissue homogenate was prepared to extract total protein, and then detect vascular endothelial growth factor (VEGF), interleukin -6 (IL-6), intercellular adhesion molecule -1 (ICAM-1), and tumor necrosis factor alpha (TNF-α) expression by using enzyme-linked immunosorbent assay(ELISA) double antibody sandwich method. Western blotting method was used for the determination of flap in extracellular regulated protein kinase (ERK1/2), Bcl-2 and p38 mitogen activated protein kinase (p38 MAPK) expression; Flap inflammatory infiltration was determined by HE staining; CD34 immunohistochemical staining method was used to detect vascular density. Results The flap survival rate, vessel density, VEGF level, and relative expression of ERK1/2 of hirudin group were significantly higher than those of model group, but p38 MAPK and relative expression of Bcl-2 were significantly lower than control group (P < 0.05); The IL-6, ICAM-1, TNF-α levels of hirudin group were significantly lower than those of control group (P < 0.05). Conclusion Hirudin for rats model with finger replantation can increase flap survival rate, promote VEGF expression, inhibit cell apoptosis, and reduce inflammatory factors expression.