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目的:探讨医用蛆虫分泌排泄物（ES）对糖尿病足溃疡（DFU）患者中性粒细胞吞噬及杀菌作用的影响。方法:采用实验研究的方法。选择东部战区空军医院内分泌科，糖尿病足中心2020年6—12月收治的符合入选标准的30例DFU患者［男16例、女14例，年龄（64±7）岁］。Percoll非连续性密度梯度离心法分离中性粒细胞，将每例患者细胞分别纳入生理盐水组、蛆虫ES组（每组30孔），分别加入无菌生理盐水和终质量浓度357 μg/mL（下同）蛆虫ES。培养1、2 h，行瑞氏染色观察并计算细胞吞噬率和吞噬指数。选择10例患者，将每例患者细胞分别纳入铜绿假单胞菌+中性粒细胞组、铜绿假单胞菌+中性粒细胞+蛆虫ES组（每组10孔），分别进行相应处理；另设置单纯铜绿假单胞菌组、铜绿假单胞菌+蛆虫ES组（每组10孔），分别加入铜绿假单胞菌+RPMI 1640培养液+无菌生理盐水、铜绿假单胞菌+RPMI 1640培养液+蛆虫ES。培养2 h，平板菌落计数法计数活菌菌落。分别选择6、6、3例患者，同前将每例患者细胞分别纳入蛆虫ES组和生理盐水组（每组6、6、3孔）并行相应处理。培养6 h，采用实时荧光定量反转录PCR法检测细胞中白细胞介素1β（IL-1β）、IL-6、溶菌酶mRNA表达，采用酶联免疫吸附测定法检测细胞培养上清液中IL-1β、IL-6含量，采用免疫荧光法观察溶菌酶表达阳性细胞情况。对数据行单因素方差分析、配对样本n t检验、LSD检验及Wilcoxon符号秩和检验。n 结果:培养1 h，蛆虫ES组细胞吞噬率、吞噬指数［53.5%（49.7%，58.0%）、3.18（2.96，3.32）］分别与生理盐水组［52.0%（47.5%，55.2%）、3.15（2.96，3.25）］相近（n Z=-1.701、-1.092，n P>0.05）；培养2 h，蛆虫ES组患者细胞吞噬率、吞噬指数［70.0%（66.7%，72.0%）、4.47（4.22，4.96）］分别明显高于生理盐水组［58.0%（55.0%，60.0%）、4.11（3.52，4.24），n Z=-4.786、-4.279，n P<0.01］。培养2 h，铜绿假单胞菌+中性粒细胞组活菌菌落数明显低于单纯铜绿假单胞菌组（n P<0.01），铜绿假单胞菌+中性粒细胞+蛆虫ES组活菌菌落数明显低于铜绿假单胞菌+蛆虫ES组和铜绿假单胞菌+中性粒细胞组（n P<0.01）。培养6 h，蛆虫ES组细胞IL-1β、IL-6、溶菌酶mRNA表达均较生理盐水组明显上调（n t=-3.279、-4.273、-4.763，n P<0.05或n P<0.01），蛆虫ES组细胞培养上清液中IL-1β、IL-6含量分别明显高于生理盐水组（n t=-9.526、-6.447，n P0.05). After 2 hours of culture, the phagocytosis rate and phagocytic index of cells in maggot ES group (70.0% (66.7%, 72.0%) and 4.47 (4.22, 4.96)) were significantly higher than 58.0% (55.0%, 60.0%) and 4.11 (3.52, 4.24) in normal saline group (n Z=-4.786, -4.279, n P<0.01). After 2 hours of culture, the number of viable bacteria colony inn Pseudomonas aeruginosa+neutrophils group was significantly lower than that in n Pseudomonas aeruginosa alone group (n P<0.01), and the number of viable bacteria colony inn Pseudomonas aeruginosa+neutrophils+maggot ES group was significantly lower than that in n Pseudomonas aeruginosa+maggot ES group and n Pseudomonas aeruginosa+neutrophils group (n P<0.01). After 6 hours of culture, the mRNA expressions of IL-1β, IL-6, and lysozyme of cells in maggot ES group were significantly higher those in normal saline group (n t=-3.279, -4.273, -4.763, n P<0.05 orn P<0.01); the concent of IL-1β and IL-6 in cell culture supernatant of maggot ES group were significantly higher than those of normal saline group (n t=-9.526, -6.447, n P<0.01); there were significantly more positive cells expressing lysozyme in maggot ES group than in normal saline group.n Conclusions:Maggot ES can enhance the phagocytosis and bactericidal effect of neutrophils on Pseudomonas aeruginosa by promoting the production of neutrophils immune defense related cytokines and lysozyme in DFU patients.