封闭负压引流技术对创面愈合过程中原癌基因表达的影响

Effect of vacuum-assisted closure on the expression of proto-oncogenes and its significance during wound healing

目的研究封闭负压引流技术(vacuum assistedclosure,VAC)对启动创面愈合过程和减少细胞凋亡的作用。方法用免疫组化法检测猪急性皮肤缺损创面和人慢性创面原癌基因c myc、c jun和Bcl2表达变化,计算阳性表达细胞数和标记指数,观察创面愈合过程。结果①VAC治疗组猪急性皮肤缺损创面清洁无明显渗出,第6天即有较多新生上皮和肉芽组织,25d完全愈合。对照组创面有较多渗出和血痂,第6天出现少量新生上皮和肉芽组织,30d愈合。伤后即刻c myc、c jun和Bcl2表达量少,主要位于基底细胞的胞浆或胞核,伤后及VAC治疗后表达迅速显著增加,但表达至峰值后迅速下降。在伤后或VAC治疗后的12d内实验组表达始终高于对照组。②人慢性创面VAC治疗后分泌物明显减少,较快形成健康的肉芽组织。c jun主要表达在表皮基底细胞、真皮成纤维细胞和炎性细胞的胞浆,VAC治疗后阳性细胞数和标记指数显著减少。c myc和Bcl2主要表达在基底细胞的胞浆,VAC治疗后表达量显著增多,标记指数显著增大。结论VAC能快速启动猪急性皮肤创面和人慢性创面的愈合过程,减少修复细胞凋亡,使创面愈合加速。

Objective To study the effects of VAC on starting the process of wound healing and decreasing apoptosis. Methods To examine the variations in expression of proto-oncogenes c-myc, c-jun and ~Bcl-2 in pig wound model with acute full-thickness skin defect and human chronic wounds by immunohistochemistry, calculate the numbers of expressive positive cells and the labelling index(LI), and observe the process of wound healing. Results ①In pig experiment, the wound in experimental group was very clean and without obvions exudates, many neoepiderm and granulation tissue rapidly appeared or formed after 6 days, and healed completely by the 25 thalay. On the contrary, in the wound of control group, more exudates and blood crust could be seen and fewer neoepiderm and granulation tissue appeared after 6 days and was heald by ~30 oth dy. Immediately after the wound was created, the expression of c-myc, c-jun and Bcl-2 was lower and mainly situated in nucleus or cytoplasma of the basilar cells. After the wound was created in control group, or after starting the VAC treatment in experimental group, their expression rapidly and obviously increased, the distribution of the positive cells also became enlarged, but the amount of expression decreased rapidly after the expressive peak have reached. In the successive 12 days following the wound was created, the expression of c-myc, c-jun and Bcl-2 in the experimental group was constantly higher than that of the control group. ② In human chronic wounds, there wasn't obvious secretions and more healthy granulation tissue was rapidly formed after VAC treatment. The expression of c-jun was mainly located in cytoplasma of basilar cells of epithelium, dermal fibroblasts and inflammatory cells, and the positive cell and labelling index obviously decreased. The expression of c-myc and Bcl-2 was mainly in cytoplasma of basilar cells, but the amount of expression and the labelling index became obviously increased after VAC treatment. Conclusions VAC could rapidly start the healing course of the pig's acute skin wound and human chronic wound, decrease atoptosis of the reparative cells, so as to accelarate wound healing. ;