鼠神经生长因子促进大张移植皮片感觉康复的临床研究

Effect of nerve growth factor on the promotion of sensory recovery of large skin graft in patients

目的观察局部应用鼠神经生长因子(NGF)对大张移植皮片感觉神经末梢再生过程的影响。方法选择中小面积烧伤和需行瘢痕整形术的成年患者48例共60处创面,随机分为NGF组、对照组(各30处)。NGF组术前采用含鼠NGF的等渗盐水(9000 AU/100 ml)纱布包裹皮片,术后用100ml该盐水行皮片下冲洗;术后20d起,于移植皮片下多点微量注射NGF,隔日1次,持续1个月。对照组单纯用等量等渗盐水作相同处理。检测术后12个月内移植皮片的两点辨别比并行皮片感觉功能评级。采集再次行整形术患者的术区组织标本行组织病理学检查,观察神经末梢再生和分布情况。结果术后12个月,NGF组17处皮片达S_4级、两点辨别比为1.11±0.14,而对照组仅5处皮片达S_4级、两点辨别比为1.56±0.73(P<0.05或P<0.01);其余各时相点2项指标组间差异与之相似。术后6个月,NGF组可在皮片移植区的微血管床、瘢痕结节旁的疏松组织间隙和移植皮片下的瘢痕组织中,见到丰富的感觉神经末梢,附件结构也较为完整;对照组上述组织中神经末梢纤细,稀少。结论局部应用NGF可加速感觉神经末梢的再生,促进移植皮片的感觉恢复。

Objective To analyze the influence of topical application of nerve growth factor （NGF） on nerve ending regeneration of large skin grafts in patients. Methods Sixty wounds from 48 adult patients with small or moderate burn area and scar excision were randomly divided into NGF and control groups, with 30 wounds in each group. The wounds in control group were treated with simple saline solution, while those in NGF group, the graft was first wrapped in a piece of gauze holding 100 ml saline solution containing 9000 AU NGF before operation, and then flushed with same amount of NGF saline underneath skin after application of the graft. From 20 post-operative day on, NGF was injected at multiple points every other day for one month. In control group, only normal saline was used. The texture of the graft, pain sensation, temperature and two -point discrimination , BMRC grade were observed for 12 months. Skin specimens were obtained from 6 wounds in control group, 5 wounds in NGF group , and 4 specimens from normal skin for immunohistological examination of protein gene product 9.5 （ PGP 9.5 ） , synaptophysin （SYN） , and neuron specific enolase （NSE）. The nerve endings regeneration and distribution were also observed. Results Compared with those in control group, each index of feeling recovered earlier and better in NGF group, with better two - point discrimination ratio and BMRC grade. One year after operation, 17 skin grafts in NGF group reached S4 grade , with twopoint discrimination ratio of 1.11 ＋0. 14, while only 5 grafts in control group reached S4 grade, with two - point discrimination ratio of 1.56 ＋ 0. 73. Six months after operation , rich nerve endings ,with integral adnexae were observed in microvascular bed of skin -graft region and tissue interspace around fibroas tissue in subcutaneous tissue in NGF group ,while nerve endings were found to be scanty and slender in subcutaneous tissue in control group. Conclusion Local application of NGF can promote nerve regeneration and sensory recovery of grafted skin.