系统性硬化症患者皮损中Ⅰ、Ⅲ、Ⅴ型胶原的表达及其作用探讨

Expression and Distribution of Type Ⅰ, Ⅲ and Ⅴ Collagens in Skin Lesions from Patients with Systemic Sclerosis

目的探讨Ⅰ、Ⅲ、Ⅴ型胶原(Col Ⅰ、Ⅲ、Ⅴ)在系统性硬化症(SSc)患者皮损中的表达、分布及其在发病机制中的作用。方法采用免疫组化SP法检测36例SSc患者(轻度纤维化9例,中度14例,重度13例)皮损中Ⅰ、Ⅲ、Ⅴ型胶原α1链〔α1(Ⅰ)、α1(Ⅲ)、α1(Ⅴ)〕的表达(以平均光密度值为半定量检测指标),并以6例正常皮肤作为对照。结果3种胶原在SSc皮损真皮呈弥漫性分布,在网状层可见深染的α1(Ⅰ)和α1(Ⅲ)团块或条带,α1(Ⅴ)分布则较均匀,在小血管和皮肤附属器周围较多;从对照到SSc轻度、中度、重度纤维化组,α1(Ⅰ)、α1(Ⅲ)和α1(Ⅴ)含量在真皮、小血管和附属器及其周围组织均呈逐渐升高趋势(P均<0.05);在SSc皮损真皮、小血管和附属器及其周围组织中,α1(Ⅴ)在早期即明显升高(80.07±1.80 vs 73.56±2.48,94.23±1.53 vs 85.73±1.70,94.06±1.64 vs 84.65±1.65,P均<0.01),持续整个纤维化过程且增幅较大,α1(Ⅰ)和α1(Ⅲ)升高则较迟,在中、后期显著升高。结论α1(Ⅴ)先于α1(Ⅰ)、α1(Ⅲ)在SSc早期即开始大量沉积,并持续整个纤维化过程;其含量改变始于真皮小血管和附属器及其周围组织,可能参与SSc血管炎的发生。

Objective To investigate the expressionand distribution of collagen Ⅰ,Ⅲ and Ⅴ （Col Ⅰ,Ⅲ and Ⅴ） in skin lesions of systemic sclerosis patients （SSc）. Methods Skin lesions were collected from 36 patients with SSc （mild fibrosis 9 patients, moderate 14, and severe 13）. The expression and distribution of α1 chain of collagen type Ⅰ,Ⅲ and Ⅴ [αα1 （ Ⅰ ）, α1（Ⅲ ） and α1 （Ⅳ）] in skin lesions were detected with immunohistoehemieal SP method, while 6 normal skin tissues were used as controls. Results All the three types of collagens were observed with diffuse distribution in dermis of SSe skin lesions. The deep staining al （ Ⅰ ） and al （ Ⅲ ） clumps and bands were seen in reticular layer, while α1 （ Ⅴ ） was more homogeneously andeommonly around small vessels and appendages. The expression of α1 （ Ⅰ ）, and α1 （ Ⅲ ）, and α1 （ Ⅴ ） appeared to gradually increase in dermis and the area around small vessels,appendages with the increase of fibrosis severity （P〈0. 05）. The level of α1 （ Ⅴ ） was obviously elevated at early stage, and persisted in whole fibrotie process, while α1 （ Ⅰ ） and α1 （Ⅲ） increased apparently later in middle and late stages. Conclusion α1 （ Ⅴ ） began to deposit prior to α1 （ Ⅰ ） and α1 （ Ⅲ ） at early stage in SSc and persisted in whole fibrotic process. The changes of α1 （ Ⅴ ） contents started in dermal tissues around small vessels and appendages, which may involve in the development of vgsculitis in SSe.