透明质酸对复合移植皮肤组织顺应性影响的实验观察

Experimental study of Hyaluronic acid on the biomechanical compliance of porcine acellular dermal transplantation

目的探讨透明质酸（HA）对复合移植皮肤组织生物力学顺应性的影响。方法选用10只日本大耳兔作为实验动物，每只大耳兔背部对称分4个区域，并随机分为4组。其中A、B、C组造成全层皮肤缺损创面，D组为正常皮肤，分别进行如下处理，A组：HA＋异种（猪）去细胞真皮基质（PADM）＋自体薄厚皮移植；B组：PADM＋自体薄厚皮移植；C组：自体薄厚皮回植；D组：不作处理。于术后第70天取创面组织标本测量挛缩率，用Instron机对各组创面组织进行顺应性测试；用Western印迹检测各组复合移植组织中I型、Ⅲ型胶原蛋白表达。结果A、B、C组挛缩率分别为10．2％±0．6％、36．6％±0．8％、32．7％±1．4％，差异有统计学意义（P=0．000）；在相同的拉伸长度下，A组与D组应力值分别为（83±8）与（81±5）kPa，差异无统计学意义（P=0．552）；B组应力值为（215±9）kPa，与D组差异有统计学意义（P=0．000）；C组应力值为（106±7）kPa，与B、D组比较差异均有统计学意义（均P=0．000）。A组局部I型、Ⅲ型胶原蛋白表达高于B组（均P=0．000），而I／Ⅲ型胶原比例低于B组。结论外用HA可提高并优化局部I型、Ⅲ型胶原蛋白表达，提高复合移植皮肤组织的顺应性。

Objective To iexplore the effect on biomechanical compliance after an addition of hyaluronic acid（HA） in transplantation of porcine acellular dermal matrix （PADM） with skin autograft. Methods Ten Japanese white rabbits were used as experimental animal, the dorsa of rabbits was symmetrically divided into four area, and then grouping was randomized. Full-thickness skin defects were created in Group A to Group C, and Group D was blank group with normal skin. The following procedures were performed ： Group A ： implanted with HA ＋ PADM ＋ thin skin autografts, GroupB ： implanted with PADM ＋ thin skin autografts and Group C： skin autografts, except for Group D. The wound tissue specimens were harvested at 70 days postoperatively, and they were recorded contracture rates of the grafts and the biomechanical compliance by Instron biomechanics tensiometer. The expression of collagens I and m in dermal fibroblasts of each group was determined by Western blot. Results On postoperation day 70, the grafts contracture rates in Group A to Group C were 10. 2% ±0. 6% , 36. 6% ±0. 8%, 32. 7%±1.4% respectively,there were notable significant difference among three groups （P = 0. 000）. Under the same tension, there was no significant difference in strain between Groups A and D （（ 83 ±8 ） vs （81± 5 ）kPa, P = 0. 552）. Some significant difference in strain existed between Groups B and D （ （ 215 ± 9 ） vs （ 81 ± 5 ）kPa, P = 0. 000）. The strain of Group C （ （106±7 ） kPa） was between Groups B and D, and significant strain difference existed among them （ P = 0. 000）. The expressions of collagens I and III in Group A were higher than those in Group B, while the ratio of collagens I to 111 in Group A was lower than that in Group B. Conclusion Topical HA may be used to increase the expressions of type I and III collagen, decrease the ratio of collagen type I / III, and enhance the biomechanics performances of transplanted skin.