P物质、肥大细胞与病理性瘢痕瘙痒的相关性研究

An immunohistochemical study on pruritus in patients with hypertrophic scars

目的 探讨病理性瘢痕瘙痒与肥大细胞及P物质的相互关系。方法 应用免疫组织化学方法 ,研究 90例瘢痕组织中P物质及肥大细胞的表达 ,并分析其和临床瘙痒的关系。结果 病理性瘢痕组织表皮层有P物质阳性染色 ,且P物质染色强度、肥大细胞数明显高于非增生性瘢痕及正常皮肤组织 (P <0 0 1)。以P物质染色等级分组 ,各组肥大细胞数差异有显著性 (P <0 0 1)。瘙痒等级计分与P物质成正相关 (r =0 6 0 18,P <0 0 1) ,以瘙痒等级计分分组 ,各组上网状真皮层肥大细胞数差异有显著性 (P <0 0 1)。结论 病理性瘢痕瘙痒与表皮中P物质、上网状真皮层中的肥大细胞有关 ,其可能的机制是P物质直接刺激表皮中的初级传入游离神经末梢 (nociceptor) ,引起上网状真皮层的肥大细胞浸润及活化。

Objective To investigate possible relationships among substance P,mast cell and pruritus in patients with hypertrophic scars. Mothods 90 cases of scars were studied immunohistochemically for their presence of SP and mast cells. The relationships between the data obtained and the clinical itching complaints were analysed. Results SP positive staining was seen in epidermis in both normal skin and hypertrophic scars with significant difference ( P <0 01). The number of mast cells showed significant difference between normal skin and hypertrophic scars ( P <0 01), while little difference between normal skin and nonhypertrophic scars ( P >0 05). SP positive staining correlated positively with both clinical pruritus ( r=0 6012,P <0 01) and the number of mast cells in the upper reticular dermis (UR) in scars ( P <0 01). Conclusion Pruritus in patients with hypertrophic scars correlate positively with the intensity of SP staining and mast cells in upper reticular dermis. SP may act directly on C-fiber nociceptor, which generates itch sensation. SP may be one of the key elements in the activation and induction of these mast cells.