真皮“生物模板”对创面愈合中肌成纤维细胞形成和凋亡的影响

Effect of dermal regeneration template on myofibroblasts and cell apoptosis during wound healing

目的 探讨真皮“生物模板”对创面愈合中成纤维细胞分化为肌成纤维细胞的干预作用和对细胞凋亡的影响。 方法 深度烧伤患者切痂后 ,创面分为两部分 ,即模板干预组和对照组。模板干预组创面应用真皮“生物模板”(异体J- 1型无细胞真皮基质 )并同时移植自体刃厚皮片 ,对照组创面则单纯移植自体刃厚皮片。分别于术后 2 ,4 ,6周取组织标本 ,每组每时相点分别取 6例次 ,共 36例次。应用脱氧核糖核苷酸末端转移酶介导的缺口末端标记 (TUNEL)法和透射电镜观察的方法检测创面组织细胞凋亡 ;同时 ,以α -辅肌动蛋白 (SMA)免疫组化染色并结合透射电镜观察的方法检测肌成纤维细胞。 结果 真皮“生物模板”移植术后 2～ 6周 ,组织标本中表达α-SMA的成纤维细胞逐渐增多 ,但对照组表达量显著高于模板干预组 (P <0 .0 5 ) ;细胞凋亡计数随着创面愈合逐渐增加 ,模板干预组明显多于对照组 (P <0 .0 5 )。 结论 真皮“生物模板”与自体刃厚皮片复合移植后 ,可减少成纤维细胞向肌成纤维细胞分化 ,诱导创面局部细胞凋亡 ,从而减少创面收缩和减轻瘢痕增生。

Objective To evaluate the effect of dermal regeneration template on wound myofibroblasts and cell apoptosis during the course of wound healing. Methods The eschar excised wounds of deep burn patients were divided into Group A and Group B. The Group A was covered by dermal regeneration template with overlying thin split-thickness autograft, while the Group B received a split-thickness autograft alone as control. At the 2nd,4th and 6th weeks after operation, six specimens/times (total 36 specimens/times) were examined for each group at each time for detecting α-smooth muscle actin (α-SMA) positive fibroblasts by means of immunohistochemistry plus electron microscopy and cell apoptosis by electron microcopy and TUNEL. Results From 2-6 weeks post operation, more fibroblasts and apoptotic cells expressing positive α-SMA were detected. Compared to the control group, the expression of α-SMA positive fibroblasts was less in the Group A (P<0.05). Apoptotic cells increased with wound healing in the Group A compared with those in the control group. Conclusions During wound healing, dermal regeneration template plus thin split-thickness autograft can decrease the differentiation of fibroblasts into myofibroblasts and induce cell apoptosis in the wounded region, and hence alleviate the wound contracture and scar proliferation.