增生性瘢痕胶原含量与微血管构筑的相关性研究对策

更新时间:2023-07-16 04:29:14 阅读: 评论:0

生童叁耋竺!:兰竺丝兰—一
增生性瘢痕胶原含量与微血管构筑的相关性研究
研究生苏永涛
导师周兴亮
中文摘要
春的图片
f深度烧伤愈合后形成的瘢痕增生,是以组织内胶原和基质成分大量沉积为主要特征的一种病理现象。每年给数以万计的患者带来巨大的肉体和精神痛苦,临床上广泛采用的各种治疗方法如手术、皮损内药物注射、硅胶膜、弹力套、术后放疗、激光、人工真皮等均有一定疗效,但由于对瘢痕增生的机制及各种治疗方法的机理的认识尚不十分充分,故上述各种疗法还多不能令人满意。厂目的:皮损内注射去炎松.A已广泛应用于增生性瘢痕(HS)和瘢痕疙瘩(K)的防治。585nm闪光灯泵浦脉冲染料激光(PDL)是近几年才用于治疗和预防HS的一种新手段。5年来,我们分别采用这两种措施,用于HS的预防和治疗,均取得了明显效果,但对其作用机制的认识却很不完善。此课题主要是研究这两种治疗方法对HS胶原含量及微血管构筑的影响,以及二者的关系,并试图为临床治疗HS提供一些可信
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服的理论依据和疗效评价指标。
\方法:对两组深IIo烧伤自行愈合后形成的Hs病例,分别采取PDL照射(A组)及TA皮损内注射(B组)进行治疗,在治疗后1个月、3个月分别切取标本(依次标记为Al、A2、B1、B2)与自然病程未经治疗的相应时段切取标本(分别标记为Cl、C2)进行常规HE染色、免疫组化染色及天狼星红苦味酸染色,并从病理特征、微血管构筑及胶原含量等几个方面与对照组进行对比分析。
山东人学帧f学位论义
结果:
1.与对照组相比,HE染色、光镜观察Al、B1组真皮层胶原纤维变薄,排列较规则,玻璃样变性细胞减少,血管密度减少,但A1组稍明显:A2及B2组胶原纤维较前变薄,排列更有序,少有旋涡状结构,真皮乳头层改善,炎性细胞减少。
2.免疫组化染色及天狼星红苦味酸染色:在治疗组第一个月胶原纤维仍较粗、较密,但A1组血管密度明显降低,Bl组血管密度亦有降低:在第3个月,胶原含量及血管密度均明显减少,I型胶原
纤维密度明显低于对照组。
3.临床疗效观察:经过一个月治疗,病人均有自觉痛痒症状减轻、颜色变淡,但瘢痕厚度变化不明显。2个月后自觉症状进一步减轻,瘢痕变薄、变软,3个月后,自觉症状基本消失,瘢痕颜色与周围皮肤相近,外形基本正常、柔软、有弹
结论:
两种治疗方法均能有效地预防和治疗HS。在HS中微血管构筑和胶原含量有较强的相关性,随着微血管的破坏,胶原纤维总量及I型胶原含量均明显降低。另外,随着胶原含量的降低,瘢痕微血管也会相应减少。微血管密度和I、III型胶原的含量变化可做为瘢痕治疗效果的可靠观察指标。若想达到满意的治疗效果,两种治疗均需维持3个月以上。
总之,两种治疗措施对HS的防治均有明显疗效,l临床可广泛应用。本课题为这两种治疗方法提供了一些可信的理论依据和疗效评价指标。
关键词:增生性瘢痕,微血管构筑,胶原含量,585nm脉冲染料激光,去炎松一A
当童:i兰塑!;兰塞堕兰一——::EXPERIMENTALSTUDYOFTHECORRELATIONBETWEENCOLLAGENCONTENTSANDMICRO—VESSEL
DENSITYOFHYPERTROPHICSCAR
Abstract
Background:Scarareusuallytermedhypertrophicwhenthey
developexcessive.Excessivecollagenformationarethecornerstoneof
Hypertrophicscar(HS).Clinicalresearchinthenonsurgicalandsurgicaltreatmentofthesepathologicscarsisextensive.IntralesionalinjectionsandpostoperativeradiationareeffectivefortreatingmostkeloidandHS.神经损伤恢复
SilliconegelsheetingandpressuregarmentarcusefulfortreatingHS.
treatmentAdditionally,somepreliminarytrialte
stingpromisingnew镜面舌
modalities,such邪artificialdermis.FortheetiologyofHSandthemechanismofthesetherapyisn’tfullyknown.Therearenosingle
beenfoundtobeuniformlyeffective.
节制的反义词
modalityhas
网站ip地址Objective:TriamcinoloneAcetonide(TA),whichhasbeenused
treatmentofHSoverthelastdecades.585一nlnplusedyeextensivelyin
laser,asanewtherapywasusedtotreatHSinrecentyears.TheyarcalleffectivefortreatingHS.Ingeneralopinion,TAismainlytodecreasecollagensynthesisandincreasecollagendegradation,whereas,t
hePDLselectivelydestructsthemicro-vascularofHS.Thepurposeofthestudyistoseektherelationshipbetweenmicro-vasculardensityandcollagencontentsofHSandtoestablishwhetherthetwotherapycaneffectivelypreventexcessiveorhypertrophicscarformation.Inthesametimewe
wanttoestablishtheconfidencemechanismofthesetherapy.Methods:57clinicalcasesarethosewhoOccursHSafterdeepbum.GroupAistreatedbyPDL.GroupBistreatedbyTAintralesionalinjection.GroupC,asthecontrolisnottmatcd.Atthefirstmonth、thirdmonthofthestudy,weexcisedthecoreofHSinthreegroups,andmarkedA1、A2,B1,B2,C1、C2respectively.Thesespecimensareusedforhistologicalstudybyimmunohistochemistystainingandpicricacid—
simsredstaining.
Result:Morphologicalchanges:
美元标志
1.HistologicalstudyshowedtheepidermallayerWasthinneraftereachofthetwotherapys.Thecollagendepositionandthemicrovesselsdensityarelessthanpre—therapy.Thecollagenfibersaremuchmore
regularinthetllirdmonththanthatinthefirstmonthingroupA.groupBandthecontrolgroup.
2.Collagenpicricacid-sirusredstainingshowed:thecollagenfibers
anddenseandhyalinizedinthefirstmonth:Atthethirdmonth,alecoarse
dermalfibroblastswerenormalinnumbers,andecreasedscrlerosiswasobserved.
3.Micro-vasculararchitecture:thevesseldensityincreased
graduallyinthecontrolsanddecreasedremarkablelyingroupAandgroupB.Cliniealobservations:
1.Through1monthtreatment,theclinicalsignsuchasstiffnesserythemaaleimproved.thepmriticwasceasedinallpatientsingroupAandgroupB.
宣传工作会议2.After2monthtreatment,thereducedheightandincreased
pliabilitywasfoundineachofthetwotreatedgroups·3.After3monthtreatment.Verygoodcolormatchofthescarwiththesurroundingskin,minimalpinkscar,nocontourabnormalityandpliablewerefoundingroupAandgroupB.
Conclusion:PDLandTAaretwoeffectivetherapysinpreventingandtreatingHS.Micro—vasculararchitecturecorrelatewellwithcollagencontents.Asthedestructionofmicro-vascularofHS,thecollagensynthesisisinhibitedandthetwotypecollagencontentsaredecreasedinproperly,especiallytypeIcollagendecreasedremarkablely.Thecorrelationcoefficientbetweenvesseldensityandcollagencontentsis0.74.Asthecollagencontentsarereduced,themicro—vesseldesityaredecreasedcorrespondingly.Notbeingtreatedproperly,themicro—vesseldensityandcollagencontentswillincreasegradually.
Keywords:
Hypertrophicscar;Microvascular;Collagen;585nmPDL;吲amcinoloneacetonide.

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标签:治疗   瘢痕   胶原   微血管   含量
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