曲安奈德、干扰素α-2b和维拉帕米治疗增殖瘢痕的作用机制比较  

Comparison of the mechanisms of intralesional steroid, interferon or verapamil injection in the treatment of proliferative scars

作　　者：徐少骏[1] 滕建英[2] 谢菁[1] 沈明强[1] 陈东明[3] 

机构地区：[1]杭州市温州路126号杭州师范大学附属医院整形外科,310015 [2]杭州师范大学临床医学院 [3]北京大学第三医院成形外科

出　　处：《中华整形外科杂志》2009年第1期37-40,共4页Chinese Journal of Plastic Surgery

摘　　要：目的比较曲安奈德、干扰素α-2b和维拉帕米局部注射对瘢痕疙瘩和增生性瘢痕增殖、凋亡和TGF-β1表达的影响。方法增生性瘢痕和瘢痕疙瘩各6例，局部注射曲安奈德（40mg／ml）、干扰素α-2b（150万U/ml）和维拉帕米（2．5mg／ml）后7d，切取标本，采用免疫组织化学、末端脱氧核苷酸介导的生物素化的脱氧尿嘧啶DNA切口末端标记方法，检测细胞增殖核抗原和TGF-β1的表达及细胞发生的凋亡情况，并以未注射药物的瘢痕疙瘩和增生性瘢痕以及健康皮肤为对照。结果①曲安奈德可抑制瘢痕疙瘩和增生性瘢痕细胞增殖和诱导细胞凋亡，同时抑制细胞TGF-β1表达从而抑制瘢痕的增殖增生；②干扰素a-2b可通过抑制瘢痕疙瘩、增生性瘢痕细胞的增殖和TGF-β1表达而抑制瘢痕的增殖增生，但其不能诱导细胞凋亡；③维拉帕米可通过抑制瘢痕疙瘩、增生性瘢痕细胞的增殖和诱导细胞凋亡而抑制瘢痕的增殖，同时抑制细胞TGF-β1表达，其诱导细胞凋亡的作用强于曲安奈德，但抑制TGFβ1表达作用弱于曲安奈德和干扰素α-2b。结论曲安奈德、干扰素α-2b和维拉帕米局部注射后，对瘢痕疙瘩和增生性瘢痕在临床上虽均有效，但作用机制不尽相同。Objective To investigate the effects of intralesional steroid, interferon α-2b or verapamil injection on prol/feration, apoptosis and TGF-β1 expression in ke]oid and hypertrophic scar in vivo. Methods 6 patients with keloids and 6 patients with hypeitrophic scar were treated with intralesional injection of triamcinolone acetonide（40 mg/ml）or IFN α-2b （15 × 10^5 U/ml）or verapamil（2.5 mg/ml）. Samples were collected on the 7th day after intralesional injection. Samples of untreated keloid and hypertrophic scar and normal skin were used as control. Expression of PCNA and TGF-β1 was detected in situ by immunohistochemical staining, and apoptosis was detected in situ by terminal deoxynucleotidyl transferase-mediated deoxyuridinetriphosphate-biotin nick end labeling （TUNEL）. Results ① Triamcinolone acetonide could prohibit proliferative scars through inhibiting cell proliferation and TGF-β1 expression, as well as inducing apoptosis, ② IFN α-2b could prohibit proliferative scars through inhibiting cell proliferation and TGF--β1 expression, but not inducing apoptosis; ③ Verapamil could also prohibit proliferative scars through inhibiting proliferation and TGF-β1 expression in fibroblasts, as well as inducing apoptosis. While the effect of inducing apoptosis was stronger than that of triamcinolone acetonide, the effect of inhibiting TGF-β1 expression was weaker than those of triamcinolone acetonide and IFN α-2b. Conclusions Although intraleional injection of steroid, interferon α-2b or verapamil were all effective in the treatment of keloid and hypertrophic scar, their mechanisms are not similar.

关 键 词：瘢痕 细胞增殖 细胞凋亡 

分 类 号：R622[医药卫生—整形外科]