胆管疤痕相关因子在梗阻型胆管损伤后不同时间段的表达  

Temporal expression of scar formation-related factors in obstructive bile duct injury

作　　者：黄强[1] 刘臣海[1] 王成[1] 胡元国[1] 邱陆军[1] 汤志刚[1] 王士堂[1] 林先盛[1] 王世杰[1] 谢放[1] 

机构地区：[1]安徽省立医院普外科胆胰病区,安徽省合肥市230001

出　　处：《世界华人消化杂志》2011年第26期2723-2729,共7页World Chinese Journal of Digestology

基　　金：安徽省科技攻关计划面上基金资助项目;No.08010302189~~

摘　　要：目的:探讨手术时机的选择对胆道修复后吻合口狭窄的影响.方法:运用家犬制作梗阻型胆管损伤的动物模型,通过HE染色及Masson特染分析损伤后胆管壁的结构改变及胶原增生情况,免疫组织化学法测定胆管梗阻损伤后不同时间段巨噬细胞MΦ、α-平滑肌肌动蛋白(α-smooth muscle actin,α-SMA)、转化生长因子-β1(transforming growth factor-β1,TGF-β1)表达情况.结果:胆管损伤后早期(BDL5)出现黏膜水肿,部分弹力纤维断裂,随着梗阻时间延长,黏膜层变薄,成纤维母细胞及胶原组织不断增生,纤维呈无规则排列,随着损伤时间的延长,胶原纤维增生不断增强[28.47±4.06(BDL5)vs59.92±9.13(BDL30)],但是疤痕相关因子MΦ、α-SMA及TGF-β1在损伤后5d即出现高表达[MΦ:0.262±0.031(BDL0)vs0.409±0.034(BDL5),α-SMA:0.239±0.035(BDL0)vs0.387±0.018(BDL5),TGF-β1:0.245±0.033(BDL0)vs0.386±0.029(BDL5),P>0.05],而后随着损伤时间的延长,其表达并未出现增高[MΦ:0.409±0.034(BDL5)vs0.422±0.023(BDL30),α-SMA:0.387±0.018(BDL5)vs0.358±0.029(BDL30),TGF-β1:0.386±0.029(BDL5)vs0.389±0.056(BDL30),P<0.05],两者无时效关系.结论:胆管损伤后时间的长短与管壁疤痕是否过度形成无关,故胆管修复时间不是术后吻合口狭窄的主要因素.AIM： To observe the temporal expression of scar formation-related factors in obstructive bile duct injury and to explore the effect of timing of surgery on the development of bile duct stricture after repair of obstructive bile duct injury. METHODS： A canine model of obstructive bile duct injury was developed. HE staining and Masson staining were used to observe the struc- tural changes and collagen proliferation of the bile duct. Immunohistochemistry was used to determine the expression of macrophages （M1）, α-smooth muscle actin （α-SMA）, and transform- ing growth factor-β1 （TGF-β1）. RESULTS： In the early stage of bile duct injury （BDL5）, mucosal edema and partial rupture of elastic fibers occurred. Prolonged obstruction led to mucosal thinning, continued proliferation of fibroblasts and collagen formation, and irregular fiber arrangement. With the prolongation of injury, the proliferation of collagen fibers was enhanced [28.47 ± 4.06（BDL5） vs 59.92 ± 9.13（BDL30）], and scar-related factors （α-SMA, M（I）, and TGF-β1 were highly expressed [McI）： 0.262 ± 0.031（BDL0） vs 0.409 ± 0.034（BDL5）; （z-SMA： 0.239 ± 0.035（BDL0） vs 0.387 ± 0.018（BDL5）; TGF-β1： 0.245 ± 0.033（BDL0） vs 0.386 ± 0.029（BDL5）, all P 〈 0.05]. With the further lengthening of injury time, the expression of the above factors was not enhanced [M（I）： 0.409 ± 0.034（BDL5） vs 0.422 ± 0.023（BDL30）; α-SMA： 0.387 ± 0.018（BDL5） vs 0.358 ± 0.029（BDL30）; TGF-J31：0.386 ± 0.029（BDLS） vs 0.389 ± 0.056（BDL30）, all P 〉 0.05]. CONCLUSION： The duration of bile duct injury has no significant correlation with excessive scar formation of the bile duct wall. The timing of repairing bile duct is not the main factor for the development of anastomotic stricture.

关 键 词：胆道损伤 巨噬细胞 转化生长因子-Β1 平滑肌肌动蛋白 

分 类 号：R657.4[医药卫生—外科学]