移植不同人工真皮支架对猪Ⅲ度烧伤创面血管化及瘢痕形成的影响  

Effects of different artificial dermal scaffolds on vascularization and scar formation of wounds in pigs with full-thickness burn

作　　者：滕建英[1] 郭瑞[2] 谢菁[3] 孙东杰[3] 沈明强[3] 徐少骏[1] 

机构地区：[1]杭州师范大学临床医学院,310036 [2]浙江大学高分子科学与工程学系 [3]杭州师范大学附属医院整形外科

出　　处：《中华烧伤杂志》2012年第1期13-18,共6页Chinese Journal of Burns

基　　金：浙江省医药卫生科学研究基金A类（2008A131）

摘　　要：目的 了解移植3种人工真皮支架对Ⅲ度烧伤创面血管化及其瘢痕形成的影响.方法 采用随机数字表法将18只广西巴马小型猪分成壳聚糖支架组、磺化羧甲基壳聚糖支架组、ADM支架组,每组6只,在每只猪背部制作Ⅲ度烫伤（下称烧伤）创面4或8个,共96个.伤后48 h切痂后,前2组创面分别移植胶原-壳聚糖/硅橡胶双层人工皮、胶原-磺化羧甲基壳聚糖/硅橡胶双层人工皮,ADM支架组创面移植ADM,每组创面24个；剩余24个创面作为油纱对照组,直接覆盖油纱.于支架移植或油纱覆盖后l、2、3、4周（“4周”指植入支架或覆盖油纱后2周＋移植表皮后2周）,观察各组创面的大体情况；取创面中央部位组织,采用生物素-链霉亲和素-过氧化物酶染色法观察CD31、α平滑肌肌动蛋白（α-SMA）、TGF-β1、TGF-β3表达阳性的血管或细胞,并计数.对数据行单因素方差分析和LSD检验. 结果（1）大体观察可见,磺化羧甲基壳聚糖支架组创面血管化程度明显优于其余3组.（2）移植或覆盖后1～3周各组创面组织CD31阳性血管数持续增多,第4周时3个支架组均减少.各时相点4组间比较,F值分别为24.005、38.822、25.274、3.856,P＜0.05或P＜0.01；磺化羧甲基壳聚糖支架组l～3周明显多于其余3组（P值均小于0.05）.（3）移植后1～3周,3个支架组创面组织α-SMA阳性血管数均持续增多,4周时下降；油纱对照组覆盖后1～4周持续增多.各时相点4组间比较,F值分别为22 637、28.087、62.651、18.055,P值均小于0.01.磺化羧甲基壳聚糖支架组各时相点均明显多于其余3组（P值均小于0.05）.（4）移植或覆盖后1～4周每400倍视野下TGF-β1阳性细胞数：壳聚糖支架组分别为（127±8）、（167±19）、（170±18）、（144±10）个,磺化羧甲基壳聚糖支架组为（171±17）、（207±25）、（130±30）、（69±16）个,ADM支架组为（106±8）、（159±17）、（171±11）、（Objective To investigate the effects of three kinds of artificial dermal scaffolds on vascularization and scar formation of wounds in pigs with full-thickness burn. Methods Eighteen Bama miniature pigs were divided into chitosan scaffold（CS） group,sulfonated carboxymethyl chitosan scaffold （SCCS）group,and acellular dermal matrix（ADM）scaffold group according to the random number table,with 6 pigs in each group.Every pig in all groups was inflicted with 4 or 8 full-thickness scald wounds on the back（totally 96 wounds）.Forty-eight hours after injury,eschars of all wounds were excised.Twenty-four wounds in CS group were transplanted with double-layer artificial dermis of collagen-chitosan and silicone rubber,those in SCCS group with double-layer artificial dermis of collagen-sulfonated carboxymethyl chitosan and silicone rubber,and those in ADM scaffold group with ADM.The rest 24 wounds in the three groups were dressed with vaseline gauze as control group.After 2 weeks of treatment,all wounds of every group were covered with skin.In post treatment（scaffold transplantation or gauze covering）week（PTW）1,2,3,and 4,gross condition of wound was observed,and specimens from central parts of wounds were harvested for observation and assessment of vessels or cells with positive expression of CD31,α smooth muscle actin（α-SMA）,TGF-β1 and TGF-β3 with SP staining.Data were processed with one-way analysis of variance and LSD test. Results （ 1 ）Degree of vascularization in SCCS group was better than that in the other three groups.（2）The number of vessels with positive expression of CD31 in CS,SCCS,ADM scaffold,and control groups increased gradually from PTW 1 to PTW 3,and decreased in PTW 4.There were statistical differences among 4 groups from PTW 1 to PTW 4（ with F value respectively 24.005,38.822,25.274,3.856,P 〈 0.05 or P 〈 0.01 ）.The numbers of vessels that expressed CD31 in SCCS group from PTW 1 to PTW 3 were more than those in the other three groups（ with P values all below 0.

关 键 词：烧伤 皮肤 人工 新生血管化 生理性 瘢痕 真皮支架 

分 类 号：R644[医药卫生—外科学]