增生性瘢痕中胶原结节的组织学特征  

Histology of collagen nodules from hypertrophic scars

作　　者：刘英开[1] 王西樵[1] 宋菲[1] 王志勇[2] 原博[2] 青春[1] 陆树良[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院灼伤整形科,上海市烧伤研究所,200025 [2]上海交通大学医学院附属瑞金医院烧伤整形科,200025

出　　处：《中华创伤杂志》2014年第4期302-306,共5页Chinese Journal of Trauma

基　　金：国家自然科学基金资助项目（81000838,81071566）

摘　　要：目的观察增生性瘢痕（hypertrophic scars，HS）中胶原结节的组织学特征，探讨胶原结节可能的形成原因。方法选取整形手术切除的人皮肤瘢痕组织，通过HE染色，光镜下观察胶原结节的形态特征；经天狼猩红染色，偏光镜下观察Ⅰ／Ⅲ型胶原的表达；经免疫组化染色检测肌成纤维细胞（myofibroblasts，MFb）的特征性蛋白α-平滑肌肌动蛋白（d—smoothmuscleactin，α—SMA）的表达及分布，以观察局部组织张力的水平。结果光镜观察结果显示，胶原结节形态多样，并不局限于球形，大小不一，结节中可见大量成纤维细胞（fibroblasts，Fb），细胞核大而淡染；非结节区域Fb数量减少，胞核小而深染，提示结节处细胞功能活跃。偏光镜观察结果显示，部分胶原结节以绿色的Ⅲ型胶原为主，而部分胶原结节以红色或黄色的Ⅰ型胶原为主，提示结节形成时间不同；免疫组化检测结果显示，早期瘢痕组织（伤后2个月）中α-SMA广泛分布于真皮深层相当于网状层水平，而时间较久瘢痕（伤后2～10年）α-SMA主要分布于结节部分，而非结节区域除血管呈强阳性染色外，几乎不表达α-SMA；胶原结节中α-SMA的分布不均一，结节表皮端α-SMA表达往往强于皮下组织端，而位于真皮浅部的结节α-SMA表达也强于深部的结节，提示结节处有大量MFb存在，组织张力高于非结节区域，且结节中及不同结节间张力分布不均一。结论胶原结节形态多样，大小不一，胶原类型与结节形成时间相关。胶原结节的形成可能与局部组织张力的分布及其演变密切相关。Objective To detect the histological characteristics of collagen nodules from hyper- trophic scars （HS） and investigate the origin of collagen nodules. Methods The scar tissues were col- lected from patients with plastic operation. Morphological characteristics of collagen nodules were ob- served by light microscopy of HE-stained sections; expressions of type I / In collagens were observed by polarized light microscopy of sirius red-stained sections; expression and distribution of myofibroblasts （MFb） -specific protein （a-smooth muscle actin, α-SMA） were observed by immunostaining in order to observe level of local tissue tension. Results Collagen nodules varied in shape, not only sphere- shaped, and in size. Moreover, abundant fibroblasts （Fb） with large and light-stained nuclei were seen in the nodules compared to non-nodule area, indicating that the cells located in the modules were active. Some collagen nodules were composed largely of collagen type Ⅲ （ green）, but some mainly contained collagen type Ⅰ （red or yellow）, indicating the difference in the time of nodule formation, α-SMA was expressed mainly in the deep dermis equivalent to the level of reticular layer of the new scar tissues （2 months after injury） ; α-SMA was expressed mainly in the nodules of the old scar tissues （2-10 yearsafter injury）, but almost not in non-nodule areas except for a strongly positive staining in the vessels. Mo- reover, ot-SMA presented a heterogeneous distribution in the collagen nodules, with stronger expression in the epidermal end than in the subcutaneous tissue end and stronger expression in the superficial dermis than that in the deeper part. It was suggested that there existed massive amount of MFb and high tension in the nodules and that the tension distribution was not uniform in or between the nodules. Conclusions Collagen nodules are of varying shape and size and collagen types are associated with the time of nodule formation. Moreover, Formation of the collagen nodules may b

关 键 词：瘢痕 胶原 成纤维细胞 

分 类 号：R641[医药卫生—外科学]