重组人源胶原蛋白Ⅲ对肛周术后创口愈合的影响和意义  

Effect and significance of recombined human originated collagen Ⅲ on wound healing after perianal operation

作　　者：王永刚[1] 翟春宝[1] 田利军[1] 史珍珍[1] 徐可[1] 

机构地区：[1]山西省人民医院普外科(结直肠肛门外科),太原030012

出　　处：《中国药物与临床》2017年第8期1109-1111,共3页Chinese Remedies & Clinics

基　　金：山西省回国留学人员科研资助项目(2016-125)

摘　　要：目的研究重组人源胶原蛋白Ⅲ对肛周术后创口愈合的影响和意义。方法采用随机对照试验(RCT)分两组研究,研究组采用重组人源胶原蛋白Ⅲ对肛周创口进行换药,对照组采用紫草膏换药。分别观察创口缩小效率、最大瘢痕厚度、瘢痕指数、创口愈合时间,并通过创口组织学、蛋白免疫印迹法半定量及m RNA定量等方法,分析创口组织转化生长因子β1、Smad3信号蛋白、胶原蛋白Ⅰ和Ⅲ的变化情况。结果研究组平均在术后5 d后开始出现肉芽,7~14 d间可见中心上皮化,最快愈合期发生在11~16 d,愈合后最大瘢痕厚度平均为2.7 mm,肛门括约功能正常;4~7 d时,创口组织明显出现胶原蛋白Ⅰ、Ⅲ,14 d时其比例接近3∶1,28 d时,胶原蛋白Ⅰ、Ⅲ含量接近正常皮肤组织,其比例为4∶1。对照组最快愈合期发生在18~23 d,愈合后最大瘢痕厚度平均为4.3 mm,影响肛门括约功能;7 d时,创口内胶原蛋白Ⅰ、Ⅲ表达量仍较少,14 d时其比例接近8∶1,28 d时胶原蛋白Ⅰ表达量超过正常皮肤,胶原蛋白Ⅲ表达量明显低于正常皮肤,其比例仍高达6∶1。创口内转化生长因子β1和Smad3信号蛋白m RNA在研究组及对照组早期表达逐渐增高,中、后期下降,但研究组在创口愈合早期,表达量更多,后期表达量更少,P均<0.05。结论重组人源胶原蛋白Ⅲ可促进肛周术后创口愈合,其机制可能与其双向调控创口组织转化生长因子β1和Smad3信号蛋白相关。Objective To investigate the effect and significance of recombined human originated collagen Ⅲon wound healing after perianal operation. Methods All patients were divided into two groups by randomized contrast trail（RCT）. The study group received the dressing change with the recombined human originated collagen Ⅲfor the perianal wound, and the control group received the dressing change with Gromwell ointment. The wound heal-ing efficiency, maximum scar thickness, scar index, and wound healing time were determined, respectively. The changes of the transforming growth factor β1（TGF-β1）, Smad3 signal protein, collagen Ⅰ and Ⅲ were analyzed by the methods of wound histology, Western blot semi-quantitative analysis and m RNA quantitative analysis. Results In the study group, the granulation appeared at an average of 5 d after the operation. The central epithelization was found at 7-14 d. The fastest healing period occurred between 11-16 d. The average of the maximum scar thickness was 2.7 mm after the healing. The anal sphincter function was normal. At 4-7 d, the wound tissues showed collagen Ⅰand Ⅲ significantly when the ratio was close to 3∶1. At 28 d, the content of collagen Ⅰ and Ⅲ was similar to the normal skin tissues, and the ratio was 4∶1. The fastest healing period occurred in the control group between 18-23 d, and the maximum scar thickness after the healing was 4.3mm, affecting anal sphincter function. At 7 d, the expression level of collagen was still low in the wound, and the ratio approached to 8 ∶1 at 14 d. At 28 d, the expression level of collagenⅠ was higher than that in the normal skin, and the expression level of collagen Ⅲ was significantly lower than that in the normal skin, and the ratio was 6∶1. The expression levels of TGF-β1 and Smad3 signaling protein in the wound at the early stage of the study group and control group gradually increased, and decreased at the middle and late stages.However, the expression level was higher at the early stage of the wound

关 键 词：胶原酶类 伤口愈合 肛周腺 

分 类 号：R657.1[医药卫生—外科学]