不同冷冻消融时间对兔气管创伤性肉芽组织增生的影响及其作用机制  

Effects of different time of cryoablation on the proliferation of airway traumatic granuloma and its mechanism in rabbits

作　　者：谢宝松[1] 叶玲 李国平 林桂阳[1] 何毅辉[4] 郑冠英[1] 赖国祥[5] Xie Baosong;Ye Ling;Li Guoping;Lin Guiyang;He Yihui;Zheng Guanying;Lai Guoxiang(Department of Pulmonary and Critical Care Medicine,Fujian Provincial Hospital,Fujian Medical University,Fuzhou 350001,China)

机构地区：[1]福建医科大学省立临床医学院呼吸与危重症医学科,福州350001 [2]厦门市第五医院呼吸内科 [3]浙江省湖州市中心医院呼吸内科 [4]福建医科大学省立临床医学院病理科 [5]南京军区福州总医院呼吸与危重症医学科

出　　处：《中华医学杂志》2018年第44期3587-3591,共5页National Medical Journal of China

基　　金：福建省卫生系统中青年骨干人才培养项目（2013-ZQN-JC-1）

摘　　要：目的探讨不同冷冻消融时间对兔气管创伤性肉芽组织增生的影响及其作用机制。方法将32只新西兰大白兔按随机数字表法分为假手术组（A组）、模型对照组（B组）、30s冷冻组（C组）和2min冷冻组（D组），每组8只。采用尼龙刷刷擦法建立实验动物模型，建模成功后，采用不同冷冻消融时间进行分组治疗；A组仅予气管横切。1周后收集各组气管组织标本，HE染色，光学显微镜下测量气管黏膜下层厚度；采用免疫组织化学染色法和实时定量逆转录聚合酶链反应（RT—qPCR）检测气管转化生长因子β1（TGF—β1）及CD34的表达。结果气管组织大体标本A组气管横截面处气管壁光滑，无肉芽组织生长，其他各组气管壁肉芽组织增生及管腔狭窄程度由轻至重依次为C、D和B组。A、B、C、D组气管黏膜下层厚度分别为（0．20±0．07）、（0．77±0．28）、（0．44±0．13）、（0．55±0．18）mm，B组均显著大于A、C与D组（均P〈0．05），C组显著小于D组（P〈0．05）。A、B、C、D组TGF-β1相对表达量分别为0．42±0．01、0．50±0．01、0．43±0．01、0．48±0．01，B组均显著高于A、C、D组（均P〈0．05），C组显著低于D组（P〈0．05）；CD34相对表达量分别为0．31±0．02、0．41±0．03、0．36±0．02、0．37±0．03，B组均显著高于A、C、D组（均P〈0．05），C组与D组之间差异无统计学意义（P〉0．05）。A、B、C、D组TGF-β1mRNA相对表达量分别为0．85±0．12、6．45±0．31、2．38±0．10、12．61±2．14，CD34mRNA相对表达量分别为1．16±0．16、7．37±0．69、2．09±0．10、4．92±0．90；B组均显著高于A、C组（均P〈0．05），C组均显著低于D组（均P〈0．05）。结论冷冻消融治疗对气道创伤性肉芽组织增生有抑制作用，每次30s的冷冻消融效果较好，抑制TGF-β1及CD34的表达是其可能的作用机制之一。Objective To investigate the effect of different cryoablation time on tracheal traumatic granulation formation and its mechanism. Methods A total of 32 rabbits were randomly assigned into four groups （A- D）. Group A underwent tracheotomy alone. Group B, C and D received intra-tracheal brush rubbing to establish airway granulation model. Group C and D underwent 30 s and 2-minute cryoablation respectively. Tracheal specimens of all groups were collected to examine pathological changes using HE staining. Levels of transforming growth factor beta 1 （TGF-β1 ） and CD34 in tracheal granulation were evaluated using immunohistochemistry （IHC） and real-time quantitative reverse transcription polymerase chain reaction （RT-qCR）. Results Tracheal lumens of group A were smooth without granulation. While the growth of granulation and luminal stenosis were most severe in Group B, followed by Group D and C. Submucosa thickness of Group B was largest as compared with other groups （0. 20 ± 0.07, 0. 77 ± 0. 28, 0. 44±0. 13 and 0. 55 ±0. 18 mm for Group A to D, respectively. P 〈0. 05）. And the submucosa layer of Group C was thinner than Group D （ P 〈 0. 05 ）. The expression and transcription levels of TGF-β1 of trachea were highest in Group B as detected by IHC and RT-qPCR （ P 〈 0. 05 ） , followed by Group D and C （ IHC ： 0.48 ± 0. 01 vs 0.43 ± 0. 01, P 〈 0. 05 ; RT-qPCR： 12. 61 ± 2. 14 vs 2. 38 ± 0. 10, P 〈 0. 05）. Both protein and mRNA levels of CD34 were highest in Group B as detected by IHC and RT-qPCR （P 〈 0.05 ）. Tracheal mRNA levels of CD34 were more abundant in Group D than Group C （4. 92±0. 90 vs 2. 09 ±0. 10, P 〈 0. 05 ）, while no significant difference was found between groups regarding protein levels measured by IHC. Conclusions Cryoablation could alleviate the hyperplasia of tracheal traumatic granulation, possibly due to the inhibition of TGF-β1 and CD34 expression. The effect of 30 s cryoablation for tracheal traumatic granulation is better.

关 键 词：肉芽组织 冷冻外科手术 转化生长因子Β1 抗原 CD34 

分 类 号：R641[医药卫生—外科学]