Marjolin溃疡不同形态区域中三种血管调节相关因子的表达及其与血管生成关系的临床研究  

Clinical research on the expression of three vascular regulatory factors in different morphological regions of Marjolin ulcer and their relationship with angiogenesis

作　　者：夏琛[1] 褚志刚[2] Xia Chen;Chu Zhigang(Department of Pathology,Tongren Hospital Affiliated to Wuhan University & Wuhan Third Hospital,Wuhan 430060,China;Department of Burns,Tongren Hospital Affiliated to Wuhan University & Wuhan Third Hospital,Wuhan 430060,China)

机构地区：[1]武汉大学附属同仁医院暨武汉市第三医院病理科,430060 [2]武汉大学附属同仁医院暨武汉市第三医院烧伤科,430060

出　　处：《中华烧伤杂志》2019年第9期676-682,共7页Chinese Journal of Burns

基　　金：武汉市卫生健康委员会医学科研项目(WX19C27).

摘　　要：目的探讨Marjolin溃疡不同形态区域中血管内皮生长因子(VEGF)、缺氧诱导因子1α(HIF-1α)和表皮生长因子受体(EGFR)的表达及其与血管生成的临床关系。方法笔者单位2012年1月—2017年12月收治符合入选标准的Marjolin溃疡患者92例[男56例、女36例,年龄(55±15)岁]、皮肤慢性非癌变溃疡患者100例[男59例、女41例,年龄(51±16)岁]、行其他皮肤相关手术治疗患者100例[男58例、女42例,年龄(52±15)岁],分别设为Marjolin溃疡组、慢性非癌变溃疡组、其他皮肤手术组。回顾性分析Marjolin溃疡组患者的病因、发病部位、溃疡直径、病程;取Marjolin溃疡组和慢性非癌变溃疡组患者溃疡组织标本、其他皮肤手术组患者术中切取组织周围附带的正常皮肤组织标本,采用免疫组织化学法检测各组织以及Marjolin溃疡组织周围正常皮肤区、溃疡区、上皮瘤样增生区、癌变区中VEGF、HIF-1α、EGFR、CD34的表达,计算阳性表达率及蛋白表达量。对数据行Pearson卡方检验、Mann-Whitney U检验、Bonferroni法检验、Bonferroni校正,对蛋白总表达量间的相关性进行Spearman相关分析。结果Marjolin溃疡组患者病因中烧伤占91.3%(84/92),44.6%(41/92)的患者肿瘤出现在下肢,62.0%(57/92)的患者皮肤表面溃疡直径为2.1~5.0 cm,病程超过20年者占75.0%(69/92)。慢性非癌变溃疡组患者溃疡组织VEGF、HIF-1α和EGFR阳性表达率分别为41.0%(41/100)、77.0%(77/100)、83.0%(83/100),显著高于其他皮肤手术组患者正常皮肤组织的12.0%(12/100)、45.0%(45/100)、67.0%(67/100),χ^2=21.589、21.522、6.827,P<0.01;Marjolin溃疡组患者溃疡组织VEGF、HIF-1α和EGFR阳性表达率分别为91.3%(84/92)、100.0%(92/92)、100.0%(92/92),显著高于慢性非癌变溃疡组和其他皮肤手术组患者相应组织(χ^2=53.372、24.772、17.159,120.543、72.777、36.661,P<0.01)。Marjolin溃疡组患者溃疡组织溃疡区、上皮瘤样增生区、癌变区VEGF阳性表达�Objective To investigate the expressions of vascular endothelial growth factor (VEGF), hypoxia inducible factor-1 alpha (HIF-1α), and epidermal growth factor receptor (EGFR) in different morphological regions of Marjolin ulcer and their clinical relationship with angiogenesis. Methods From January 2012 to December 2017, the patients admitted to our hospital who met the inclusion criteria were selected, including 92 patients with Marjolin ulcer [56 males and 36 females, aged (55±15) years], 100 patients with chronic non-cancerous skin ulcer [59 males and 41 females, aged (51±16) years], and 100 patients performed with other skin-related surgery [58 males and 42 females, aged (52±15) years], and they were enrolled into Marjolin ulcer group (MU), chronic non-cancerous ulcer group (CNU), and other skin surgery group (OSS) respectively. The etiology, pathogenic site, ulcer diameter, and course of patients in group MU were retrospectively analyzed. Ulcer tissue specimens from patients of group MU and group CNU and specimens of normal skin tissue attached to the tissue resected during operation from patients of group OSS were collected. The expressions of VEGF, HIF-1α, EGFR, and CD34 in the above-mentioned tissue and the surrounding normal skin, ulcer, epitheliomatous hyperplasia, and canceration areas in Marjolin ulcer tissue were detected by immunohistochemical method, and the positive expression rate and protein expression level were calculated. Data were processed with Pearson chi-square test, Mann-Whitney U test, Bonferroni method, and Bonferroni correction, and Spearman correlation analysis was used to analyze the relationship among the total protein expression levels. Results In group MU, burns accounted for 91.3%(84/92) of the causes of patients, 44.6%(41/92) of the patients had tumors in the lower extremities, 62.0%(57/92) of the patients had skin ulcer diameter of 2.1-5.0 cm, and 75.0%(69/92) of the patients had a course of disease of more than 20 years. The positive rates of VEGF, HIF-1α, and EGFR in ul

关 键 词：癌 鳞状细胞 血管内皮生长因子类 缺氧诱导因子1 Α亚基 受体 表皮生长因子 血管 Marjolin溃疡 

分 类 号：R632.1[医药卫生—外科学]