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作 者:姜笃银[1,2] 陈璧[1] 贾赤宇[1] 张红[1,2]
机构地区:[1]第四军医大学西京医院烧伤科 [2]泰州市第四人民医院创伤整形研究所,225300
出 处:《中华烧伤杂志》2003年第2期104-108,共5页Chinese Journal of Burns
基 金:国家自然科学基金资助项目 ( 3 90 70 82 2 )
摘 要:目的 比较异种脱细胞真皮基质 (Xeno ADM)与同种异体脱细胞真皮基质 (Allo ADM)移植物免疫学反应的差异。 方法 选用健康小猪和健康自愿者的中厚皮 ,分别制成Xeno ADM和Aoll ADM后 ,与深度烧伤患者的断层超薄自体皮 (UTS)重叠 ,即时覆盖其切痂创面 ,相应设为Xeno组(2 6例 )和Aoll组 (10例 )。于另 8例深度烧伤患者切痂创面上移植单纯断层自体中厚皮 (TTS) ,设为对照组。采用免疫组化方法 ,于移植术后进行组织学观察 ,并检测外周血和移植物内免疫细胞分型情况。 结果 与对照组比较 :(1)移植术后 ,Xeno组和Allo组外周血免疫细胞分型情况无明显改变(P >0 .0 5 )。 (2 )Xeno组移植物局部长期存在炎症 免疫反应 ,其中 80 %以上为CD3+ CD4 + 和CD4 5RO+ 细胞 ,CD8+ 细胞、Vs8C+ 浆细胞、CD5 7+ 的自然杀伤细胞 (NK)相对较少 ;另可见嗜酸性粒细胞和CD6 8+ CD4 + 异物巨细胞反应 ,在发生排异反应前的Xeno ADM中尤为明显 (P <0 .0 5~ 0 .0 1)。Allo组仅在移植早期 (术后 8周以内 )有中度炎症 免疫反应。 结论 人体对脱细胞真皮基质的特异性免疫反应 ,可能是在单核 巨噬细胞参与下、以CD4 + T淋巴细胞介导的细胞免疫为主要表现 ;Objective To investigate the immunologic reaction difference between xenogeneic and allogeneic acellular dermal matrix(ADM) grafting. Methods Split thick skin samples harvested from healthy piglets and human volunteers who underwent losing weight operation were processed to be xeno ADM and allo ADM. The ADMs overlapped with ultrathin auto skin were employed to immediately cover the wound after escharectomy in deep burn patients. The patients were correspondingly set to be Xeno (26 cases) and Allo (10 cases) groups. Another 8 cases with deep burn wounds were grafted with only split thick autoskin (TTS) after escharectomy as control group. The tissue samples from grafted area were observed by immunohistochemistry after the grafting. The typing of immune cells in peripheral blood and grafted tissue was determined. Results (1) The CD4 +, CD45RO + and CD4 +/CD8 + cell ratios in peripheral blood in Xeno group increased slightly after the skin grafting when comparing to those in control group (P>0.05). (2) There existed lasting inflammatory and immunological reaction in the local site of grafts in Xeno group. In addition, more than 80% of the inflammatory cells could be found to be CD3 +/CD4 +, CD45RO + . But CD8 +, Vs8C + plasmocytes and CD57 + NK cells were found less. Furthermore, eosinophil and CD68 +/CD4 + foreign body megalocyte reactions could also be identified, especially in Xeno ADM before rejection (P<0.05 0.001). There was only mild inflammatory and immunological reaction during early grafting stage (within 8 post operational weeks) in Allo group. Conclusion The specific immunologic reaction of human host to ADM might be participated by mononuclear cells and macrophages and presented mainly as cellular immune reaction induced by CD4 + T lymphocytes. Furthermore, the foreign body megalocyte constructed by help T cell and macrophage might play important roles in the reaction. [
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