论文摘要
目的:在创面愈合的过程中,基因调控发挥了重要的作用。已证实封闭负压引流技术（Vacuum-assisted closure,VAC）能够促进慢性创面的愈合,但确切的机制不完全清楚。本课题旨在通过研究人慢性创面经VAC处理前后,创缘组织中与创面愈合密切相关的C-ski和Smad3的表达情况,探讨其发挥作用的机制,为VAC有效地治疗慢性创面提供新的理论依据。方法:选取本科室收治的各类慢性创面患者共14例,全部给与VAC治疗。分别于治疗前1d,治疗后1、4、7d取创缘全层皮肤组织,应用免疫组织化学法检测样品组织中的C-ski和Smad3的表达情况;应用RT-PCR法检测C-ski和Smad3mRNA变化情况。结果:1)VAC治疗后大体观察:创面清洁,渗液明显减少,且可见大量的鲜红色肉芽组织生成,创缘被新生上皮覆盖;2)VAC治疗后镜下观察:细胞水肿消失,炎性细胞浸润,创面中呈现大量的炎性细胞、成纤维细胞及血管内皮细胞组成的肉芽组织;3)免疫组化结果:C-ski及Smad3的阳性表达于成纤维细胞的细胞核和细胞质中。VAC治疗后4d,C-ski的阳性表达细胞数明显增加,与对照组比较差异有统计学意义（P<0.01）;相反,Smad3的阳性表达细胞数显著减少,与对照组比较差异有统计学意义（P<0.01）;4)RT-PCR结果:C-ski mRNA的表达随着VAC治疗时间的增加而显著增强（p<0.05）,而Smad3 mRNA随着VAC治疗时间的增加而显著减弱（p<0.05）;5)C-ski阳性表达与Smad3阳性表达呈显著负相关（r=-0.873）（p<0.01）。结论: VAC能促进慢性创面愈合的机制,可能与VAC能够促进创缘组织中C-ski表达的增长和抑制Smad3的表达有关,从而加速成纤维细胞的增殖,达到慢性创面愈合的治疗效果。
论文目录
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标签：封闭负压引流技术论文; 慢性创面论文;