CAJ | 학술논문

目的寻找血管内皮生长因子(VEGF)、bFGF 在Ⅲ～Ⅳ期压疮创面中的分布规律及表达特征,探讨其其与溃疡形成之间的关系.方法选择2010年6月-2012年3月温州医学院2家附属医院收治的41例患者,其中Ⅲ～Ⅳ期压疮患者21例共23个创面、急性外伤患者14例、正常皮肤供者6例.将上述患者手术中采集的样本分为4组:压疮中心组、压疮边缘组、急性创面组、正常皮肤组,样本数分别为23、23、14、6.HE染色观察创面的组织形态,Masson染色观察胶原纤维在创面中的分布,免疫组织化学染色观察VEGF、bFGF在创面中的表达.对数据进行独立样本t检验及配对样本t检验.结果 (1)2个压疮创面组见大量炎性细胞聚集,胶原纤维减少或消失；VEGF、bFGF阳性表达主要位于Fb和内皮细胞,在压疮中心组表达量分别为100±39、132 ±46,在压疮边缘组表达量分别为228 ±48、299±80. 2组之间比较,差异有统计学意义(t值分别为13.497、13.020,P值均小于0.01).(2)急性创面组Fb增多,可见少量胶原纤维；VEGF、bFGF阳性表达主要位于Fb,表达量分别为292±59、443±194,与2个压疮创面组比较,差异有统计学意义(t值为2.370～ 11.570,P＜0.05或P＜0.01).(3)正常皮肤组的组织结构合理,胶原纤维丰富；VEGF、bFGF表达较少,分别为45 ±18、54±22.与其他3组比较,差异具有统计学意义(t值为3.983～ 14.087,P值均小于 0.01).结论 Ⅲ～Ⅳ期压疮创面VEGF、bFGF表达显著低于急性外伤创面,胶原纤维合成减少或消失可能是其重要因索.
목적 심조혈관내피생장인자(VEGF)、bFGF 재Ⅲ～Ⅳ기압창창면중적분포규률급표체특정,탐토기기여궤양형성지간적관계.방법 선택2010년6월-2012년3월온주의학원2가부속의원수치적41례환자,기중Ⅲ～Ⅳ기압창환자21례공23개창면、급성외상환자14례、정상피부공자6례.장상술환자수술중채집적양본분위4조:압창중심조、압창변연조、급성창면조、정상피부조,양본수분별위23、23、14、6.HE염색관찰창면적조직형태,Masson염색관찰효원섬유재창면중적분포,면역조직화학염색관찰VEGF、bFGF재창면중적표체.대수거진행독립양본t검험급배대양본t검험.결과 (1)2개압창창면조견대량염성세포취집,효원섬유감소혹소실；VEGF、bFGF양성표체주요위우Fb화내피세포,재압창중심조표체량분별위100±39、132 ±46,재압창변연조표체량분별위228 ±48、299±80. 2조지간비교,차이유통계학의의(t치분별위13.497、13.020,P치균소우0.01).(2)급성창면조Fb증다,가견소량효원섬유；VEGF、bFGF양성표체주요위우Fb,표체량분별위292±59、443±194,여2개압창창면조비교,차이유통계학의의(t치위2.370～ 11.570,P＜0.05혹P＜0.01).(3)정상피부조적조직결구합리,효원섬유봉부；VEGF、bFGF표체교소,분별위45 ±18、54±22.여기타3조비교,차이구유통계학의의(t치위3.983～ 14.087,P치균소우 0.01).결론 Ⅲ～Ⅳ기압창창면VEGF、bFGF표체현저저우급성외상창면,효원섬유합성감소혹소실가능시기중요인색.
Objective To study the distribution and expressions of vascular endothelial growth factor (VEGF) and basic fibroblast growthth factor (bFGF) in the Ⅲ-Ⅳ stage of pressre ulcer wound,and to explore their correlation with ulceration.Methods Forty-one patients hospitalized in the two Affiliated Hospital of Wenzhou Medical College from June 2010 to March 2012 were recruited,including twenty-one patients with 23 pressure ulcer of stage Ⅲ-Ⅳ,14 acute injury patients,and 6 donors of normal skin.Samples harvested from the 41 patients through surgery were divided into four groups,including pressure ulcer centre group (n ＝ 23),pressure ulcer margin group (n ＝ 23),acute wound group (n ＝ 14),and normal skin group (n ＝ 6).The histological changes in wounds were observed after HE staining.The distribution of collagen fiber in wound was observed with Masson staining.Expressions of VEGF and bFGF in wounds were detected with immunohistochemical staining.Data were processed with independent samples t test and paired samples t test.Results (1) In the two pressure ulcer groups,large number of inflammatory cells were found in aggregation; the expression of collagen fiber was decreased or disappeared; the positive expressions of VEGF and bFGF were mainly located in fibroblasts and endothelial cells.The expression levels of VEGF and bFGF were respectively 100 ± 39,132 ± 46 in pressure ulcer centre group,and 228 ± 48,299 ± 80 in pressure ulcer margin group.The differences between the two pressure ulcer groups were statistically significant (with t values respectively 13.497 and 13.020,P values below 0.01).(2) In acute wound group,a large number of fibroblasts but a small amonnt of collagen fibers were observed; the positive expressions of VEGF and bFGF were mainly located in fibroblasts,with respective expression levels of 292 ± 59 and 443 ± 194,which were significantly higher than those of the two pressure ulcer groups (with t values from 2.370 to 11.570,P ＜0.05 orP ＜0.01).(3) In normal skin group,structure of tissue wasappropriate,and abundant collagen fibers were observed; the expression levels of VEGF and bFGF were respectively 45 ± 18 and 54 ± 22,which were significantly lower than those of the other three groups (with t values from 3.983 to 14.087,P values all below 0.01).Conclusions In contrast with those of the acute wounds,the expression levels of VEGF and bFGF are significantly decreased in the pressure ulcer wound at stage Ⅲ-Ⅳ.It may be closely correlated with the decrease or cessation of the synthesis of collagen fiber.