炎症因子、生长因子以及凋亡因子在压疮慢性难愈合性创面中的表达及作用

摘要

目的:探讨炎症反应、生长因子及凋亡因子在压疮慢性创面中的表达及作用.方法:选取2013年10月至2015年7月河南大学第一附属医院收治的患者,其中临床Ⅲ、Ⅳ期压疮患者共20例,急性创面10例,正常皮肤组织6例.通过HE染色观察不同创面组织的形态学特征;免疫组织化学法检测组织中细胞凋亡因子Caspase-3的分布规律;荧光定量PCR法定量分析IL1β、IL-6、TNF-α、VEGF、bFGF及其受体KDR、FGFR1基因水平的变化特征.结果:Ⅲ、Ⅳ期压疮创面中可见炎性细胞浸润;凋亡信号因子caspase-3在压疮组中的表达高于其他两组,差异有统计学意义;IL-1β、1L-6、TNF-α表达高于急性创面组和正常皮肤组;VEGF和bFGF生长因子及其受体KDR和bFGFR1表达分别低于对照组.结论:炎症因子和凋亡因子在压疮慢性创面中持续长时间的高表达、生长因子及其受体显著的低表达可能是压疮慢性难愈合性创面形成的机制和难以彻底治愈的重要因素.%Objective:To study the distribution and expressions of inflammatory,growth factors,apoptosis factors in the late stage of pressure ulcer chronic wounds.Methods:Twenty patients were recruited from the First Affiliated Hospital of Henan University during Octomber 2013 to July 2015.Including twenty patients of stage Ⅲ,Ⅳ pressure ulcer,ten acute injury patients and six normal health persons.The histological changes of different wounds were observed by HE staining,the distribution of Caspase-3 protein in four groups was detected by immunohistochemistry technique.The expressions of mRNAs for interleukin (IL)-1β,interleukin (IL)-6,tumor necrosis factor-a (TNF-a),vascular endothelial growth factor (VEGF),vascular endothelial growth factor receptor 2(KDR),fibroblast growth factors(bFGF) and fibroblast growth factors receptor1 (FGFR1)were determined by real-time reverse transcription polymerase chain reaction.Results:Large numbers of inflammatory cells were found in the stage of Ⅲ,Ⅳ pressure ulcer wound under HE staining.The levels of Caspase-3 were mainly localized in fibroblasts or endothelial cells.Compared with the other two groups,the expression of Caspase-3 in pressure ulcers groups was higher (P ＜0.01).The expressions of IL-1β,IL-6 and TNF-α were higher than those of the acute group and normal group.The expressions of VEGF,KDR,bFGF and FGFR1 were lower than those of the control group respectively.Conclusion:Overproduction or prolonged expression of inflammatory factor and apoptosis factor,the expression of VEGF and its receptor KDR and bFGF and its receptor FGFR1 were significantly decreased in the stage Ⅲ,Ⅳ pressure ulcer wound.These characteristics can be used to comprehensively evaluate etiology and treatment of pressure ulcer chronic wounds.