细菌胶原酶对瘢痕降解的实验研究及临床观察

目的探讨细菌胶原酶治疗增生性瘢痕及瘢痕疙瘩的作用机理;观测评价其临床疗效。方法通过动物实验对细菌胶原酶降解增生性瘢痕的作用进行验证,并通过１０个病例对其临床疗效进行初步观察。结果动物实验显示,两次注药后,两周内瘢痕块体积平均缩小８６％,较对照组差异有非常显著意义（Ｐ＜０００１）。临床观察显示,经过两次病灶内细菌胶原酶的注射（剂量２００～２０００Ｕ）,瘢痕体积两周内平均缩小４６９２％,其中有４例缩小５０％以上,占病例总数的３０％。经过对５名病人３～１６个月随访,除１例瘢痕疙瘩于治疗后第２个月复发外,余均无复发迹象。胶原酶作用后的瘢痕组织,光镜及电镜下可以清楚地看到处于溶解状态的胶原结构。结论细菌胶原酶可以直接降解瘢痕组织内的胶原纤维,可望成为一种快速有效的治疗增生性瘢痕和瘢痕疙瘩的新方法。     

细菌胶原酶对瘢痕降解的实验研究及临床观察

目的 探讨细菌胶原酶治疗增生性瘢痕及瘢痕疙瘩的作用机量；观测评价其临床疗效。方法 通过动物对细菌胶原酶降解增生性瘢痕的作用进行验证，并通过１０个病例对其临床疗效进行初步观察。结果 动物实验显示，两次注药后两周内瘢痕块体积平均缩小８６％，较对照组差异有非常显著意义。临床观察显示，经过两次病灶内细菌胶原酶的注射，瘢痕体积两周内平均缩小４６．９２％，其中有４例缩小５０％以上，占病例总数的３０％。经过对５     

介绍一种小面积增生性瘢痕体积测量方法

目前临床上评价增生性瘢痕及瘢痕疙瘩治疗效果常用的指标多为瘢痕是否缩小 ,局部瘙痒症状是否改善 ,瘢痕硬度及颜色变化等。但这些指标均为观察者的主观判断 ,缺乏说服力。我们在临床实践中 ,总结出一种简单而实用的小面积增生性瘢痕体积的测量方法 ,可以将小面积增生性瘢痕治疗后体积缩小的速度及程度量化 ,从而对各种治疗方法进行有效评价和比较。用非常柔软的保鲜薄膜覆盖于增生性瘢痕及瘢痕疙瘩上 ,再将儿童玩具橡皮泥扣置于增生性瘢痕或瘢痕疙瘩上 ,适当挤压 ,则取得一个体积和瘢痕疙瘩等大的阴模 ,用注射　　器向阴模内加水 ,水的容积…     

胶原酶对裸鼠移植肥厚性瘢痕的治疗作用

目的观察胶原酶对肥厚性瘢痕(HTS)胶原降解的影响,探讨它对 HTS 的治疗作用。方法建立 HTS 裸鼠移植模型,局部注射胶原酶于瘢痕组织。治疗后取材行光、电镜观察和分析。结果 HTS 组织胶原纤维被降解,真皮层变薄,瘢痕缩小,质地变软,与对照组差异十分明显。结论胶原酶的局部注射可能是治疗 HTS 的较好方法。     

增生性瘢痕胶原降解与形态学的观察

目的　探讨胶原降解和瘢痕形态结构在增生性瘢痕形成中的作用。方法　应用SDS 聚丙烯酰胺凝胶加胶原底物电泳、氨基酸分析法和复合染色法 ,观测增生性瘢痕组织中胶原酶活性、胶原降解和瘢痕的组织形态。　结果　增生性瘢痕组织胶原纤维排列紊乱 ,胶原纤维间有大量的酸性粘多糖 ,紧密包绕胶原纤维 ,胶原酶活性明显下降 ,胶原降解减少。　结论　胶原酶活性降低 ,酸性粘多糖阻止胶原酶对胶原的降解可能是胶原降解减少和瘢痕形成的重要原因     

增生性瘢痕和瘢痕疙瘩中PKC活性测定

目的　测定增生性瘢痕和瘢痕疙瘩等瘢痕组织中PKC活性变化,探讨PKC在瘢痕形成中的作用。方法　利用PKC活化后催化底物多肽磷酸化,然后计数底物中掺入32P的放射活性的原理,测定增生性瘢痕、瘢痕疙瘩、成熟瘢痕和正常皮肤组织中PKC活性。结果　增生性瘢痕和瘢痕疙瘩组织中PKC的活性显著高于成熟瘢痕和正常皮肤(P＜0.001,分别高出正常皮肤318.30%和519.07%),瘢痕疙瘩高于增生性瘢痕(P＜0.001,高出48.60%)而成熟瘢痕和正常皮肤间没有差异(P＞0.05)。结论　瘢痕组织中PKC活性升高且与增生程度相关,提示PKC可能参与了细胞增殖和合成物质的信号转导。     

IL-32在病理性瘢痕中的表达及其生物学作用研究

目的:探讨IL-32在增生性瘢痕和瘢痕疙瘩的形成过程中所起的生物学作用。方法:收集2009年10月至2011年6月广东医学院附属医院整形外科手术切除的瘢痕疙瘩组织12例,增生性瘢痕组织12例,正常皮肤24例,分别应用免疫组织化学技术、RT-PCR和Western Blot检测IL-32在它们中的表达情况。结果:IL-32在正常皮肤增生性瘢痕和瘢痕疙瘩组织中均有表达,在正常皮肤中表达较强,在增生性瘢痕及瘢痕疙瘩组织中表达较弱;IL-32mRNA和IL-32蛋白在增生性瘢痕和瘢痕疙瘩中的表达较正常皮肤明显降低(P均<0.05),而增生性瘢痕组和瘢痕疙瘩组之间差异无统计学意义(P>0.05)。结论:IL-32在病理性瘢痕组织的形成过程中起着一定的重要作用,有进一步研究的价值。     

胶原酶对裸鼠移植肥厚性瘢痕的治疗作用

目的观察胶原酶对肥厚性瘢痕（ＨＴＳ）胶原降解的影响，探讨它对ＨＴＳ的治疗作用。方法建立ＨＴＳ裸鼠移植模型，局部注射胶原酶于瘢痕组织。治疗后取材行光、电镜观察和分析。结果ＨＴＳ组织胶原纤维被降解，真皮层变薄，瘢痕缩小，质地变软，与对照组差异十分明显。结论胶原酶的局部注射可能是治疗ＨＴＳ的较好方法。     

1565 nm非剥脱点阵激光治疗瘢痕疙瘩与增生性瘢痕

增生性瘢痕以及瘢痕疙瘩的治疗是亟待解决的医学难题。1565 nm非剥脱点阵激光是瘢痕治疗全新的治疗方法,临床尝试使用1565 nm非剥脱点阵激光来治疗增生期的增生性瘢痕以及瘢痕疙瘩的确有明显的治疗作用。非剥脱性点阵激光造成瘢痕组织局部的热效应,这种热效应,在不破坏组织胶原支架结构,不引起较强炎症反应基础上,能够导致瘢痕局部的成纤维细胞增殖受到抑制,甚至能够促进成纤维细胞的凋亡,瘢痕逐渐萎缩,达到治疗目的。     

增生性瘢痕和瘢痕疙瘩中PTK活性测定

目的测定增生性瘢痕和瘢痕疙瘩组织中PTK活性变化,探讨PTK在瘢痕形成中的作用。方法利用活化的PTK催化底物多肽磷酸化,再计数底物中掺入32P的放射活性的原理,测定增生性瘢痕、瘢痕疙瘩、成熟瘢痕和正常皮肤组织中PTK活性。结果增生性瘢痕和瘢痕疙瘩组织中PTK的活性显著高于正常成熟瘢痕和正常皮肤（P＜0.001,分别高出正常皮肤150.80%和313.80%）,瘢痕疙瘩高于增生性瘢痕（P＜0.001,高出65.01%）而成熟瘢痕和正常皮肤间没有差异（P＞0.05）。结论瘢痕组织中PTK活性升高且与增生程度相关,PTK介导生长刺激的信号转导使细胞增殖和合成物质的功能增强而发生瘢痕增生。     

Intra-lesional injections of collagenase are ineffective in the treatment of keloid and hypertrophic scars.

The treatment of keloid and hypertrophic scars remains difficult. Enzymatic digestion of keloid scars has been previously proposed as an effective treatment strategy for reducing the volume of keloid scars. To test this, we administered intra-lesional injections of pure collagenase (between 600 and 4500 units for each scar) into the keloid and hypertrophic scars of seven human volunteers (five keloid and two hypertrophic scars). Five patients (three keloid and two hypertrophic) received more than one injection of collagenase. The treatment resulted in a temporary reduction in scar volume for three of the patients with keloid scars. However, scar volumes for these three patients returned to the same (or greater) levels after 6 months of follow-up. Treatment with collagenase produced no change in scar volume for the two patients with hypertrophic scar. Side effects were numerous and severe including; pain, swelling, blistering, ulceration and ecchymosis at the site of injection. One patient required admission to hospital for 48 h after the first injection. Maximum length of follow-up was 6 months. None of the seven patients completed the study and returned for final follow-up at 2 years. This pilot study suggests that treatment of keloid and hypertrophic scars with intra-lesional injections of collagenase is ineffective.     

Effect of hyperbaric oxygen therapy on patellar tendinopathy in a rabbit model

BACKGROUND: Hyperbaric oxygen therapy is a method for augmenting oxygen availability to tissues. This study investigated the effect of hyperbaric oxygen therapy on the collagenase-induced tendinopathy in the rabbit patellar tendon. METHODS: In this study, 13 rabbits were treated by ultrasound-guided injection of 0.025 mL collagenase into the patellar tendon at the right knee, with the left knee serving as a control condition. The rabbits were randomly divided into two groups. After tendinopathy had been confirmed by histologic examination 3 weeks after treatment, hyperbaric oxygen therapy was initiated for group 1. The hyperbaric oxygen therapy involved 30 daily sessions of 2.5 ATA for 120 minutes starting 6 weeks after treatment. The rabbits in group 2 were put in normobaric room air. Both groups were killed 10 weeks after treatment. Histologic examinations as well as mechanical and biochemical tests were performed after the animals were killed. RESULTS: The ultimate tensile load in the tendon that had hyperbaric oxygen therapy was 34.8% greater than that in the control tendon 10 weeks after treatment (p < 0.05). Hydroxyproline concentrations increased 82.2% simultaneously in the tendons that had hyperbaric oxygen therapy, as compared with the concentrations in the control tendons (p < 0.05). However, no statistical difference was found between the two groups in terms of pyridinoline concentration at the 10th week (p > 0.05). The histologic examination demonstrated an increase in blastlike tenocytes in group 1, with more mature phenotype, more organized collagen matrix, absence of myxoid degeneration, and increased vascularity at the 10th week, as compared with the control knee. CONCLUSIONS: The results validate the effectiveness of hyperbaric oxygen therapy in the treatment of tendinopathy. Hyperbaric oxygen therapy may increase collagen synthesis and collagen cross-link formation during the early healing process.     

病理性瘢痕中热休克蛋白47的表达与胶原沉积相关性研究

目的　探讨热休克蛋白 4 7(heatshock protein 4 7,HSP4 7)在病理性瘢痕中的表达与胶原沉积的相关性。　方法　取经病理科确诊的正常皮肤 (10名 )、增生性瘢痕 (19例 )和瘢痕疙瘩 (16例 )组织标本 ,应用免疫组织化学方法、苦味酸 -天狼星红偏振光分析法检测组织中 HSP4 7的表达及胶原纤维含量。　结果　增生性瘢痕平均 IOD值5 2 115 9.5 0± 2 72 994 .13,瘢痕疙瘩组织平均 IOD值 4 0 74 4 0 .30± 2 95 780 .6 3中 HSP4 7表达量显著高于正常皮肤组织平均 IOD值 130 5 0 .17± 4 789.4 1,差异有统计学意义 (P<0 .0 1) ;HSP4 7的表达量与病理性瘢痕总胶原纤维含量呈正相关关系 (r=0 .386 ,P<0 .0 5 )。　结论　 HSP4 7在病理性瘢痕中异常高表达 ,并可能在病理性瘢痕胶原沉积的过程中发挥重要作用。     

胶原酶对裸鼠移植肥厚性瘢痕的治疗作用

目的 观察胶原地肥厚性瘢痕（ＨＴＳ）胶原降解的影响,探讨它对ＨＴＳ的治疗作用。方法 建立ＨＴＳ裸鼠移植模型,局部注射胶原酶于瘢痕组织。治疗后取材行光、电镜观察和分析。结果 ＨＴＳ组织胶原纤维被降解,真皮层变薄,瘢痕缩小,质地变软,与对照组差异十分明显。结论 胶原酶的局部注射可能是治疗ＨＴＳ的较好方法。     

Intradiscal collagenase for treatment of lumbar disc herniations

In a series of 34 patients with herniated lumbar discs, treated by intradiscal injection of highly purified collagenase, the post-treatment course has been followed-up clinically and by repeated computed tomographies (CT). Good or excellent results have been achieved in 17 patients. An only slight improvement of pain was noted in 2 patients. Fifteen patients had to be operated on due to not improved or worsened clinical symptoms. The most striking result of our CT follow-up was a tendency of the disc herniation to increase initially after collagenase injection. About two thirds of the patients had such an increase at the one week after injection control. After 6 weeks this rate had decreased to only about one quarter, but in the meantime 13 patients had to be operated. Only after 6 months most hernias of the up till then not operated patients were smaller and none were larger than before treatment. There was also a transient density decrease of the treated disc, most pronounced one week after collagenase injection. At controls 6 months later density had reached again pre-treatment levels. It is likely that the volume increase tendency of the disc material after collagenase injection is responsible for a worsening of the clinical symptoms, which not seldomly occurs during the initial post-treatment period, and in some patients makes an operation necessary.