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。     

经椎间孔硬膜外注入胶原酶治疗腰椎间盘突出症(附382例报告)

方法：自１９９４年以来采用胶原酶经腰椎间孔硬脊膜外注射治疗腰椎间盘突出症３８２例。本方法,采用胶原酶１２００Ｕ注入突出节段的硬脊膜外腔、让药物渗透到病变的椎间盘内,达到了溶解的目的。经随访优良率达９１％。结论：作者认为本手术方法简单易行、病人痛苦少、无后遗症收到较好的经济效益和社会效益,有推广的必要     

王氏抗肝纤方治疗肝纤维化的实验研究

目的：观察王氏抗肝纤方对肝纤维化的治疗作用及其作用机制。方法：采用二甲基亚硝胺诱导肝纤维化模型,从组织学改变观察王氏抗肝纤方的疗效,以γ干扰素及膈下逐阏汤作为对照组。结果：王氏抗肝纤方对肝纤维化大鼠能显著降低血清ＡＬＴ、ＡＳＴ及肝组织Ｈｙｐ含蛳,减少肝组织中ＣｏｌＩ、ＣｏｌⅣ的沉积和α－ＳＭＡ的表达,提高肝组织间质胶原酶活性。其作用同γ干扰素而明显优于膈下逐瘀汤。结论：王氏抗肝纤方具有较好的抗肝纤     

经皮切割联合盘内注射治疗腰椎间盘突出症

目的 :探讨经皮切割抽吸 (PLD)联合盘内注射胶原酶 (CNL)治疗腰椎间盘突出症的临床价值。方法 :本组共2 95例腰椎间盘突出症患者 ,其中联合治疗组 (PLD加CNL组 ) 14 5例和单纯经皮椎间盘切割组 (PLD组 ) 15 0例。PLD按常规操作完成 ,在PLD基础上 ,椎间盘内注射胶原酶 60 0U。术后观察、分析两组疗效及并发症。结果 :术后随访 6～ 2 4个月 ,全部病例 1次穿刺成功率为 93 .75 % ,治疗有效率 (按Macnab标准 ) :PLD CNL组 94% ,PLD组为 82 .5 % ,前者明显高于后者 (P <0 .0 0 1) ;PLD加CNL组中有疼痛反应者占 8%。结论 :PLD加CNL联合治疗腰椎间盘突出症具有更好的疗效、更广的适应证、较少的疼痛反应 ,值得推广。     

胶原酶浓度对大鼠胰岛分离纯化产量的影响

目的观察胶原酶浓度对大鼠胰岛分离纯化产量的影响,筛选出获取高产量胰岛的最佳消化液的胶原酶浓度。方法 75只雄性SD大鼠按胶原酶浓度分为5组：Ⅰ组（0.5 mg/ml）、Ⅱ组（0.75 mg/ml）、Ⅲ组（1.0 mg/ml）Ⅳ组（1.2 mg/ml）和Ⅴ组（1.5 mg/ml）,每组15只。通过胆灌注胶原酶V来消化大鼠胰腺,分离胰岛,采用不连续密度梯度Ficoll离心法纯化胰岛,根据胰岛直径计数所获胰岛的数量及胰岛当量,并利用葡萄糖刺激胰岛素释放试验评估胰岛功能。结果分离的大鼠胰岛具有较好的质量,胰岛纯度为95%左右,活性率为90%左右,体外培养生长良好。随着胶原酶的浓度增加,胰岛数量和胰岛当量明显增加（P〈0.05）,并且最大直径的胰岛数量也在增加（P〈0.05）,在胶原酶浓度1.0 mg/ml时获得的胰岛产量最高,其次为1.2 mg/ml,在其他浓度时,胰岛产量都较低（P〈0.05）。在低糖和高糖刺激下胰岛素的释放分别为（1.346±0.128）ng/ml和（2.565±0.208）ng/ml,差异具有显著性意义（P〈0.05）,刺激指数为（1.908±0.152）,提示胰岛细胞功能良好,电镜照片显示胰岛生长状况良好。结论进行大鼠胰岛分离纯化时最适宜的胶原酶浓度为1.0~1.2 mg/ml,可获得稳定高产量的胰岛,过低和过高的浓度都是不适宜的。     

单纯Ⅱ型胶原酶消化法分离、培养人退变椎间盘髓核细胞的形态学观察

目的:探讨单纯Ⅱ型胶原酶消化法体外培养扩增人退变椎间盘髓核细胞的可行性。方法:收集20例人退变椎间盘髓核,单纯Ⅱ型胶原酶消化分离出髓核细胞并连续培养传代,倒置相差显微镜和HE染色观察细胞形态学变化,甲苯胺蓝染色检测髓核细胞内聚集蛋白聚糖的表达,免疫细胞化学法行Ⅱ型胶原染色,观察髓核细胞的类软骨表型表达情况。结果:单纯Ⅱ型胶原酶消化法可较好的分离培养人退变椎间盘髓核细胞,20例人退变椎间盘髓核,培养成功16例;原代髓核细胞平均7d贴壁,呈类圆形或多角形,P1代髓核细胞平均12h贴壁,呈大梭形或多角形,两代细胞融合95%所需时间分别为30d和7d,差异有统计学意义(P0.01);聚集蛋白聚糖和Ⅱ型胶原主要表达于原代和P1代髓核细胞浆内,被甲苯胺蓝染成天蓝色,免疫细胞化学染色主要表现为黄褐色沉淀,两代间聚集蛋白聚糖和Ⅱ型胶原的表达无统计学差异(P0.05)。结论:单纯Ⅱ型胶原酶消化法可简化髓核细胞分离步骤,提高培养效率;传一代后髓核细胞增殖速率提高,但仍维持类软骨表型,表达聚集蛋白聚糖和Ⅱ型胶原。     

臭氧与胶原酶联合应用治疗腰椎间盘突出症

目的：研究臭氧髓核氧化术结合胶原酶溶解术治疗腰椎间盘突出症的临床疗效。方法：对45例腰椎间盘突出症患者进行臭氧结合胶原酶盘内、外注射治疗。术后随访6-12个月,按照Macnab评定标准进行疗效评定。结果：45例患者,优32例,良8例,可2例,差3例;优良率为88.9%,有效率为93.3%。结论：臭氧髓核氧化术结合胶原酶溶解术治疗腰椎间盘突出症集合了两者的优点,疗效好,是腰椎间盘突出症首选的微创治疗方法。     

Use of intralesional collagenase in the treatment of peyronie&rsquo;s disease: A review

AIM: To review the relevant literature in an effort to examine the body of evidence available to date. METHODS: Ovid MEDLINE search database was queried using MeSH terms “penile induration”, “peyronie’s disease”, “Collagenases” and “Collagenase” using various permutations. No temporal parameters were employed. RESULTS: In all, 5 relevant clinical trials were isolated from 34 results. These trials were analyzed using the Oxford Centre for Evidence-Based Medicine criteria. They were further examined based on study design and methods; the primary and secondary outcomes were reviewed for treatment efficacy and collagenase-related side effects. CONCLUSION: Intralesional collagenase appears to be safe and effective in the non-surgical treatment of Peyronie’s disease. However, the data remains limited and further inquiries into the safety of collagenase, treatment standardization and standardized outcomes reporting remain necessary. Furthermore, studies comparing intralesional collagenase to alternative medical and surgical therapy will be important in guiding the future treatment decision process.     

Treatment of Peyronie's Disease With Collagenase Clostridium histolyticum and Vacuum Therapy: A Randomized,Open-Label Pilot Study

BackgroundCollagenase Clostridium histolyticum (CCH) is indicated for the treatment of penile curvature in adult men with Peyronie's disease (PD) with palpable plaque and curvature deformity of at least 30° at the start of therapy.AimTo evaluate the efficacy and safety of CCH plus vacuum-pump therapy with and without penile modeling for the management of PD.MethodsAdult men with PD and penile curvature of at least 30° were randomly assigned to receive CCH 0.58 mg plus vacuum therapy alone (n = 15) or with penile plaque modeling (n = 15). Patients received no more than four treatment cycles (cycle = ∼6-week duration), each consisting of two intralesional injections of CCH administered 24 to 72 hours apart. Vacuum therapy was applied twice daily from 14 days after the second injection of each cycle until the following cycle. Modeling was performed 24 to 72 hours after the second injection of each cycle.OutcomesThe primary end point was change in penile curvature from baseline to week 36; additional end points included changes in Peyronie's Disease Questionnaire (PDQ) domain scores, composite response (≥20% decrease in penile curvature and decrease in PDQ bother score ≥ 1 point), and global response (small but important, moderate, or much improvement in the Global Assessment of PD).ResultsAt week 36, improvement in penile curvature from baseline was similar in the two groups (mean change from baseline = −23.7° [SD = 10.9] for CCH + vacuum + modeling and −23.3° [SD = 7.2] for CCH + vacuum; between-group difference = −0.3°, 95% CI = −7.3 to 6.6). Improvements in most PDQ domains, including bother, were observed from baseline to week 36 in the two groups. Most patients were composite (66.7% and 84.6% with CCH + vacuum + modeling and CCH + vacuum, respectively) and global (86.7% and 92.3%, respectively) responders. The most common adverse events were penile contusion, penile swelling, and penile pain.Clinical ImplicationsVacuum-pump therapy administered alone or in combination with modeling after CCH treatment could improve PD symptoms.Strengths and LimitationsThis was a pilot study with a small sample and limited follow-up duration.ConclusionCCH and vacuum-pump therapy (alone or combined with modeling) could be an appropriate consideration for men with PD and warrants further investigation.Ralph DJ, Abdel Raheem A, Liu G. Treatment of Peyronie's Disease With Collagenase Clostridium histolyticum and Vacuum Therapy: A Randomized, Open-Label Pilot Study. J Sex Med 2017;14:1430–1437.