细胞因子对异种脱细胞真皮基质免疫调节作用的临床研究

目的　探讨烧伤患者接受异种 /异体脱细胞真皮基质 (xeno /allo ADM )移植后全身和局部多种细胞因子与移植物近期转归的关系。　方法　在大面积烧伤患者的四肢切痂创面上 ,移植xeno ADM (12例 ,19块 )或allo ADM(15例 ,18块 ) ,其上覆盖自体超薄断层皮片 ,并以 6例单纯移植自体中厚断层皮片 (auto TTS)的烧伤患者为对照。移植物成活后 4～ 8周 ,收集局部组织标本、血清和xeno ADM排斥后的创面渗出液 ,采用免疫组织化学染色与酶联免疫吸附法 (ELISA) ,检测白细胞介素 (IL) 1β、IL 4、IL 6、肿瘤坏死因子α(TNF α)和γ型干扰素 (IFN γ)的含量。　结果　免疫组织化学染色结果显示 ,移植物内IL 1β、IL 4、IL 6、TNF α和IFN γ的阳性细胞密度或着色强度相比较 ,xeno ADM >allo ADM >auto TTS (P <0 .0 5 )。ELISA检测结果显示 ,xeno ADM被排斥后创面渗出液中IL 4、IL 6、TNF α和IFN γ水平明显高于自体血清 ,但其血清IL 4与IFN γ水平分别低于和高于未排斥时。xeno ADM移植后血清中IL 4、IFN γ水平明显高于allo ADM和auto TTS(P <0 .0 5～ 0 .0 1)。　结论　xeno ADM移植后可在局部检测到高水平的IL 1β、IL 4、IL 6、IFN γ ,可能与细胞杀伤和细胞因子介导的免疫放大作用有关。这些细胞因子的动态变

Clinical study on the immunoregulation effects of cytokines on the acellular xenogenic dermal matrix

OBJECTIVE: To investigate the relationship between some cytokines and early outcome of grafts in burn patients receiving xeno-/allo-ADM grafting. METHODS: Nineteen xeno-ADMs were grafted onto the wounds of 12 patients after escharectomy in extremities, and 18 allo-ADMs were grafted onto the escharectomy wounds of 15 patients in extremities. All the grafts were covered with thin split thickness skin autografts. Six patients grafted with split thickness skin autografts (auto-TTS) were employed as control. After the grafts survived for 4 to 8 weeks, immunohistochemistry and ELISA methods were employed to determine the contents of IL-1 beta, IL-4, IL-6, TNF-alpha and IFN-gamma in the exudation fluid from wounds after the rejection of xeno-ADM, local skin and peripheral blood. RESULTS: It was exhibited by immunochemistry staining that the positive cellular density and staining intensity of the IL-1 beta, IL-4, IL-6, TNF-alpha and IFN-gamma in the grafts were ranked as following: Xeno-ADM > allo-ADM > auto-TTS (P < 0.05 - 0.01). The levels of IL-4, IL-6, TNF-alpha and IFN-gamma in the exudation fluid during the rejection of xeno-ADM were obviously higher than those in the blood of the patients as determined by ELISA, while the serum levels of IL-4 and IFN-gamma in xeno-ADM group were lower and higher than those in xeno-ADM when without rejection respectively. The serum levels of IL-4, TNF-alpha and IFN-gamma in xeno-ADM group were significantly higher than those in allo-ADM and auto-TTS groups (P < 0.05 - 0.01). CONCLUSION: Local detection of high levels of IL-1 beta, IL-4, IL-6, TNF-alpha and IFN-gamma might be related to the immune augmentation mediated by cytotoxic lymphocytes and cytokines. The dynamic changes of these cytokines might be helpful to the explanation of the bad outcome of xeno-ADMs.