不同取皮法对白癜风自体移植表皮角质形成细胞的影响

目的 探讨负压吸疱和切削取皮对移植表皮角质形成细胞生理状态的影响。方法 免疫组化法检测32例稳定期白癜风患者两种取皮法获得的自体表皮PCNA和Caspase-3的表达情况。 结果 32例白癜风患者两种方法所取正常表皮组织皆有不同程度的PCNA表达，发疱所获表皮阳性细胞多灶状分布于基底层，切削所取表皮少数阳性细胞还见于棘层中下部，切削取皮与发疱取皮总的阳性表达率比较差异有统计学意义（χ2 = 10.99，P ＜ 0.05），切削取皮与正常人对照比较差异无统计学意义（χ2 = 1.31，P ＞ 0.05），而发疱取皮与正常人对照的表达差异有统计学意义（χ2 = 14.08，P ＜ 0.05）。32例白癜风患者两种方法所取皮肤组织切片皆见Caspase-3表达，主要见于基底层及棘层中下部的角质形成细胞的胞质，两两比较发现患者切削取皮、发疱取皮与正常人对照组总的阳性表达率差异无统计学意义（χ2 = 1.41、2.89、1.91，P ＞ 0.05）。结论 表皮细胞增殖功能对移植表皮的成活可能有重要的作用，切削取皮较吸疱取皮对角质形成细胞的增殖功能影响小。

Effects of different skin sampling methods on autologous epidermal keratinocytes transplanted to patients with vitiligo

Objective To compare the effects of two skin sampling methods (negative pressure suction blister and skin shaving) on the physical status of autologous epidermal keratinocytes transplanted to patients with vitiligo. Methods Skin samples were obtained from the normal skin of 32 patients with stable vitiligo by suction blister under negative pressure and skin shaving alone or in combination. Immunohistochemistry was performed to examine the expression of proliferating cell nuclear antigen (PCNA) and caspase-3 in these samples.Skin tissues resected from 15 normal human subjects served as the control. Results There was an expression of PCNA and caspase-3 at different degrees in all the skin tissues obtained by the two sampling methods from the 32 patients. Most PCNA-positive cells were focally distributed at the basal layer in epidermis obtained from suction blisters, and a few PCNA-positive cells were observed in the middle and lower part of the prickle cell layer of epidermis from shaved skin. There was a significant difference in the percentage of PCNA-positive cells between the epidermis from suction blisters and shaved skin as well as between the epidermis from suction blisters and normal control skin (x2 = 10.99, 14.08, both P < 0.05), but not between the epidermis from shaved skin and normal control skin (x2 = 1.31, P > 0.05). The expression of caspase-3 was predominantly located in the cytoplasm of keratinocytes in the basal layer as well as middle and lower part of prick cell layer, and no difference was observed in the percentage of caspase-3-expressing keratinocytes between the epidermis from shaved skin, suction blisters and normal control skin (x2 = 1.41, 2.89, 1.91, all P > 0.05). Conclusions The proliferation activity of epidermal cells seems important to the survival of grafted skin, and compared to the suction blister technique, skin shaving appears to have less influence on the proliferation of keratinocytes.