真皮模板对深度烧伤患者创面愈合过程中转化生长因子β1及其受体和信号转导蛋白Smad 3表达的影响

目的观察真皮模板对深度烧伤创面愈合过程中转化生长因子(TGF)β1及其受体和信号转导蛋白Smad3表达的影响。方法20例烧伤患者四肢Ⅲ度创面切痂后分为两部分,进行同体对照试验其一移植真皮模板(异体脱细胞真皮基质) 自体刃厚皮片,设为模板干预组;另一部分单纯移植自体刃厚皮片,为对照组。分别在术后1、2、3、4周取患者移植创面组织标本进行免疫组织化学染色,采用图像分析系统测定标本中TGFβ1、TGFβ1受体(TβR)Ⅰ、TβRⅡ及Smad3蛋白的阳性表达率。结果移植术后1—4周两组创面组织切片中均可见TGFβ1、TβRⅠ、TβRⅡ、Smad3蛋白呈阳性表达。随着创面逐渐愈合,四者的阳性表达率均逐渐减少,术后1周模板干预组TGFβ1的表达率为(13.08±4.65)%,4周时为(9.03±1.89)%。相同时相点下模板干预组各项指标的阳性表达率均低于对照组(P<0.05)。结论真皮模板与自体刃厚皮复合移植可降低深度烧伤创面TGFβ1、TβRⅠ、TβRⅡ、Smad3蛋白的表达水平,这可能是真皮模板减轻创面瘢痕增生的机制之一。

The influence of dermal template on the expressions of signal transduction protein Smad 3 and transforming growth factorβ1 and its receptor during wound healing process in patients with deep burns

OBJECTIVE: To investigate the influence of dermal template on the expressions of signal transduction protein Smad 3 and transforming growth factor beta1 and its receptor during wound healing process in patients with deep burns. METHODS: Twenty burn patients with excision of full thickness burn in the extremities were enrolled in the study and divided into two groups, i.e. template interferring group (E, n = 20, grafting of dermal template allogeneic acellular dermal matrix] with razor thin autoskin) and control group (C, n = 20, grafting of razor thin autoskin only). The contralateral side served as the self-control. Tissue samples from the burn wounds were harvested at 1, 2, 3 and 4 post-operative weeks (POW) for immunohistochemistry staining. The positive expression rates of TGF-beta1, TbetaRI, TbetaRII and Smad3 proteins were determined by image analysis system. RESULTS: The positive expressions of TGFbeta1, TbetaRI, TbetaRII and signal transduction protein Smad 3 in the tissue samples in both groups could be identified during 1 approximately 4 POW, and they diminished thereafter with the process of wound healing. The expression rate of TGF-beta1 in E group was (13.08 +/- 4.65)% at 1 POW and (9.03 +/- 1.89)% at 4 POW. The positive expression rate of above indices in E group was obviously lower than that in C group in corresponding time points (P < 0.05). CONCLUSION: The expression levels of TGFbeta1, TbetaRI, TbetaRII and Smad 3 protein in deep burn wounds could be lowered by mixed grafting of dermal template with razor thin autoskin, which might be beneficial in ameliorating of scar hyperplasia in the burn wound.