解读创面修复"失控"本质,拓宽创面愈合研究视野

正常创面愈合是在损伤因素刺激下机体通过再生或增生方式恢复损伤组织的有序过程,其本质是一种"可控"、适度的生物学行为.多种因素包括外环境因素、全身或局部因素、遗传因素等可能导致机体对创伤修复的生理性"可控"向病理性"失控"演变的临床现象.创面难愈、创伤后的组织进行性损害以及瘢痕过度增生是临床上典型的创面修复"失控"现象.通过对糖尿病合并创面难愈、烧伤创面的进行性损害以及增生性瘢痕形成的机制研究,我们发现:糖尿病代谢紊乱所致皮肤组织中糖含量增高和代谢产物蓄积引起的皮肤微环境改变,是导致糖尿病创面难愈的始动因素之一;烧伤后的组织进行性损害的发生发展取决于"间生态"组织的病理转归;真皮组织缺损导致的模板作用缺失可能是引起增生性瘢痕形成的始动环节.这一系列研究提示:创面愈合"失控"的本质是创面愈合过程不能以可预见的生物学步骤,按时相规律有序地进行组织学和(或)功能性修复,从而引起创面经久不愈、创面加深、瘢痕过度增生并导致功能障碍.相关研究的重点应通过寻找修复"失控"的始动环节并对此干预.

Nature of wound healing with controllable disorder

Normally,wound healing is characterized by a sequence of pathophysiological process in fashions of proliferation and regeneration,which can be described as a highly ordered biological process under control.Environmental alteration,systematical diseases,local pathological changes,heredity,et al,often develop controllable disorder in healing process.The impaired wound healing,progressive injury,and excessive scar formation are three major clinical abnormalities.Our studies indicate that the increased contents of glucose and accumulation of active metabolic intermediates due to metaboic disorder contribute to the cutaneous environmental alterations associated with diabetes mellitus.Thus,the cutaneous environmental alteration is one of the initial events for impaired healing.The succession of progressive injury in deep partial thickness burn wounds is carried out depending on the physiological outcome of parabiotic tissues.The loss of dernal template due to the damage to the integrity and the continuity of dermal tissue may be one of the leading reasons of hyperplastic scar formation.The nature of wound healing with controllable disorder could be described as followed:the healing process could not be carried out according to predictable series of healing events,which fail to reconstitute histologically or functionally in timely and orderly fashions,thus result in the occurrence of delayed healing or nonhealing wound,progressive injury,excessive scar formation,and function disorder as well.The related research should focus on the initial event of controllable disorder in wound healing,and therefore contribute to providing the treatment depending on these approaches.