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۷ν
T-MAC     Դվ     ʱ2006-02-22 17:36:15

۷ν  

Ԫ[ϸ]

---------------------------------------------

1 ۵ĸ

    ۣscar) Ǵ޸ıȻ漰Ƥ˿ڼ϶˿ڵȻϹ3ֻһ˿ѿ֯˿ڣDZƤǴѿ֯ҪСѪܺͳάϸȳɷֹ쳣ԭתΪ֯-ʵϾ""˿Ϻ󲻻߳Ƥ԰۳֮Ϊ""normal scar)˿Ϲг쳣ѿ֯еijάϸֳֹͣҷڽԭϸʵҲ˿߳Ƥָ֢״빦ܵϰ""쳣ۣabnormal scar

    ۵ķ鿯Ųͬ۸ήdz״״۵ȵӲѧϽ(scar)ֻΪ(normal scar)ۣabnormal scarࣻҪ(hypertrophic scar, HS)۸(keloid, K)ٴǶΪƷѡԼΪǰᵽĸ۵䱾ƤάеһǴ޸а I III ͽԭڵϸʳɷ֯йȳԱջܵIJ״̬

2 ۷Ļ

    ΪôһЧӶԼ򵥻شǿԴӶǶȽзȥѰҴ

2.1 ɫ

    ͳƲ۵ķΪ 5-15%;˿ڲ۵ķ39-68%; ˺䷢ɸߴ33-91%ɫֲ۵ķΪ˵ 5-10۸ķʺܸߣɫdz䷢ʽں֮

2.2Ŵ

    McCarthyһֱõһƬʾһ弸ͬĶλdzƵ۸񲡱ǵĸĸҲƵIJ״ѧֵͨ 4 K߼ϵ 4 99Ա28Kʷռ28.2%,ΪdzȾɫŴһֿΪŴԹϵ

2.3

    ഺڷ۵ĿԶˣŮڷۻӣijЩ˸ڲԴ?quot;"ΪҪʹ""ؽΪ

2.4 鼰ˮƽ

    Щλ˺۵ĿҪСһЩǰֳԼŲճĤȴ۸÷ڶعǰ֫Ǽͼ米Ȳλ˳̶Ҳγɵij̶й II ˺HS̶III ˸Ƚ˿̶ȽĴˮƽ벡еĹϵпѡ˳ƤƵϵĵ᣻Ƥƴֱп۷ĿвĴֱ˿ڻ֯IJпڹķʹùֵķٵIJߵȶܴٽ˿ǼҪDeitch ͳ10۷Ϊ0~6%10~14Ϊ 4~19% 15~21Ϊ30~35%˿ʱ䳬21۷ߴ50~83%

2.5

    ˺ϸʾ۲ָЧӦϵеҪTGF-β,bFGF,PDGF,IGF-1

2.6 ߼ڷ

    бHSѪҺ EK߱HSиߵı̬ӦѪIg MIg GIg A½ K׷ഺŮڼԭе۲֢״ԱøֿɻŮԵ򲻷оƼйҲѧ߷غۻKغؽΪ߱

2.7

    ijЩְصонʾ۷صĿҴӻˮƽȥѰβ۵ĸԵĴʩҲǴϣģ

3 ۸

    ٴϿHSK1)λIJȫλܷHSKһĺ÷-عǰǼ米򤲿ȣ2) HSг˵۸һ㲻ˣ3)ѹƷHSЧ KЧ4)֯ƬHS н϶״ṹ KֽṹѧHSK϶ԳάϸһЩо  Ag NORs γȾɫֲⷢ Ag NORs ֵƤ KеֵָHS,ʾ۸FBFBиǿֳ PCNA(ֳϸ˿ԭ)ⷢHSKάϸܶȴƤ,KFBֳִܶHS,ǹKԿƵĻATP()HSKATPֵƤHSڻԾATPֵƽϢ۵ijATPֵ½۸иˮƽATP ֵһֱάбATPֵ10δʾ۸гֳ˵FBڽԭHSFBƤFB6~7KFBΪ20

4.۵ҩ

    ڷ۵ҩdz֮Ҫ

4.1Ƥʼ

    ٴϳ۵Ƽȥ-A(Triamcinolone Acetonide)εƼע䵽֯ͨʹFBmRNAµֹFBֳFBĽԭϳϸʲͬʱɼ֢Ӧ۵ʹTGF-βIGF-1ȴӼ٣һȥ-A ʹԭøƼ-α򵰰׼ʹøٽԭĽȥAÿ10~40mg Ϊֶע֯ÿһ4~8ΪһƳַСKЧҽָӦⲻӦеĸЧӦֲƤήɫؼ˻ɫëϸѪƤγɵȣȫӦѪѹ񴩿׻շֿ̥ۺ

4.2άҩ

    ܴٽƤϸʹ۵FBǰԭٽԭϳʹFBDNAϳɼ,ֲ֢в

4.3˾أtranilast𰱻ᣩ

    H1֯׿Ʒʴϸͷ֯FBֳ˾KʱҪһ200mg,3/ðϲЧ͸뷨˾͸ԼᲡ˵ʹ֢״ڿڷ

4.4(verapamil)

    һֿʧҩ-ͨƼ˳άϸ׺ϳLeeȽ첫֯,0.1~0.5mMOL/Lֲע , 3עһ, 3 Ч

4.5(Interferon,IFN)

    IFN-αβγFBֳƽԭϳĸǻøƽԭݼԭøٽԭӦIFN-αIFN-γԽͳάϸͽԭmRNAˮƽ,FBbFGFƽԭϳ, ֹ GransteinIFN-γע10K,Ϊ0.1mg0.01mg/,3 / , 8 6С

4.6 ҽҩ

    ڷͨƬԽԭϳЧӦúڲҶѻȾһЧ
Ϊʾҩ۵ĻǶԵνʵоٴ۲ֵõķͨ:ٶFBЧӦ, οʹFBα,ͷڽԭ;ڵεĻѪʹ֯ѪҺѭ,ȱأͨӳ绯ø(SOD)ĻɻɻĴЧӦõƵĿྭٴ۲ȡõЧڷ۵ҩؼ ,ù,һ谷,ˮɼ, 5 ,,࿨

5.۵ѹƷ

    ѹƷͨʩѹʹֲѪFBԸıԭھ½FBƤϸѹƷʹԭøӣα򵰰׼ԭøǿɽԭԭֽﵽĿѹƷҪʵЧһҪڿܳIJ˻ڴƤ󼴿ʼҪڼѹƷ֣ʱÿͣϢʱòҪ30϶Чؽѹ(rebond hypertrophy)Ҫ㹻ʶȵѹ԰ʽ"ѹ"ʧܵҪԭ

6.ĤеӦ

    ȸݹзЧԹ͹轺( NSGS) и첢ûʵоٴ,ù轺ĤԵڶ,֯ڢǰԭ,͸,άϸڽԭĹ,ԭЧ

ڹĤ۵Ļѧ"ˮ"ѧ˵轺Ĥʹˮ,ƤˮתƵʲ,ʹˮԵ׼ͷˮԻɢ,ˮʼ,ѧѹ½,֯ĿǰĹƷ۵Уcica-care)ٴʹù轺ĤʱҪ벡ÿʱԽԽ 2~ 3ϲſɲЧ

7.

    ߿ƻFBHSKĽԭӰϸʻıҲʹ֯ϸdzHSKɲһЧֻHS, KΪ32P۴, ͨͷβʹFBֹͣ90(90Sr)ųĸβ߿һĸɫسֲɦоϰʹȻӦã𰩱⻹ҪӣRiutableԼӦ÷۰37ڱ 6۰һСȶë֢УһŽǻ֢У

8.۵ļ

    ĹⲨΪʹ̻֯֯ЧӦND-YAG⣨ʯʯ⣩ʹ۳άϸ(FB) , ٴЧΪ80%Alster 585nmȾϼ14(HS),ЧΪ83%ⲻڴ۵ͼ˲ĸֲΧ֯ʹԭάƽ˳Ч

9.Ʒ۷еǰ

    Ʒͨת򷽷Ŵʵij໼ߵضϸʹԲȱʧʧȥܵĵijֻıﵽƼĿͨDz鵼Ͳ鵼;лת

    Nirenberg1967,ĿǰҪŴԼͶпչ,ԺɫӦƤҲ׽ܻתƵİƤƤϸڻȡ,ת,ҲװתȾϸֲƤ,ǿչƵĺӻתȾϸFB,ʹӴ,Դγɹ̷Ӱ,ﵽٽ۲ЧFBԴḻڱ鵼ĻתȾֲ󲻱ų֮FBٷֻ˻ͻıײǻƺܺõİFB"ɱ"ӻˮƽFBڽԭĹӻˮƽHS,Kǿܵ

10.۵

    ȻHSKҪֶԲ䶼ҪҲһ۲ʺӰ칦ƻòжԱܵ۲ƣ䲻ΧҪгۣ¶λߣҲгˮƽIJһЩԭΪҪƵ۲-ƩDZ¶λС-ҲҪгݽǶҲǿеģڷǹDZ¶λĴHSԳµĴƬΪ۽Ͳȷѡ

    ԲʱһHSڴ˺6~8ܿʼֳ3~6ǽԭĸ߷Ȼ۽ȶ 1ԺʼһҲܻ~ĸ߷շĿԭӦѡȶڽһΪ 1ƱȽϺijЩӰ칦ܲλIJⷭڽб򤾱ճצؽ˼

11, о½չ

11.1 ϸ

    ϸ(apoptosis)ϸ(necrosis) ͬǻΪάڻȶɻƵϸûµȻ?quot;ϸ"(programmed cell death, PCD)ϸΪСȾɫܼں˱߳ʰ߿״ĤϸֽС԰Ĥγɵ͵ĵлС壻Ӿϳ"ݴ"ʽϸϳĵϸάֻƽⷽdzҪķϸƵϰFBPCDϰǵ³άϸ(FB)ֳڹĽԭϸΪ۷Ҫ

    Ishiharaceramide)յƤFBPCD40mM Ƽ KFB12СʱKFBĴϸΪ66.8%,FBֻ9.6% ʾKFBжԿĴٵЧӦwestern blotting ӽⷢKFBȵ-1IGF-1ȱFBΪԴIGF-1 ǿKFBյоʾKFBIGF-1ĸ߱˿PCDЧӦʹFBֳKķLadin 20 Kʯ걾KFBͻP53Ϊ18/20Bcl-2 Ϊ19/20 6KFBP53Bcl-2Ϳɳ10˵FBΪʾͻP53Bcl-2 KϸƵлK

ҿHS걾öģ۲֤FBĵǴٳ۳˵ڻ ǽöģ۲FBĶ̬仯öij̶巢ֵԽֵԽγɵHSԽԣ֮ԽֵԽHSԽ۳ʱԽڴģTGF-β1иźFBIFN-γѸٳִFB֤ TGF-β1IFN-γڷӴٽЧӦʱFBĻưҪɫ

11.2 ϸźŴϵͳ

    ϸźŴcell signal transduction) ָϸݼضʽͨϸĤϸźŷӵյø빹ĸıữȥữת¼»ıѧЧӦӰϸֳֻ𤸽ʺϳɹܵһϵеԵĹ

    Chin 3K3Ƥ걾FBоKFBҰữԸҲKEGFRƤ壩DDR1(״ṹ1Shcĸ߱ҰἤøڿϸֻлϸǨҪźŴеĹؼɷϺҰἤøữźŷҰữˮƽߵKFBзֵıƤ壨EGFRڶϸϸ170KDa ǵEGF弤лԵҰἤøEGF˿ԴɴٽԭǸ͸IJEGFPữźųᵼϸ⽺ԭǰǶѻΪ۸EGFRĸ߱ữļǿ۸֮һDDRIһµĽԭ͵ĽԭDDR1Ұữˮƽͨڽԭ-άϸźϵͳӰ۸ķչShcҰἤøֱӵ书ǽźϵͳηٽ۸нԭ

    ۸EGFRDDR1Shcĸ߱ữˮƽڻҿѡܵ32P﷨ⶨPKA׼øAԣ3H-뷨ͷ߷ⶨHSFBFBTGF-β1FBֳԭϳɼźͨ·֤ʵcAMP/PKAͨļתTGF-β1ڳάϸĴֳٽԭڵûcAMPRaf-1cAMP/PKAܴٽϸķֻٽϸPKAʹϸͣϸڵG1-G2TGF-β1HSFBֳPKAԽ˵йcAMP/PKAͨ·ļƻֹ۵Ĺͨ·ʹcAMP/PKAԵҩ簱ݱͪɿɼPTXβͼԤ

11.3 TGF-βо

    תβ(TGF-β) ǴٽǿĶTGF-β1,2γ,TGF-β3 Բȡ;ԿTGF-β1,2ֹ۵ЧӦ: TGF- β1 ,2TGF;TGF-β3׿TGF-β1,2 ; õ׾Biglycan,DecrinTGF-β,;ԴTGF- β׿TGF-β; ÷ѺTGF-βĻ; ƤʼضԿTGF-β1,2

    ԺֳPCMV4-hTGF-β1ԴϼγеǽӺĿĻֱעʹԴϸڳȶرշȫⷴӦ߲ôII0ģֱڴӦ TGF-β1кͿԼû鼼PCMV4-h TGF-β1DNAע TGF-β1ɼӿƤǨٶСϿкͿԿ TGF-β1ЧӦעPCMV4-h TGF-β1ǰ 2IͽԭI/IIIͽԭ½ע 1ܺѪTFG-β1кͿ忪ʼ 3ֵܺTGF-β1ܼӿ˿ܿƽԭĹȺϳӶЧӦ TGF-β1DNAϸܿƤΪֿԭֲݼϵͳ TGF-β1

11.4͸ݼӣHASF۳άϸѧõʵо

    ̥˿гڸŨȵ͸ᣨHAϵҪHAij̥˿ѪҺˮд͸ݼӣHASFҿѡ˺ 2֢״HSFB20~25õˮȡHASFFBзֱ벻ͬŨȵHASFȻ3H-TdRMTTFBֳй۲죻FBԭϳɼIIIǰԭϳɽвⶨⶨҺеøLDHHASFHSFBֳЧӦмЧӦϵHASFHSFBԭϳһΧҲӶǿHASFݼFBϳHAͬЧϵ LDHHASFͨHSFBĶԶ

HḀϺͶԳ궯ĻʹγһϵĻ1)HAڷʹϸδֻ״̬˺ٽδֻϸֳǨطֻΪFBغϳʣ2) HAʹԭάֱϸ3) HAкǿˮнĸΧγɴɵȰ̥˿γɷɢˮڵԵĽԭ֯4) HAϸϸܰϸǨƾϸϸɻֹܰϸͷǰӶ̥ԷӦĿǰHAۼἡؽճٴӦõı

11.5۶ʵģ͵̽

    ۶ʵģǴ޸оشͳΪ岻ܲȨԵͬϿ?quot;ڲԭ۸ֻͼ۵Ķģδܳɹ""ڴ޸ʵодڵҪȱ쳣γɵĶģﴴ˵Ĵעʺ۵ijδʺ"δɶIJ۶ģؽӰоǰйоͨ;ȡһͨٴʵܽᾭ飻ͨȡԲ˵֯йоFBйоĿǰΪеоپǽಡ֯()Ƥųͼ۲۵йر仯ЩоʮҪϾɶʵģΪѧһֱΪѰģͶŬ̽1951йHSKڶϵıȻδܾظ֤1987MorrisöļԴϷƤǴ1998Ⱥ47ֻõ˫԰εȫƤȱ湲400԰δƤƽ20죩ʼ¡ƤڳʵɫƤ20-25߷߶ΪȫƤȵ3-4ʱΪ150԰δΪ70%δƤʱΪ50鷢80%άʱѳ262ѡͬʱгǵģʽгӰƤڶ԰δ鷢ʵ߶ȲԽ䷢Խ֤ʵöԲHS淢ʸ淢ָ԰δƲö淢ֲṹйöȱеĤṹõɸСȵĴ˿κβ۸ıһԵĤԽĤԽṹ븹Ƥ˿Խ۷Խʴ԰С봴Խ۷ԽߵĽȫǺΪ֤ʵöHSǴӶ෽֤֯ƬΪƤǴֳFBԭֲˮƽdz״ڽ״ԵĽṹFBΪ˺ԽԭΪHS𽥷չı仯һ˿ƤǰԭڴеıTʧHSǿʾԭγHSĻǷöнԭṹҲöнԭȳرǢͽеTGF-β1йʵԴTGF-β1ǰԭǿҲ֤ʵһڴעԴTGF-β1 IFN-γ֤ʵTGF-β1ɴIFN-γHSķӦһTGF-β1дٽ I ǰԭmRNAЧöԴTFG-β1 mRNAҲ˵HS һµ

    ǻôģͶ۷չеϸ˶̬۲ò˵IJ۵ı걾Խж̬۲ôģȫ̶̬۲ϸıǨClarkָƤ˿һƤ˿ֹͣͽ;DesmouliereڴƤ˿ģй۲쵽˿һ15ѿ֯FBĵ16-20Ŵ߷(151)Ƿö˿Ƥƽ20죩Ӧųֵĵ߷Ƴٵ60ųڴ֮ǰFBFBֳTGF-β1յͬʱFBһƳٵ80ųIFN-γעռѸٷֵIFN-γЧӦһµʾFB߷ԽֵԽԽƽ֮߷ԽֵԽԽ

ʵ֤öԲHSṹ״ƵôģͿԶ۽ж̬۲ģ͵ȷ۵оӰ!

 

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