【摘要】：目的:本研究通過(guò)搜集單純淺靜脈曲張及深靜脈血栓后遺癥患者潰爛的皮膚組織,以免疫組織化學(xué)的方法檢測(cè)白介素-10(Interleukin-10,IL-10)在其中的表達(dá),探討IL-10與靜脈性潰瘍之間的關(guān)系及不同原因形成的靜脈性潰瘍?cè)诎l(fā)病機(jī)制上是否存在差異。比較手術(shù)前后下肢潰瘍皮膚中IL-10的表達(dá),研究雙下肢大隱靜脈高位結(jié)扎+曲張靜脈剝脫+交通支血管縫扎術(shù)在治療下肢靜脈性潰瘍中的治療效果,從而為臨床治療靜脈性潰瘍提供理論依據(jù)。方法:收集25例在我院接受治療的單純性下肢靜脈曲張及21例下肢深靜脈血栓后遺癥(Post-thrombotic syndrome,PTS)患者潰瘍皮膚組織,所有患者均行下肢深靜脈順行造影以了解深靜脈瓣膜功能及血管通暢的情況,并排除動(dòng)脈缺血、糖尿病、感染、淋巴腫及其他自身免疫性疾病。所有患者患肢病變的大隱靜脈均給予剝脫,局部曲張病變血管給予切除,潰瘍處給予縫扎,術(shù)后均給予血管活性藥物應(yīng)用,未使用抗生素。將所取標(biāo)本分為三組,即正常皮膚組、術(shù)前潰瘍組和術(shù)后潰瘍組,術(shù)中取潰瘍區(qū)域四周的皮膚組織作為潰瘍組,淺靜脈高位結(jié)扎開(kāi)口處周圍正常皮膚作為正常對(duì)照組,術(shù)后一周取潰瘍周圍皮膚作為術(shù)后潰瘍標(biāo)本。采用免疫組化的方法來(lái)測(cè)定各組組織標(biāo)本中IL-10的表達(dá)。每個(gè)組織切片都在高倍鏡下隨機(jī)選取3個(gè)視野進(jìn)行觀察,每個(gè)視野中查看100個(gè)細(xì)胞,當(dāng)所取組織細(xì)胞質(zhì)中出現(xiàn)棕色時(shí),即判定這個(gè)細(xì)胞的表達(dá)為陽(yáng)性,按此標(biāo)準(zhǔn),記錄每個(gè)視野中呈陽(yáng)性表達(dá)的細(xì)胞數(shù)量,同時(shí)計(jì)算出陽(yáng)性表達(dá)率,每組切片取三個(gè)視野平均值。所有數(shù)據(jù)以均值±標(biāo)準(zhǔn)差(`x±S)來(lái)表示,數(shù)據(jù)分析SPSS17.0來(lái)處理,兩兩比較用t檢驗(yàn),設(shè)顯著性檢驗(yàn)水準(zhǔn)為α=0.05,P〈0.05視為有顯著性差異。結(jié)果:經(jīng)統(tǒng)計(jì)學(xué)分析,陽(yáng)性表達(dá)的IL-10細(xì)胞在術(shù)前潰瘍組織中比正常皮膚要顯著增加(P〈0.05);術(shù)后一周患者愈合中的潰瘍組織IL-10的表達(dá)要比術(shù)前明顯降低(P0.05);單純淺靜脈曲張患者潰瘍皮膚組織中IL-10的表達(dá)與PTS無(wú)顯著性差異。術(shù)前潰瘍皮膚組織中可見(jiàn)大量胞質(zhì)或胞膜被染成棕色的細(xì)胞,著色較深,呈局灶性分布,主要位于真皮層。其中潰瘍組標(biāo)本的皮膚真皮層中存在了炎性物質(zhì)的聚集,新生的血管較正常組皮膚明顯增多。另外,正常皮膚組的標(biāo)本中同樣散見(jiàn)陽(yáng)性表達(dá)的細(xì)胞,數(shù)量稀少,且染色淺淡。結(jié)論:1.IL-10在靜脈性潰瘍患者皮膚組織中的表達(dá)較正常皮膚明顯升高,說(shuō)明IL-10與靜脈性潰瘍的發(fā)病機(jī)制有密切關(guān)系。2.IL-10在單純大隱靜脈曲張和PTS患者潰瘍皮膚組織中的表達(dá)無(wú)顯著差異,說(shuō)明二者在發(fā)病機(jī)制上相似。3.雙下肢大隱靜脈高位結(jié)扎+曲張靜脈剝脫+交通支靜脈結(jié)扎術(shù)可以使下肢靜脈性潰瘍患者皮膚組織中IL-10的表達(dá)降低,因此可以用IL-10作為評(píng)判術(shù)后療效的指標(biāo)。
[Abstract]:Objective: to investigate the expression of interleukin-10 (IL-10) in patients with superficial varices and deep venous thrombosis sequelae by immunohistochemical method. To explore the relationship between IL-10 and venous ulcers and whether there are differences in pathogenesis of venous ulcers caused by different causes. To compare the expression of IL-10 in the skin of lower extremity ulcer before and after operation, and to study the effect of high ligation of varicose vein of lower extremity on the treatment of venous ulcer of lower extremity. So as to provide a theoretical basis for clinical treatment of venous ulcer. Methods: the skin tissues of 25 patients with simple varices of lower extremity and 21 patients with Post-thrombotic syndrome were collected. All patients underwent anterograde deep vein angiography to understand the valvular function and patency of the deep vein, and to exclude arterial ischemia, diabetes, infection, lymphadenoma and other autoimmune diseases. All patients were treated with exfoliation of saphenous vein, resection of local varicose vessels, suture ligation of ulcer, and vasoactive drugs without antibiotics. The specimens were divided into three groups: normal skin group, preoperative ulcer group and postoperative ulcer group. The skin tissue around the ulcer area was taken as the ulcer group during the operation, and the normal skin around the opening of high ligation of superficial vein was taken as the normal control group. The skin around the ulcer was taken as the ulcer specimen one week after operation. Immunohistochemical method was used to detect the expression of IL-10 in tissues of each group. Each tissue section was randomly selected for observation under a high-power microscope. 100 cells were examined in each field. When brown appeared in the cytoplasm of the tissue, the positive expression of the cell was determined, according to this criterion. The number of positive cells in each field was recorded and the positive expression rate was calculated. All the data were expressed as mean 鹵standard deviation (`x 鹵S), the data were analyzed by SPSS17.0, and compared with each other by t test, the significant test level was set as 偽 0. 05% (P < 0. 05) and the difference was significant (P < 0. 05). Results: by statistical analysis, The positive expression of IL-10 cells in the ulcer tissue was significantly higher than that in the normal skin tissue (P < 0. 05), the expression of IL-10 in the ulcer tissue was significantly lower than that in the preoperation group (P0.05), and the expression of IL-10 in the ulcer skin group of the patients with superficial varicose vein was significantly lower than that in the patients with superficial varicose vein. There was no significant difference between the expression of IL-10 and PTS in weaving. A large number of brown cells were found in the skin tissue of ulcers before operation, which were stained with dark and focal distribution, mainly located in the dermis. In the ulcer group, inflammatory substances were accumulated in the dermis, and the neovascularization was significantly higher than that in the normal skin. In addition, positive cells were also scattered in normal skin group. Conclusion 1. The expression of IL-10 in the skin of patients with venous ulcer was significantly higher than that in normal skin. 2. There was no significant difference in the expression of IL-10 in the skin tissues of patients with varicose great saphenous vein and PTS, which indicated that the pathogenesis of venous ulcer was similar to that of IL-10. The high ligation of varicose vein in both lower extremities can reduce the expression of IL-10 in the skin tissue of patients with venous ulcer of lower extremity, so IL-10 can be used as an index to evaluate the curative effect after operation.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R654.4

【共引文獻(xiàn)】

相關(guān)期刊論文 前2條

1 趙為國(guó);吳良平;戴曉江;王俊;;下肢靜脈性潰瘍的微創(chuàng)治療[J];江西醫(yī)學(xué)院學(xué)報(bào);2009年07期

2 陸黎;鄒君杰;章希煒;;胱抑素C水平與下肢靜脈性潰瘍發(fā)生的相關(guān)性研究[J];南京醫(yī)科大學(xué)學(xué)報(bào)(自然科學(xué)版);2012年07期

，

本文編號(hào)：2182817