目的探讨分期疗法对慢性下肢静脉性溃疡(chronic venous leg ulcer,CVLU)的治疗效果。方法本院2011-09～2012-03共收治22例下肢CVLU,均采用分期疗法,观察治疗效果和溃疡愈合及复发情况。结果 22例中除1例伴髂静脉受压综合征经一期治疗2...目的探讨分期疗法对慢性下肢静脉性溃疡(chronic venous leg ulcer,CVLU)的治疗效果。方法本院2011-09～2012-03共收治22例下肢CVLU,均采用分期疗法,观察治疗效果和溃疡愈合及复发情况。结果 22例中除1例伴髂静脉受压综合征经一期治疗2周无效而放弃,21例溃疡愈合,曲张静脉消失(95.5%,21/22)。于治疗后1月和3月复诊,彩色超声显示:12例深静脉返流患者,7例(58.3%)返流消失,5例(41.7%)返流明显减轻;8例下肢皮肤色素沉着明显减轻(38.1%,8/21)。结论分期疗法是治疗CVLU的可行性手段。展开更多
The role of endogenously produced cytokines and growth factors in the impaired healing of chronic leg ulcers remains uncertain. The aim of this study was to d etermine the functional capacity of skin cells in ulcer be...The role of endogenously produced cytokines and growth factors in the impaired healing of chronic leg ulcers remains uncertain. The aim of this study was to d etermine the functional capacity of skin cells in ulcer bed tissue compared to t hose in the edge of ulcers and skin distal to ulcers. Biopsies from leg ulcers o f ten randomly selected patients were examined immunohistochemically for cytokin es and growth factors produced by keratinocytes (KC) and vascular endothelial ce lls (EC). The phenotype of leukocytes infiltrating venous ulcers and the express ion of vascular adhesion molecules responsible for extravasation were also studi ed. The expression of cytokines and growth factors by KC was similar in areas ad jacent and remote from an ulcer. In the dermis adjacent to an ulcer, the express ion of IL-1α,IL-1β,IL-1Ra, EGF and PDGFa by EC was higher than the levels o f expression in EC from the distant dermis. The expression of IL-6, TNFαand GM -CSF was comparable to that in cells from intact dermis. For all these factors staining was cytoplasmic, suggesting production in these areas. Ulcer bed tissue contained few fibroblasts and blood capillaries showing a high staining intensi ty for CD62E and CD106 EC adhesion molecules but no FGF2 expression (P < 0.05). The intensity of staining for scavenging CD15+elastase+granulocytes and CD35+ (C3bR) activated macrophages in the ulcer bed was comparable to that in the margin but higher than that in thedistantdermis(P < 0.05),whereasstainingforCD68+,HLA DR+,TGFβ+and CD54+dermal macrophages was similar in all areas. There was reduced staining for CD4+and CD8+cells in the ulcer bed (P < 0.05). There were no CD1a+Langerhans cells in the epidermis encr oaching upon the granulation tissue and there was reduced CD1a staining in the a djacent epidermis (P < 0.05). In conclusion, there is chronic accumulation of sc avenging cells with lack of remodeling of the granulation tissue and, at the sam e time, preserved cytokine and growth factor secretory potential of KC and derma展开更多
文摘目的探讨分期疗法对慢性下肢静脉性溃疡(chronic venous leg ulcer,CVLU)的治疗效果。方法本院2011-09～2012-03共收治22例下肢CVLU,均采用分期疗法,观察治疗效果和溃疡愈合及复发情况。结果 22例中除1例伴髂静脉受压综合征经一期治疗2周无效而放弃,21例溃疡愈合,曲张静脉消失(95.5%,21/22)。于治疗后1月和3月复诊,彩色超声显示:12例深静脉返流患者,7例(58.3%)返流消失,5例(41.7%)返流明显减轻;8例下肢皮肤色素沉着明显减轻(38.1%,8/21)。结论分期疗法是治疗CVLU的可行性手段。
文摘The role of endogenously produced cytokines and growth factors in the impaired healing of chronic leg ulcers remains uncertain. The aim of this study was to d etermine the functional capacity of skin cells in ulcer bed tissue compared to t hose in the edge of ulcers and skin distal to ulcers. Biopsies from leg ulcers o f ten randomly selected patients were examined immunohistochemically for cytokin es and growth factors produced by keratinocytes (KC) and vascular endothelial ce lls (EC). The phenotype of leukocytes infiltrating venous ulcers and the express ion of vascular adhesion molecules responsible for extravasation were also studi ed. The expression of cytokines and growth factors by KC was similar in areas ad jacent and remote from an ulcer. In the dermis adjacent to an ulcer, the express ion of IL-1α,IL-1β,IL-1Ra, EGF and PDGFa by EC was higher than the levels o f expression in EC from the distant dermis. The expression of IL-6, TNFαand GM -CSF was comparable to that in cells from intact dermis. For all these factors staining was cytoplasmic, suggesting production in these areas. Ulcer bed tissue contained few fibroblasts and blood capillaries showing a high staining intensi ty for CD62E and CD106 EC adhesion molecules but no FGF2 expression (P < 0.05). The intensity of staining for scavenging CD15+elastase+granulocytes and CD35+ (C3bR) activated macrophages in the ulcer bed was comparable to that in the margin but higher than that in thedistantdermis(P < 0.05),whereasstainingforCD68+,HLA DR+,TGFβ+and CD54+dermal macrophages was similar in all areas. There was reduced staining for CD4+and CD8+cells in the ulcer bed (P < 0.05). There were no CD1a+Langerhans cells in the epidermis encr oaching upon the granulation tissue and there was reduced CD1a staining in the a djacent epidermis (P < 0.05). In conclusion, there is chronic accumulation of sc avenging cells with lack of remodeling of the granulation tissue and, at the sam e time, preserved cytokine and growth factor secretory potential of KC and derma
