Niessen Frank B, Schalkwijk Joost, Vos Hans, Timens Wim
Department of Plastic Surgery, University Hospital Groningen, The Netherlands.
J Pathol. 2004 Jan;202(1):121-9. doi: 10.1002/path.1502.
The exact pathogenesis of hypertrophic scar and keloid formation is still unknown and a good therapy to prevent or treat these scars is lacking. Because immunological processes seem to be important in excessive scar formation, immunological cells and parameters were studied in a standardized breast reduction wound-healing model in the present study. Standardized scar samples were taken from infra-mammary breast reduction scars, 3 and 12 months following surgery. The samples were investigated for their number of mast cells, Langerhans cells, T-lymphocytes, and macrophages, and the presence of interleukin-4 (IL-4) and counter-regulating interferon-gamma (gamma-IFN), in relation to the scar's clinical appearance--normal or hypertrophic. In this study, hypertrophic scar formation was significantly associated with an increased number of epidermal Langerhans cells (p=0.0001) and significantly (p<0.05) increased expression of epidermal IL-4. No relationship was found between mast cell, T-lymphocyte and macrophage numbers or gamma-IFN staining and the formation of normal or hypertrophic scars. These results, combined with previous observation of abnormal keratinocyte behaviour in this context, indicate that the epidermal immune barrier plays an important role in the development of hypertrophic scars.
增生性瘢痕和瘢痕疙瘩形成的确切发病机制仍不清楚，且缺乏预防或治疗这些瘢痕的有效疗法。由于免疫过程在过度瘢痕形成中似乎很重要，因此在本研究中，我们在标准化的乳房缩小伤口愈合模型中对免疫细胞和参数进行了研究。标准化的瘢痕样本取自乳房下乳房缩小术后3个月和12个月的瘢痕。对样本的肥大细胞、朗格汉斯细胞、T淋巴细胞和巨噬细胞数量，以及白细胞介素-4（IL-4）和反向调节干扰素-γ（γ-IFN）的存在情况进行了研究，并与瘢痕的临床表现——正常或增生性进行了关联分析。在本研究中，增生性瘢痕的形成与表皮朗格汉斯细胞数量增加显著相关（p = 0.0001），且表皮IL-4的表达显著增加（p < 0.05）。肥大细胞、T淋巴细胞和巨噬细胞数量或γ-IFN染色与正常或增生性瘢痕的形成之间未发现关联。这些结果，结合此前在这种情况下对角质形成细胞异常行为的观察，表明表皮免疫屏障在增生性瘢痕的发展中起重要作用。
