Pascarella Luigi, Schönbein Geert W Schmid, Bergan John J
Department of Bioengineering, Whitaker Institute of Biomedical Engineering, Jacobs School of Engineering, University of California San Diego, La Jolla, CA, USA.
Ann Vasc Surg. 2005 Nov;19(6):921-7. doi: 10.1007/s10016-005-7661-3.
Recent histological and immunocytochemical analyses of venous leg ulcers suggest that lesions observed in the different stages of chronic venous insufficiency (CVI) may be related to an inflammatory process. This inflammatory process leads to fibrosclerotic remodeling of the skin and then to ulceration. The vascular network of the most superficial layers of the skin appears to be the target of the inflammatory reaction. Hemodynamic forces such as venous hypertension, circulatory stasis, and modified conditions of shear stress appear to play an important role in an inflammatory reaction accompanied by leukocyte activation which clinically leads to CVI: venous dermatitis and venous ulceration. The leukocyte activation is accompanied by the expression of integrins and by synthesis and release of many inflammatory molecules, including proteolytic enzymes, leukotrienes, prostaglandin, bradykinin, free oxygen radicals, cytokines, and possibly other classes of inflammatory mediators. The inflammatory reaction perpetuates itself, leading to liposclerotic skin and subcutaneous tissue remodeling. In light of the mechanisms of venous ulcer formation cited above, therapy in the future might be directed against leukocyte activation in order to diminish the magnitude of the inflammatory response. With this in mind, the attention of many investigators has been drawn to two different drugs with an anti-inflammatory effect: pentoxifylline and flavonoids.
近期对下肢静脉溃疡的组织学和免疫细胞化学分析表明，在慢性静脉功能不全（CVI）不同阶段观察到的病变可能与炎症过程有关。这种炎症过程会导致皮肤发生纤维硬化重塑，进而引发溃疡。皮肤最表层的血管网络似乎是炎症反应的靶点。诸如静脉高压、循环淤滞以及剪切应力改变等血流动力学因素，在伴有白细胞活化的炎症反应中似乎起着重要作用，而这种炎症反应在临床上会导致CVI：静脉性皮炎和静脉溃疡。白细胞活化伴随着整合素的表达以及多种炎症分子的合成与释放，这些炎症分子包括蛋白水解酶、白三烯、前列腺素、缓激肽、游离氧自由基、细胞因子以及可能的其他类别的炎症介质。炎症反应持续存在，导致脂肪硬化性皮肤和皮下组织重塑。鉴于上述静脉溃疡形成的机制，未来的治疗可能针对白细胞活化，以减轻炎症反应的程度。考虑到这一点，许多研究者的注意力已转向两种具有抗炎作用的不同药物：己酮可可碱和类黄酮。
