Salameh J R, Talbott Ladawn M, May Warren, Gosheh Bashar, Vig Parminder J S, McDaniel D Olga
Departments of Surgery, University of Mississippi Medical Center, Jackson, Mississippi, USA.
Am Surg. 2007 Jun;73(6):561-7; discussion 567-8.
Incisional hernias represent one of the most common complications of laparotomies. Previous investigations have suggested that a disorder in collagen fiber structure and production level may be an important pathologic cause of abdominal wall hernias. We hypothesized that a cross-examination of multiple extracellular matrix biomarkers might identify underlying defects contributing to the development of hernias. We examined two patient populations: patients with incisional hernias (presenting for hernia repair) and patients with no hernia after previous laparotomy (undergoing a second laparotomy). Patients with previous wound infections, open abdomens, or on steroids were excluded. Fascia samples were obtained from all patients at the time of their second operation and they were studied. Western blots and reverse transcriptase-polymerase chain reaction were used to determine the ratio of type I, III, and IV collagens, as well as matrix metalloproteinase 1 (MMP1) and MMP2 in both groups. Values of P < 0.05 were considered statistically significant. At the protein level, collagen I/III ratio was slightly decreased in patients with incisional hernias compared with those with no hernia, whereas it was significantly decreased at the mRNA transcript level (0.49 vs 1.03, P < 0.01, respectively). The MMP-1 mRNA transcripts were not different in incisional hernia (IH) versus nonincisional hernia, but the MMP-2 level was significantly increased in patients with IH. Reduced collagen I/III and MMP-1/MMP-2 ratios in IH might be consequence of the biological activities between key elements participating in the development of IH after laparotomies. The potential role of MMP-2-specific inhibitors in preventing IH is of significance for future studies.
切口疝是剖腹手术最常见的并发症之一。先前的研究表明，胶原纤维结构和产生水平的紊乱可能是腹壁疝的一个重要病理原因。我们推测，对多种细胞外基质生物标志物进行交叉检查可能会发现导致疝形成的潜在缺陷。我们检查了两组患者：切口疝患者（前来进行疝修补术）和先前剖腹手术后无疝的患者（接受二次剖腹手术）。排除有既往伤口感染、开放性腹部或正在使用类固醇的患者。在所有患者进行二次手术时获取筋膜样本并进行研究。使用蛋白质印迹法和逆转录聚合酶链反应来测定两组中I型、III型和IV型胶原蛋白以及基质金属蛋白酶1（MMP1）和MMP2的比例。P值<0.05被认为具有统计学意义。在蛋白质水平上，与无疝患者相比，切口疝患者的胶原蛋白I/III比例略有降低，而在mRNA转录水平上则显著降低（分别为0.49对1.03，P<0.01）。切口疝（IH）患者与非切口疝患者的MMP-1 mRNA转录本无差异，但IH患者的MMP-2水平显著升高。IH中胶原蛋白I/III和MMP-1/MMP-2比例的降低可能是剖腹手术后参与IH形成的关键因素之间生物学活性的结果。MMP-2特异性抑制剂在预防IH方面的潜在作用对未来研究具有重要意义。
