School of Nursing, Wenzhou Medical College, Wenzhou, Zhejiang Province, People's Republic of China.
J Wound Ostomy Continence Nurs. 2012 Jul-Aug;39(4):391-6. doi: 10.1097/WON.0b013e318259c47e.
The purpose of this study was to explore the expression of apoptotic factors in stage III pressure ulcers and explain their effects on wound healing.
The sample comprised 8 patients with stage III pressure ulcers, along with 4 volunteers with normal skin who were undergoing elective surgical procedures.
Eight patient tissue specimens from wound of stage III pressure ulcers were obtained from hospitalized patients. Tissue specimens from 4 volunteer patients were obtained during surgery. All 12 tissue specimens were analyzed for presence of apoptosis-related factors including bax/bcl-2 (B-cell lymphoma 2), Fas/fasL (Fas ligand), and terminal deoxynucleotide transferase-mediated dUTP nick end labeling (TUNEL) as well as immunohistochemical analysis with Fas/FasL.
Bax positive cells were strongly expressed from surrounding zone to center zone in the specimens obtained from stage III pressure ulcers, and Bcl-2 expression staining decreased contrarily (P < .01). Comparison, apoptotic factors bax positive cell and fas/fasL mRNA expression occurred rarely in tissue specimens from the control group. Fas/fasL mRNA-positive granules were detected in epidermal cells and fibroblasts, demonstrating a progressive increase from the margin of the pressure ulcers progressing toward the center of the wound bed. We also found an increased intensity of TUNEL staining in ulcer center as well as wound margin, compared with control skin tissue.
These results suggest that molecular regulators of apoptosis are involved in pressure ulcer wound healing. Results also suggest that differences in the expression and distribution of the apoptotic related factors in stage III pressure ulcers play an important role in the delayed wound healing characteristic of these complex wounds.
本研究旨在探讨凋亡因子在 III 期压疮中的表达，并解释其对创面愈合的影响。
样本包括 8 例 III 期压疮患者，以及 4 例因选择性手术而接受治疗的正常皮肤志愿者。
从住院患者的 III 期压疮创面获得 8 例患者组织标本，从 4 例志愿者患者手术中获得组织标本。对所有 12 个组织标本进行凋亡相关因子（包括 bax/bcl-2（B 细胞淋巴瘤 2）、Fas/fasL（Fas 配体）和末端脱氧核苷酸转移酶介导的 dUTP 缺口末端标记（TUNEL））的存在进行分析，并进行 Fas/FasL 的免疫组织化学分析。
从 III 期压疮标本中获得的组织中，Bax 阳性细胞从周围区域到中心区域强烈表达，而 Bcl-2 表达染色则相反（P <.01）。相比之下，对照组组织标本中很少出现凋亡因子 bax 阳性细胞和 fas/fasL mRNA 表达。Fas/fasL mRNA 阳性颗粒在表皮细胞和成纤维细胞中被检测到，从压疮边缘向创床中心呈渐进性增加。我们还发现，与对照皮肤组织相比，溃疡中心和创缘的 TUNEL 染色强度增加。
这些结果表明，凋亡的分子调节剂参与压疮创面愈合。结果还表明，III 期压疮中凋亡相关因子的表达和分布差异在这些复杂创面的延迟愈合特征中发挥重要作用。
