Stewart Tara Lynn, Ball Brandon, Schembri Paul J, Hori Keijiro, Ding Jie, Shankowsky Heather A, Tredget Edward E
From the Department of Surgery, University of Alberta, Edmonton, Canada.
J Burn Care Res. 2012 Nov-Dec;33(6):764-71. doi: 10.1097/BCR.0b013e318257db36.
Hypertrophic scarring (HTS) is a fibroproliferative disorder that commonly develops after severe burn injuries. Overexpression of transforming growth factor-β (TGF-β) by an increased number of fibrocytes has been associated with increased extracellular matrix molecule expression leading to HTS. The most widely accepted adjuvant to clinical assessment of burn depth is laser Doppler imaging (LDI) and may predict injury to the dermis that corresponds to cellular and molecular changes associated with HTS. A prospective, blinded, control trial was performed comparing LDI and clinical assessment for the decision to operate. Immunohistochemistry and real-time reverse transcription polymerase chain reaction was performed to determine whether there is a correlation between histological assessment of burn depth and LDI, and the presence of fibrocytes was detected using confocal microscopy. The positive predictive value for a burn requiring a graft was calculated to be >90%. Immunohistochemistry on biopsy samples revealed an increased expression of TGF-β, connective tissue growth factor, heat shock protein 47, and collagen type I in deep burn wounds compared to superficial burns. Using the fibrocyte-specific markers procollagen type I and lymphocyte-specific protein-1, there was an increased number of fibrocytes in deep burn areas compared to superficial burn. In deep burn injuries, increased infiltration of fibrocytes occurs leading to an overexpression of TGF-β1 and connective tissue growth factor. More importantly, LDI was >90% accurate at predicting the need for excision and grafting. The accuracy of the decision to debride deep dermal burns to avoid HTS using both clinical parameters and LDI was supported by histological and biochemical measurements.
肥厚性瘢痕（HTS）是一种纤维增生性疾病，通常在严重烧伤后发生。成纤维细胞数量增加导致转化生长因子-β（TGF-β）过度表达，这与细胞外基质分子表达增加有关，进而导致肥厚性瘢痕。激光多普勒成像（LDI）是临床上评估烧伤深度最广泛接受的辅助手段，它可以预测与肥厚性瘢痕相关的细胞和分子变化所对应的真皮损伤。我们进行了一项前瞻性、双盲、对照试验，比较LDI和临床评估在决定是否进行手术方面的作用。进行了免疫组织化学和实时逆转录聚合酶链反应，以确定烧伤深度的组织学评估与LDI之间是否存在相关性，并使用共聚焦显微镜检测成纤维细胞的存在情况。计算出需要植皮的烧伤的阳性预测值>90%。活检样本的免疫组织化学显示，与浅度烧伤相比，深度烧伤创面中TGF-β、结缔组织生长因子、热休克蛋白47和I型胶原的表达增加。使用I型前胶原和成纤维细胞特异性标志物淋巴细胞特异性蛋白-1，与浅度烧伤相比，深度烧伤区域的成纤维细胞数量增加。在深度烧伤损伤中，成纤维细胞浸润增加，导致TGF-β1和结缔组织生长因子过度表达。更重要的是，LDI在预测切除和植皮需求方面的准确率>90%。组织学和生化测量结果支持了使用临床参数和LDI来决定清创深度真皮烧伤以避免肥厚性瘢痕的准确性。
