Sahin Sevinc
Bozok University School of Medicine, Yozgat, Turkey.
Ostomy Wound Manage. 2017 Apr;63(4):30-40.
Thymosin beta 4 (Tβ4) is a peptide that has been shown in dermal, corneal, and cardiac preclinical injury models to potentially affect tissue protection, regeneration, and repair. Sacrococcygeal pilonidal sinus disease (SPSD) is a chronic inflammatory disorder associated with a high incidence of recurrence, chronic fistulation, and a challenging postoperative surgical wound healing process. Retrospectively, an immunohistochemical analysis was conducted to evaluate endogenous Tβ4 expression in excisional skin biopsies from patients with SPSD. Patient demographics (age, gender) and surgical procedure data were obtained from their electronic medical records. Two (2) samples were cut from each specimen and prepared for histopathological assessment: 1 from the inflamed sinus tracts containing hair and granulation tissue (chronic wound group) and 1 from the normal tissue at least 1 cm away from the sinus tract (control group). Tβ4 expression was evaluated in the epidermal, dermal/subcutaneous collagen, and vascular structures of the samples from the sinus tract and healthy tissue. Inflamed sinus tract tissue and noninflamed normal tissue adjacent to the sinus tract were sampled from each specimen to confirm the diagnosis of SPSD and to determine distribution and intensity of Tβ4 expression. Presence of cytoplasmic staining for Tβ4 was considered in favor of positive Tβ4 expression; intensity of Tβ4 expression was scored as 0 = no staining, 1 = mild, 2 = moderate, and 3 = strong level of expression. A total of 31 excisional skin biopsy specimens were available from 31 patients with SPSD (mean age 26.0 ± 7.6 years, 25 [80.6%] men, 6 [19.4%] women) who underwent primary surgical closure. Demographic variables were analyzed using descriptive statistics. Data compliance with normal distribution was evaluated using the Kolmogorov-Smirnov and Shapiro-Wilk tests, and the Mann-Whitney U test was used for comparison of numerical data. P <.05 was considered statistically significant. Inflamed sinus tract tissue had significantly higher Tβ4 expression scores than noninflamed tissue samples in the epidermis (2.4 ± 0.8 [1.0-3.0] versus 0.8 ± 0.5 [0.0-2.0], P = .000), dermal/subcutaneous collagen (2.6 ± 0.5 [2.0-3.0] versus 1.6 ± 0.5 [1.0-2.0], P = .000), and vascular structure (2.6 ± 0.5 [2.0-3.0] versus 1.1 ± 0.3 [1.0-2.0], P = .000). Study findings indicate Tβ4 is endogenously expressed in normal skin tissue and is overexpressed in inflamed sinus tract tissue in patients with SPSD. Preclinical studies with a larger sample size are needed to enhance understanding of the potential role of Tβ4 in the inflammatory and tissue remodeling processes of SPSD by elucidating its mechanism of action at the molecular level, physiological role, and the therapeutic potential in dermal healing.
胸腺素β4（Tβ4）是一种肽，在皮肤、角膜和心脏临床前损伤模型中已显示可能影响组织保护、再生和修复。骶尾部藏毛窦疾病（SPSD）是一种慢性炎症性疾病，复发率高，易形成慢性瘘管，术后手术伤口愈合过程具有挑战性。回顾性地，进行了一项免疫组织化学分析，以评估SPSD患者切除皮肤活检标本中内源性Tβ4的表达。从患者的电子病历中获取患者人口统计学信息（年龄、性别）和手术过程数据。从每个标本中切取两（2）个样本，准备进行组织病理学评估：1个来自含有毛发和肉芽组织的发炎窦道（慢性伤口组），1个来自距窦道至少1厘米的正常组织（对照组）。在窦道和健康组织样本的表皮、真皮/皮下胶原和血管结构中评估Tβ4表达。从每个标本中采集发炎窦道组织和窦道附近的非发炎正常组织，以确诊SPSD并确定Tβ4表达的分布和强度。Tβ4细胞质染色阳性被认为是Tβ4表达阳性；Tβ4表达强度评分为0 = 无染色，1 = 轻度，2 = 中度，3 = 强表达水平。共有31例接受一期手术缝合的SPSD患者的31个切除皮肤活检标本（平均年龄26.0±7.6岁，25例[80.6%]男性，6例[19.4%]女性）。使用描述性统计分析人口统计学变量。使用Kolmogorov-Smirnov和Shapiro-Wilk检验评估数据是否符合正态分布，使用Mann-Whitney U检验比较数值数据。P <.05被认为具有统计学意义。发炎窦道组织在表皮（2.4±0.8[1.0 - 3.0]对0.8±0.5[0.0 - 2.0]，P =.000）、真皮/皮下胶原（2.6±0.5[2.0 - 3.0]对1.6±0.5[1.0 - 2.0]，P =.000）和血管结构（2.6±0.5[2.0 - 3.0]对1.1±0.3[1.0 - 2.0]，P =.000）中的Tβ4表达评分显著高于非发炎组织样本。研究结果表明，Tβ4在正常皮肤组织中内源性表达，在SPSD患者的发炎窦道组织中过表达。需要进行更大样本量且更深入的临床前研究，以通过阐明其在分子水平的作用机制、生理作用以及在皮肤愈合中的治疗潜力，来增强对Tβ4在SPSD炎症和组织重塑过程中潜在作用的理解。
