Excessive neutrophils characterize chronic pressure ulcers
Excessive neutrophils characterize chronic pressure ulcers
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DOI：
10.1046/j.1524-475x.2003.11617.x
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发表时间：
2003-11-01
影响因子：
2.9
通讯作者：
Diegelmann, RF
中科院分区：
文献类型：
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作者：
Diegelmann, RF
虽然压力诱导的缺血引发压疮的形成是公认的，但对这些溃疡的发病机制的许多复杂机制仍然知之甚少。据报道，慢性溃疡含有升高水平的蛋白水解酶，特别是嗜酸性粒细胞衍生的基质金属蛋白酶-8和弹性蛋白酶。这一证据表明，中性粒细胞是慢性压力性溃疡发病机制的主要组成部分。因此，本研究的特点是慢性压力性溃疡的细胞成分。从11名患者的压疮肉芽组织中获得3毫米活检（6毫米深）。从这11名患者中共获得14份活检标本进行分析。将每份标本的一部分固定在福尔马林中进行常规组织学检查。将活检的其他部分冷冻用于髓过氧化物酶活性分析。此外，通过灌洗收集溃疡表面上的细胞用于组织学表征。对所有14例压疮活检的常规组织学分析显示，每个压疮表面附近的区域含有致密的中性粒细胞浸润，伴有水肿和明显的基质分离。在更深的区域，血管密度增加，许多血管含有圆形内皮细胞，周围环绕着迁移的中性粒细胞。通过Cytospin制备通过灌洗从溃疡表面收集的细胞，发现大于95%为中性粒细胞，偶尔有大的巨噬细胞主动吞噬耗尽的中性粒细胞。此外，溃疡活检中髓过氧化物酶活性与实际中性粒细胞计数显著相关，进一步证实了中性粒细胞的密集存在。这些研究直接表明慢性压疮肉芽组织中有广泛的中性粒细胞浸润。此外，中性粒细胞及其破坏性酶的持续存在似乎是广泛基质解离的原因，因此有助于这些溃疡的慢性化。
Although it is well recognized that pressure-induced ischemia initiates the formation of pressure ulcers, the many complex mechanisms responsible for the pathogenesis of these ulcers remain poorly understood. It has been reported that chronic ulcers contain an elevated level of proteolytic enzymes, especially neutrophil-derived matrix metalloproteinase-8 and elastase. This evidence suggests that neutrophils are a major component in the pathogenesis of chronic pressure ulcers. Therefore, this study characterized the cellular components of chronic pressure ulcers. Three-millimeter biopsies (6 mm deep) from granulation tissue in pressure ulcers were obtained from 11 patients. A total of 14 biopsies were obtained from these 11 patients for analysis. A portion of each specimen was fixed in formalin for routine histology. Other portions of biopsies were frozen for analysis of myeloperoxidase activity. In addition, cells on the surfaces of the ulcers were collected by lavage for histologic characterization. Routine histologic analysis of all 14 biopsies of the pressure ulcers showed regions near the surface of each that contained dense neutrophil infiltration associated with edema and apparent marked matrix dissociation. In the deeper regions there was an increased density of blood vessels, and many contained rounded endothelial cells surrounded by migrating neutrophils. Cells collected by lavage from the ulcer surface were prepared by Cytospin and found to be greater than 95% neutrophils with occasional large macrophages actively phagocytosing depleted neutrophils. In addition, there was a significant correlation of myeloperoxidase activity with actual neutrophil counts in the ulcer biopsies further confirming the dense presence of neutrophils. These studies directly show that there is extensive neutrophil infiltration in chronic pressure ulcer granulation tissue. Furthermore, the persistence of neutrophils and their destructive enzymes appears responsible for the extensive matrix dissociation and thus contributes to the chronicity of these ulcers.