Clarification of mechanisms for delayed re-epithelialization of chronic wounds -to establish treatment based on wound healing theory-

为了阐明慢性创面延迟再上皮化的机制，我们检测了与烧伤创面（急性创面，对照）相比，压疮创面迁移表皮中α5β1表达、迁移表皮下纤维连接蛋白（FN）分布、真皮-表皮交界处层粘连蛋白-1表达的变化以及组织学结果。采用过氧化物酶免疫组织化学方法对22例压疮和24例烧伤的4 μm石蜡切片进行α5β1、FN和层粘连蛋白-1染色。切片也用苏木精和伊红（HE）染色。在这些免疫染色和HE染色的标本中，我们用IPLab测量了α5β1阳性表达、FN分布增加、层粘连蛋白-1表达阴性或减少、组织学表皮延长（显示角化不全的部分）和表皮增厚的距离。然后，我们分析了各组烧伤或压疮中这些发现的相关性 ...更多信息 .接下来，我们对两组研究结果的差异进行了分类。在烧伤标本中，α5β1阳性与纤维连接蛋白升高、α5β1阳性与层粘连蛋白-1阴性、纤维连接蛋白升高与层粘连蛋白-1阴性之间存在统计学显著相关性。此外，表皮延长与α5β1阳性、纤连蛋白增加和层粘连蛋白-1阴性显著相关。在压疮标本中，α5β1阳性与FN增高、α5β1阳性与层粘连蛋白-1阴性、FN增高与表皮延长、表皮延长与表皮增厚之间存在显著相关性。压疮组与烧伤组比较，α5β1阳性的距离明显缩短，FN阳性的距离明显增加，LN-1阴性。表皮增厚的增加也是显著的。这些数据表明，α5β1和FN是表皮迁移的重要促进因素，并且迁移的真皮中α5β1表达的减少和迁移的表皮下FN分布被认为是压疮延迟再上皮化的机制。少

To clarify the mechanisms of delayed re-epithelialization in chronic wounds, we examined the changes in α5β1 expression in the migrating epidermis, fibronectin (FN) distribution under the migrating epidermis, laminin-1expression at the dermal-epidermal junction and histological fmdings for pressure ulcers compared with those for bums (acute wounds, control). Four μm of paraffin sections in a serial of 22 samples with 20 pressure ulcers and 24 samples with 24 burns were stained for α5β1, FN and laminin-1 by a peroxidase immunohistochemical method. The sections were also stained with hematoxylin and eosin (HE). In these immunostained and HE stained specimens, we measured the distance of positive expression of α5β1, increased distribution of FN, negative or decreased expression of laminin-1, histological epidermal elongation (portion showing parakeratosis) and epidermal thickening using IPLab. We then analyzed the correlation of those findings within each group of burns or pressure ulcers … More . Next we sorted the differences in the findings between the two groups. With burn specimens, there was a statistically significant correlation between positive α5β1 and increased fibronectin, positive α5β1 and negative laminin-1, and increased fibronectin and negative laminin-1. In addition, epidermal elongation significantly correlated with positive α5β1, increased fibronectin, and negative laminin-1. With pressure ulcer specimens, a significant correlation was shown between positive α5β1 and increased FN, positive α5β1 and negative laminin-1, increased FN and epidermal elongation, and epidermal elongation and epidermal thickening. The pressure ulcer group showed a significant decrease in the distance of positive α5β1, increased FN, negative laminin-1 compared with the burn group. Increase in epidermal thickening was also significant. These data demonstrated that α5β1 and FN were the significant contributing factors in epidermal migration, and the decrease in α5β1 expression in the migrating epidemis and FN distribution under the migrating epidermis were considered to be mechanisms of delayed re-epithelialization with pressure ulcers. Less