王景 张海丽

[摘要]目的：观察并探讨激光联合全蝎软膏对兔耳早期增生性瘢痕的治疗效果。方法：将16只新西兰大白兔随机分为空白对照组、模型组、全蝎软膏组和联合组，每组4只;建模后立即对全蝎软膏组和联合组患处进行药物涂抹或激光照射治疗，对照组和模型组用PBS处理;于治疗后的第50d取各组动物皮肤织进行病理、酶联免疫法（ELISA）、荧光定量PCR和Smad 4蛋白检测。结果：与空白对照组相比，模型组兔耳术后形成增生性瘢痕，联合组和全蝎软膏组经治疗后无瘢痕出现;HE染色结果显示，经激光联合全蝎软膏治疗后组织纤维化程度明显减轻;ELISA和荧光定量PCR检测结果表明，联合组与模型组相比，I型胶原蛋白（Col I）、Ⅲ型胶原蛋白（Col Ⅲ）、肿瘤坏死因子α（TNF-α）及MMP的表达量均显著降低（P<0.05）;Western blot结果证实了激光联合全蝎软膏治疗后可显著抑制组织内Smad 4蛋白的表达（P<0.05），从而调控TGF-β细胞通路而抑制增生性瘢痕的形成。结论：本研究证实了激光联合全蝎软膏具有治疗HTS的作用，并为临床上治疗HTS提供新途径。

[关键词]全蝎软膏;半导体激光;增生性瘢痕;早期治疗;Smad 4蛋白;TGF-β通路

Abstract： Objective  To observe and explore the therapeutic effect of laser combined with scorpion ointment on early hypertrophic scar in rabbit ears. Methods  The sixteen New Zealand white rabbits were randomly divided into blank control group， model group， scorpion ointment group and combined group. After modeling， the patients in the treatment group were immediately treated with drug smear or laser irradiation， while those in the control and model groups were treated with PBS. On the fiftieth day after treatment， the skin tissues of each group were taken for pathological examination， enzyme-linked immunosorbent assay （ELISA）， fluorescence quantitative PCR and Smad 4 protein detection. Results Compared with the control group， hypertrophic scar was formed in the model group after ear surgery， and no scar appeared in the laser combined with scorpion ointment group after treatment. The results of HE staining showed that the degree of tissue fibrosis was significantly reduced after laser combined with scorpion ointment treatment. The results of ELISA and quantitative fluorescence PCR showed that the expressions of Col I， Col Ⅲ， TNF-a and MMP in the combined treatment group were significantly lower than those in the model group （P<0.05）. The western blot results confirmed that laser combined with scorpion ointment could significantly inhibit the expression of Smad 4 protein in tissues （P<0.05）， thereby regulating the TGF-β cell pathway and inhibiting the formation of hypertrophic scars. Conclusion This study confirms that laser combined with scorpion ointment can be used to treat HTS， and provides a new way for clinical treatment of HTS.

Key words： scorpion ointment; semiconductor saser; hypertrophic scar; preemptive therapy; smad 4 Protein; TGF-β pathway

增生性瘢痕（Hypertrophic scar，HTS）是臨床上较为常见的病理性皮肤疾病，其形成的主要原因是组织在自我修复过程中成纤维细胞（Fibroblast，FB）过度增殖，同时以大量的胶原蛋白在细胞外基质（extracellular matrix，ECM）内沉积而最终导致高于正常皮肤组织的增生性瘢痕形成[1-3]。传统医学认为，增生性瘢痕发病的主要原因为“气滞血瘀，余毒未尽”，此外，HTS的形成亦与气虚、血虚和痰湿等个体体质因素相关[4-5]。目前，临床上防治HTS的手段众多，主要包括手术切除、压迫疗法、冷冻、放化疗及药物注射等，以及两种或两种以上联用的综合疗法，但因HTS具体的形成机制尚未明确，致使治疗效果均不理想，仍存在复发率较高、诊疗费用高等问题[6-7]。……