摘要目的 了解烧伤患者Ⅲ度创面不同时期肉芽组织中神经纤维数量和形态学变化.方法 切取40例烧伤患者伤后1、2、3、4周Ⅲ度创面肉芽组织,同时取其中10例患者的供皮区组织作为正常对照.采用单克隆抗神经丝蛋白抗体免疫荧光染色,存荧光显微镜和激光扫描共聚焦显微镜(LSCM)下观察不同时期肉芽组织和正常皮肤组织中神经纤维的变化. 结果 荧光显微镜下观察到,伤后1周创面神经纤维稀疏短小,神经纤维阳性面积百分比为(0.14±0.08)%,低于正常对照[(0.62±0.12)%,P＜0.05];伤后2周神经纤维稍增多,单根走行,无分支,神经纤维阳性面积百分比为(0.40±0.09)%,仍低于正常对照(P＜0.05);伤后3周神经纤维明显增多,常交错呈网状,有较多分支,神经纤维阳性而积百分比为(0.73±0.16)%;伤后4周神经纤维数量较伤后3周无明显改变,多根聚集,神经纤维阳性面积百分比为(0.66±0.13)%,接近于正常对照.LSCM下,伤后1～2周创而神经纤维极为短小;伤后3周肉芽组织中的神经纤维形态不规则,有部分肿胀和扭曲、变细,局部出现断裂和空洞;伤后4周神经纤维形态与伤后3周相似,分支减少;正常皮肤中的神经纤维内部结构连续完整,无明显病理改变. 结论 烧伤创面中神经纤维的数量和形态变化与肉芽组织形成的时间有关.

abstractsObjective To observe the change in quantity and morphology of neve fibers in different periods in granulation tissue in full-thickness bum wound. Methods The granulation tissue samples were harvested from 40 patients with full-thickness burn in our unit at lst,2nd,3rd and 4th post burn week (PBW).10 samples were obtained at each time point.Donor site tissues from 10 burn patients were used as normal control.1mmunofluorescent staining technique with anti-neurofilament(NF)monoclonal antibody was employed to examine the expression of nerve fibers in granulation tissue and normal skin.The morphology of nerve fibers was observed with flurorescence microscope and Jaser scanning confocal microscope. Results Flurorescence microscopy showed:nerve fibers were short and rare at 1 PBW,the ratio of nerve fibers positive area was(0.14±0.08)%.Nerve fibers increased slightly and were in single filament without branches,and the positive area ratio of nerve fibers(0.40±0.09)%was much lower than that of normal control [(0.62±0.12)%,P＜0.05].Nerve fibers increased significantly and were arranged like a mesh with more branches and sproutings.and the positive area ratio of nerve fibers was(0.73±0.16)%at 3 PBW.The quantity of nerve fibers at 4 PBW was similar to that of 3 PBW.and the positive area ratio of nerve fibers was(0.66±0.13)%.Observations under LSCM:the nerve fibers were short at 1,2 PBW;was irregular at 3PBW.among them some were swollen and distorted,and fragmentation and vacuolation were observed.They became aggregated at 4PBW with less branches.similar to that at 3 PBW.The structures of nerve fibers in normal control were intact,without obvious pathologcial changes. Conclusion The change in quantity and morphology of nerve fibers in burn wound is related to the time of granulation tissue development.