氢气对皮肤移植损伤的保护作用 来自北京协和医院整形外科的王友彬教授课题组的研究，最近在线发表在浙江大学科学 B （ Biomedicine Biotechnology ）上， 这是国际上首次关于用氢气治疗皮瓣移植后损伤保护的研究 。皮瓣移植是整形外科重要的手术方式。这应该是整形美容患者的福音。 关于皮瓣，网络上的定义：皮瓣是一具有血液供应的皮肤及其附着的皮下脂肪组织所形成。由于皮瓣自身有血液供应，同时又有皮下脂肪待优点，因而皮瓣移植术的用途不同于游离皮片，主要用于以下几方面： 1 、修复有肌腱、骨、关节 、大血管、神经干等组织裸露的新鲜创面或陈旧性创伤。 2 、器官再造 如鼻、唇、眼睑、眉。 3 、洞穿性缺损的修复 如面颊部洞穿性缺损，除制作衬里外亦常需要具有丰富血运的皮瓣覆盖。 4 、增强局部血运 改善营养状态如放射性溃疡，褥疮等。 皮肤或皮瓣移植手术在整形外科中具有非常重要的地位和作用，但这种手术也会发生一些并发症，最常见的是皮瓣血运障碍。皮瓣出现血液循环障碍，导致皮瓣部分或全部坏死是比较常见的严重的并发症，皮瓣是否出现血循环障碍，从本质上看，就是血液供应是否充分，静脉、淋巴回流是否通畅。也可以发生皮下血肿和感染。大多数皮瓣移植术是为解决患者美观和提高功能问题，一旦失败不仅会给患者带来经济负担，也会给患者和医生带来巨大的精神负担（设想一下，病没有治好，反而增加一个创伤，而且是体表），因此，提高皮瓣移植术成功率，减少并发症是整形外科特别关注的重要问题。但是，目前国际上仍缺乏可靠有明确效果的针对性的理想治疗手段（据说高压氧的效果似乎还不错）。 氢气作为一种理想的无副作用的抗氧化物质，是否可以用于减少皮瓣移植后损伤，值得尝试。 2009 年我在一次学术讨论中提到刚发现氢气具有治疗缺血再灌注损伤的作用，王教授对该信息非常敏感，迅速开展进行这方面的尝试，并很快证明氢气水注射确实可以发挥一定的保护作用，经过随后 3 年不断深入研究，最后形成本研究论文。皮瓣手术在临床上方便用局部给药，将来可以尝试用局部给氢气的方法，不仅可以提高氢气的浓度，而且更容易获得伦理学认可，如果可以证明效果，将具有非常好的应用前景。 hydrogen rich saline on skin flap IR.pdf 论文摘要：皮肤缺血再灌注损伤是一种多因素参与的过程，再整形外科手术经常发生。其机制涉及到缺氧、炎症和氧化损伤。氢气通过选择性抗氧化具有治疗脑缺血的作用。本研究评价了腹腔注射氢气生理盐水对皮瓣移植后缺血再灌注损伤的保护效果。研究选择大鼠腹部皮瓣移植手术为模型，腹腔注射氢气生理盐水为治疗手段，普通生理盐水为对照。手术后连续 5 天治疗后，对皮肤存活面积、局部血流量、活性氧水平和炎症因子水平，心态学分析炎症细胞浸润程度。研究结果发现，氢气生理盐水可以显著提高移植皮瓣存活面积和血流量、氧化损伤和炎症因子等指标明显减轻，局部组织炎症细胞浸润明显减少。研究结果提示，氢气生理盐水注射可以作为减少皮肤缺血再灌注损伤的治疗手段，作用可能和氢气减少移植皮瓣的炎症反应和氧化损伤有关。 Protectiveeffect of hydrogen-rich saline on ischemia/reperfusion in rat skin flap * Ling ZHAO 1 , You-bin WANG †‡2 , Shi-rui QIN 1 ,Xue-mei MA †‡1 , Xue-jun SUN 3 , Ming-lian WANG 1 , Ru-gang ZHONG 1 ( 1 College of Life Science and Bioengineering, BeijingUniversity of Technology, Beijing 100124, China) ( 2 Peking Union Medical College Hospital, Beijing 100032,China) ( 3 Department of Diving Medicine, Faculty of Naval Medicine,Second Military Medical University, Shanghai 200433, China) † E-mail:wy.benz@yahoo.com.cn; xmma@bjut.edu.cn Received Dec. 17, 2012; Revision accepted Apr. 1, 2013;Crosschecked Apr. 8, 2013 Abstract: Objective: Skin damage induced by ischemia/reperfusion (I/R) isa multifactorial process that often occurs in plastic surgery. The mechanismsof I/R injury include hypoxia, inflammation and oxidative damage. Hydrogen (H 2 ) gas has been reported toalleviate cerebral I/R injury by acting as a free radical scavenger. Here, weassessed the protective effect of hydrogen-rich saline on skin flap I/R injury.Methods: Abdominal skin flaps of rats were elevated and ischemia was inducedfor 3 h; subsequently, hydrogen-rich saline (HRS) or physiological saline wasadministered intraperitoneally 10 min before reperfusion. On postoperative d 5,flap survival, blood perfusion, the accumulation of reactive oxygen species andlevels of cytokines were evaluated. Histological examinations were performed toassess inflammatory cell infiltration. Results: Skin flap survival and bloodflow perfusion were improved by HRS relative to the controls. The production ofmalondialdehyde (MDA), an indicator of lipid peroxidation, was markedlyreduced. A multiplex cytokine assay revealed that HRS reduced the elevation inthe levels of inflammatory cytokines, chemokines and growth factors, with theexception of regulated on activation, normal T-cell expressed and secreted(RANTES) growth factor. HRS treatment also reduced inflammatory cellinfiltration induced by I/R injury. Conclusion: Our findings suggest that HRSmitigates I/R injury by decreasing inflammation and, therefore, has the potentialfor application as a therapy for improving skin flap survival.
氢气生理盐水对紫外线 B 皮肤损伤的保护作用 南京医科大学第一附属医院皮肤科最近的研究发现，氢气可以对抗紫外线引起的皮肤损伤，文章发表在 J Biomed Res. （原南京医科大学学报）上。 众所周知，太阳来源的紫外线可以引起皮肤损伤，其中紫外线 B （ UVB ）辐射诱导皮肤产生的活性氧（ ROS ）是导致损伤的重要原因，氢气具有抗 ROS 氧化损伤和抗炎症作用。在本研究中，我们试图证明，富氢生理盐水是否具有保护紫外线辐射皮肤损伤的效果。 选择 C57BL/6 雌性小鼠，经 UVB 辐射照射引起皮肤损伤为疾病模型。给予小鼠腹腔注射富氢生理盐水和富氮生理盐水。显微镜检测伤后皮肤损害。 UVB 辐射后肿瘤坏死因子 α ，白介素（ IL ） -1β 和 IL-6 等炎症因子显著升高，组织超氧化物歧化酶降低，丙二醛和一氧化氮的活性升高。富氢生理盐水通过改变这些标志物的水平和改善病理改变。结果表明，富氢生理盐水可能通过减少炎症和氧化应激保护皮肤对抗紫外线辐射损伤。 J Biomed Res. 2012 Sep;26(5):365-71. doi:10.7555/JBR.26.20110037. Epub 2012 Apr 24. Hydrogen-richsaline protects against ultraviolet B radiation injury in rats. Guo Z , Zhou B , Li W , Sun X , Luo D . Source Departmentof Dermatology, the First Affiliated Hospital of Nanjing Medical University,Nanjing, Jiangsu 210029, China; Abstract Exposureof skin to solar ultraviolet (UV) radiation induces photo-damage. Ultraviolet B(UVB) is the major component of UV radiation which induces the production ofreactive oxygen species (ROS) and plays an important role in photo-damage.Hydrogen gas reduces ROS and alleviates inflammation. In this study, we soughtto demonstrate that hydrogen-rich saline has the effect on skin injuries causedby UVB radiation. UVB radiation was irradiated on female C57BL/6 rats to induceskin injury. Hydrogen-rich saline and nitrogen-rich saline were administered torats by intraperitoneal injection. Skin damage was detected by microscope afterinjury. UVB radiation had a significant affection in tumor necrosis factoralpha, interleukin (IL)-1β and IL-6 levels, tissue superoxide dismutase,malondialdehyde and nitric oxide activity. Hydrogen-rich saline had aprotective effect by altering the levels of these markers and relievedmorphological skin injury. Hydrogen-rich saline protected against UVB radiationinjury, possibly by reducing inflammation and oxidative stress. KEYWORDS:
标签: 皮肤
