课题背景：激素治疗瘢痕是常用和疗效较为肯定的方法，但存在很多缺点如常发生激素的副作用和瘢痕萎缩等。为了探索更好的应用激素，又能避免激素副作用的治疗方法，特设立本课题。

偏倚或不足：课题仅使用含有去炎松-A 1 mg/cm2的固体脂质纳米颗粒卡波姆凝胶，未设其他剂量组做对照；实验亦未涉及到与其他治疗方法的比较，没有设立更多的实验组作为多因素之间关系的分析。

同行评价：增生性瘢痕和瘢痕疙瘩由于其确切的发病机制不甚明确，尚没有金标准治疗方法。糖皮质激素治疗增生性瘢痕效果虽较好，但长期应用有一定的副作用。作者针对这一问题，在应用方法上作一些改进，对临床应用有一定帮助。

摘要
目的：为克服目前瘢痕非手术治疗中糖皮质激素治疗的副作用，尝试应用去炎松-A固体脂质纳米颗粒经透皮吸收技术治疗瘢痕，观察其效果。
方法: 实验于2007-04/08在解放军兰州军区总医院动物实验中心实验室进行。①造模：选用新西兰白兔16只，每个兔耳上将全层皮肤切除，形成1 cm×1 cm上、下两个创面，术后30 d上皮化生逐渐形成病理性瘢痕。②分组干预：造模成功后随机分为对照组和实验组，每组8只。对照组不干预，实验组于术后30 d起应用含有去炎松-A 1 mg/cm2 的固体脂质纳米颗粒卡波姆凝胶覆于已形成的瘢痕上透皮吸收。③观察指标：分别于模型形成后第30，60，90和120天时依次取每只大白兔左耳上、下，右耳上、下的病理性瘢痕作为标本来源进行组织病理学观察，同时采用免疫组化检测组织中的ki-67表达和羟脯氨酸含量，并抽静脉血测血中皮质醇浓度。
结果：16只白兔均进入结果分析。①实验组做模型后第30天时ki-67表达及羟脯氨酸含量与对照组比较无明显差异（P > 0.05），但第60，90和120天实验组瘢痕组织中表达及羟脯氨酸含量较对照组明显减少（P < 0.01）。②实验组及对照组各时段血中的皮质醇浓度比较无明显差异（P > 0.05）。③实验组造模后120 d病理性瘢痕中成纤维细胞的数量少于对照组。
结论：含有去炎松-A 1 mg/cm2 的固体脂质纳米颗粒卡波姆凝胶透皮吸收对瘢痕有治疗作用，且长期应用血液中的皮质醇浓度不升高，能预防糖皮质激素治疗瘢痕的副作用。
关键词：固体脂质纳米颗粒；病理性瘢痕；去炎松-A；透皮吸收技术；卡波姆凝胶；ki-67；羟脯氨酸；皮肤组织构建

郭庆民，薛晓东，吴建，蒋丽媛， 樊芙蓉.去炎松-A固体脂质纳米颗粒透皮吸收在瘢痕治疗中的效应[J].中国组织工程研究与临床康复，2008，12(1):35-38 [www.zglckf.com/zglckf/ejournal/upfiles/08-1/1k-35(ps).pdf]

Triamcinolone acetonide acetate-loaded solid lipid nanoparticles of transdermal drug delivery in treatment of scars

Abstract

AIM：In order to conquer the side-effects of glucocorticoid in non-operative treatment of the pathological scar, this study investigated the therapeutic effect of triamcinolone acetonide acetate (TAA)-loaded solid lipid nanoparticles (SLN) of transdermal drug delivery for treating the scar.
METHODS: From April to August in 2007, the experiment was carried out in the Animal Central Laboratory of the General Hospital of Lanzhou Military Area Command of Chinese PLA.①Sixteen New Zealand white rabbits, subjected to cutting the full skin on the ears and formed two 1×1 cm2 injures, were used in the study, then the pathological scar model was gradually conducted after epithelization at 30 days postoperatively.②The successful models were randomly divided into control (C) group and treatment (T) group, each containing 8 animals. No treatment was given in C group after modeling, while T group was treated with transdermal drug delivery of TAA-loaded SLN (1 mg/cm2) carbomer gel for 90 days since the 30th day after modeling.③The cutaneous tissue samples from rabbit ear scar in each group were harvested on the 30th, 60th, 90th and 120th days after modeling for the pathomorphological examination. Hydroxyproline (Hyp) content and ki-67 expression were determined by immunohistochemical technique. Meanwhile the quantity of corticosteroid in venous blood was also detected.
RESULTS: All the 16 rabbits were involved in the result analysis.①Content of the Hyp and the expression of ki-67 were no remarkably significant between C group and T group (P > 0.05), but higher in the scar of rabbits in C group on the 60th, 90th, 120th days after modeling compared with T group (P < 0.01).②There was no significant difference in the quantity of corticosteroid between C group and T group (P > 0.05).③The fibroblasts in the pathological scar was reduced in T group than in C group at 120 days postoperatively.
CONCLUSION: Treatment with transdermal drug delivery of TAA-loaded SLN (1 mg/cm2) carbomer gel is beneficial to the treatment of pathological scar, and it would be significant to maintain quantity of corticosteroid and prevent side-effects of glucocorticoid.

Guo QM, Xue XD, Wu J, Jiang LY, Fan FR.Triamcinolone acetonide acetate-loaded solid lipid nanoparticles of transdermal drug delivery in treatment of scars.Zhongguo Zuzhi Gongcheng Yanjiu yu Linchuang Kangfu 2008;12(1):35-38(China)
[www.zglckf.com/zglckf/ejournal/upfiles/08-1/1k-35(ps).pdf]