为观察3.74 μm远红外激光致角膜损伤的特点和损伤修复过程, 利用该激光在光斑直径为2 mm、照射时间为0.8 s、辐照量为23.2 J/cm2的条件下照射C57BL/6J小鼠角膜, 采用大体观察、裂隙灯显微镜、光学相干断层扫描(OCT)以及组织病理方法, 在角膜损伤后3 h、6 h、12 h、1 d、3 d、7 d、14 d和21 d进行观察。大体观察角膜损伤即刻可见灰白色损伤斑, 表面凹凸不平, 角膜混浊随时间逐渐加重, 1 d达到顶峰, 3～7 d混浊减轻, 14～21 d再次加重。裂隙灯下角膜损伤累及全层, 角膜厚度随时间先增大后逐渐恢复。OCT观察角膜损伤后明显外凸, 反射光带全层性增强, 3 h角膜显著增厚, 12 h达到最厚, 后逐渐恢复至正常。经组织切片观察: 上皮层损伤后3 h核固缩深染, 6～12 h核染色变淡消失, 1 d 时1～2层新生上皮完全覆盖损伤区, 3～7 d上皮细胞增至3～4 层, 14～21?d恢复正常; 基质层损伤后3～6 h核染色质大量脱失, 12 h出现浸润细胞, 后浸润细胞增多, 由基质深层向浅层迁移, 14～21 d浸润细胞减少, 纤维排列仍不规则; 内皮层损伤后3 h细胞脱落, 1 d出现少量新生细胞, 其后逐渐增多并趋向恢复。结果表明, 3.74 μm激光在23.2 J/cm2照射剂量下可致角膜全层损伤, 角膜损伤反应随时间先加重后逐渐恢复, 21 d时上皮和内皮层基本恢复正常, 但基质层并未恢复透明。本研究为红外激光角膜损伤危害评价和损伤治疗研究提供了试验依据。

本文综述了2 940 nm铒激光近几年在医学美容方面的应用研究进展, 通过研究激光术后皮肤状态, 为术后皮肤护理提供思路, 旨在缓解患者术后的皮肤不适感, 减轻患者术后的不良反应, 促进患者术后创面愈合, 提高患者治疗的满意度。

Photobiomodulation (PBM) promoting wound healing has been demonstrated by many studies. Currently, 630 nm and 810 nm light-emitting diodes (LEDs), as light sources, are frequently used in the treatment of diabetic foot ulcers (DFUs) in clinics. However, the dose–effect relationship of LED-mediated PBM is not fully understood. Furthermore, among the 630 nm and 810 nm LEDs, which one gets a better effect on accelerating the wound healing of diabetic ulcers is not clear. The aim of this study is to evaluate and compare the effects of 630 nm and 810 nm LED-mediated PBM in wound healing both in vitro and in vivo. Our results showed that both 630 nm and 810 nm LED irradiation significantly promoted the proliferation of mouse fibroblast cells (L929) at different light irradiances (1, 5, and 10mW/cm2. The cell proliferation rate increased with the extension of irradiation time (100, 200, and 500 s), but it decreased when the irradiation time was over 500 s. Both 630 nm and 810 nm LED irradiation (5mW/cm2 significantly improved the migration capability of L929 cells. No difference between 630 nm and 810 nm LED-mediated PBM in promoting cell proliferation and migration was detected. In vivo results presented that both 630 nm and 810 nm LED irradiation promoted the wound healing and the expression of the vascular endothelial growth factor (VEGF) and transforming growth factor (TGF) in the wounded skin of type 2 diabetic mice. Overall, these results suggested that LED-mediated PBM promotes wound healing of diabetic mice through promoting fibroblast cell proliferation, migration, and the expression of growth factors in the wounded skin. LEDs (630 nm and 810 nm) have a similar outcome in promoting wound healing of type 2 diabetic mice.

为研究不同治疗剂量的红光对Ⅰ型糖尿病SD大鼠背部急性创面的愈合效果, 对大鼠采取腹腔注射链脲佐菌素(60 mg/kg)溶液, 2周后测外周血, 血糖浓度≥16.7 mmol/L时认为Ⅰ型糖尿病模型造模成功。将60只糖尿病大鼠随机分成5组, 分别为对照组(L0, 不治疗)、治疗组一(L1, 12 J/cm2)、治疗组二(L2, 24 J/cm2)、治疗组三(L3, 48 J/cm2)、治疗组四(L4, 96 J/cm2)。用8 mm直径打孔器在大鼠背部中线两侧对称地制造2个急性创面。1 d后用633 nm±10 nm波长红光按各分组的不同能量密度照射创面。创面后第0、3、7、10天行创面拍照, 第3、7、10天分别随机取4只大鼠行创面取材。石蜡包埋后做HE染色、Masson染色、CD31免疫组化学染色、CD68免疫荧光染色。试验结果显示: 创面愈合率显示治疗组愈合加快, 其中L3组作用效果显著; HE显示治疗组的创面再上皮化加快, 第7天时L3促进作用明显; CD31免疫组织化学染色显示治疗组能促进创面下血管生成, L3和L4最为突出; CD68免疫荧光显示治疗组能减弱第10天时创面炎症浸润程度, 其中L2、L3阳性率最低。试验总结: 在试验的能量密度范围内, 红光能促进Ⅰ型糖尿病SD大鼠背部创面愈合, 且当能量密度为48 J/cm2时(L3), 其促进效果最为显著。

创面愈合延迟是最具挑战性的糖尿病临床并发症之一，其与活性氧（ROS）的过量生成有关。光生物调节作用（PBM）可以从多方面促进创面愈合，可作为糖尿病患者创面延迟愈合的一种治疗方法。本文研究了PBM对高糖培养的人胚胎皮肤成纤维细胞（CCC-ESFs）活性氧稳态的影响，探讨了PBM对改善细胞氧化应激损伤的作用。首先体外培养CCC-ESFs，细胞被随机分为对照组（正常培养基和高糖培养基）和808 nm激光照射组（功率密度分别为10，20，40 mW/cm²，能量密度分别为1.5，3，6，12 J/cm²），对照组不照光。高糖造模48 h后进行激光照射，随后分别检测细胞的增殖活力、ROS含量、总超氧化物歧化酶含量、总抗氧化能力、线粒体膜电位和相关细胞因子表达量。结果表明：高糖环境降低了细胞的增殖活力，ROS含量显著增多，抗氧化能力下降，细胞凋亡增多；采用808 nm激光照射后，细胞的增殖效应没有得到明显改善，但细胞的ROS含量下降，抗氧化酶表达量出现上升趋势，促炎细胞因子表达量降低。这些结果表明，PBM可以修复高糖环境下产生的氧化应激损伤，调节炎症反应，促进创伤愈合。

皮肤是人体最大的器官,分为表皮、真皮及皮下组织结构。而皮肤创面愈合涉及多种复杂生物学效应,主要包括炎症期、增殖期、重塑期, 是不同的组织结构及大量浸润细胞相互作用的过程。近年来弱光治疗广泛应用于临床烧伤、创伤, 尤其是在糖尿病皮损伤等慢性难愈性皮肤创面上具有独特的优势,可通过促进胶原生成、成纤维细胞增殖、微血管新生以及组织重建从而减少疼痛和缩短治愈时间。本研究采用1.2 μm半导体激光治疗机作为治疗光源, 分别通过动物模型实验和细胞实验摸索该波长激光促进皮肤伤口愈合的剂量参数, 进一步证实1.2 μm激光可通过促进角质细胞迁移诱导创面再上皮化,从而促进创面的愈合。

本研究旨在观察重组人源胶原蛋白(recombinant human collagen,r-hc)对小鼠皮肤激光损伤的修复作用, 初步探索其作用机制。应用458~514 nm激光照射小鼠背部皮肤制作皮肤损伤模型, 将r-hc外涂于创伤皮肤, 剂量为 8 mg/mL(生理盐水配制), 每天涂抹1次, 连续给药14 d。分别于给药后1、4、7、14 d用双光子显微镜收集二次谐波(second harmonic generation,SHG)信号检测伤口真皮中的胶原纤维, 并进行常规 HE 染色, 观察伤口局部的病理学改变。体外试验检测r-hc对人皮肤角质形成细胞和成纤维细胞增殖活力的影响, 计算细胞存活率。在小鼠模型上显示, 与对照组相比, r-hc可明显加速伤口的愈合, 缩短伤口愈合时间; SHG显示 r-hc能够促进创伤局部胶原的产生; 体外试验也显示它有促进人皮肤成纤维细胞和角质形成细胞增殖的能力。由此可见, r-hc(8 mg/mL)对小鼠激光损伤皮肤有修复作用, 可能是通过促进表皮角质细胞和真皮成纤维细胞的增殖, 促进胶原的沉积而发挥修复作用的。

This paper investigates the appropriate range of values for the transcutaneous blood oxygen saturation (StO2) of granulating tissues and the surrounding tissue that can ensure timely wound recovery. This work has used a multispectral imaging system to collect wound images at wavelengths ranging between 520 nm and 600 nm with a resolution of 10 nm. As part of this research, a pilot study was conducted on three injured individuals with superficial wounds of different woundages at different skin locations. The StO2 value predicted for the examined wounds using the Extended Modified Lambert–Beer model revealed a mean StO2 of 61 ± 10.3% compared to 41.6 ± 6.2% at the surrounding tissues, and 50,1 ± 1,53% for control sites. These preliminary results contribute to the existing knowledge on the possible range and variation of wound bed StO2 that are to be used as indicators of the functioning of the vasomotion system and wound health. This study has concluded that a high StO2 of approximately 60% and a large fluctuation in this value should precede a good progression in wound healing.

低功率激光(632.8 nm)照射(Low-power laser irradiation, LPLI)生物组织作为一种无损伤的物理疗法, 可以加速细胞生长、血管再生及伤口愈合等过程。一氧化氮(Nitric oxide, NO)是伤口愈合的关键因素之一, 其促进炎性细胞的趋化, 增强胶原的合成和沉积, 刺激细胞增殖和新生血管生成。我们研究发现LPLI可以促进NO的产生, 并且抑制细胞外调节蛋白激酶(Extracellular signal-regulated protein kinases, ERK) 的活性阻碍了NO的产生, 证明LPLI通过活化ERK调控NO的生成。这一研究将为低功率激光照射加速伤口愈合在临床上的应用奠定基础。