كشت و پيوند سلول هاي فيبروبلاست انساني (آلوگرافت) بر روي پرده آمنيوتيك جهت درمان بيماران مبتلا به اپيدرمولايزيس بولوسا

Evaluation of Culture and Human Fibroblast Cells Transplant (Allograft) on Amniotic Membrane for Treatment of Epidermplysis Bullosa

زﻣﯿﻨﻪ و ﻫﺪف: اﭘﯿﺪرﻣﻮﻻﯾﺰﯾﺲ ﺑﻮﻟﻮﺳﺎ )(EB ﯾﮏ ﺑﯿﻤﺎري ژﻧﺘﯿﮑﯽ ﻫﻤﺮاه ﺑﺎ ﺷﮑﻨﻨﺪﮔﯽ ﭘﻮﺳﺖ و ﺑﯽﺛﺒﺎﺗﯽ در ﻣﺤﻞ اﺗﺼﺎل درم ﺑﻪ اﭘﯿﺪرم اﺳﺖ. ﺗﻐﯿﯿﺮ ﺷﮑﻞ ﺷﺪﯾﺪ دﺳﺖ ﺑﻪ ﻋﻠﺖ اﯾﺠﺎد زﺧﻢ و ﭼﺴﺒﻨﺪﮔﯽ ﺑﯿﻦ اﻧﮕﺸﺘﺎن و ﮐﻒ دﺳﺖ اﯾﻦ ﺑﯿﻤﺎران ﻣﻨﺠﺮ ﺑﻪ از دﺳﺖ دادن ﻋﻤﻠﮑﺮد و ﮐﺎﻫﺶ ﮐﯿﻔﯿﺖ زﻧﺪﮔﯽ آﻧﻬﺎ ﻣﯽﺷﻮد. ﭘﻮﺷﺶ زﺧﻢ ﺑﻌﺪ از ﺑﺎز ﮐﺮدن ﭼﺴﺒﻨﺪﮔﯽ از ﻣﺸﮑﻼت ﺑﺰرگ ﺟﺮاﺣﯽ ﺗﺮﻣﯿﻤﯽ اﺳﺖ. ﻫﺪف ﻣﺎ در اﯾﻦ ﻣﻄﺎﻟﻌﻪ اﺳﺘﻔﺎده از آﻣﻨﯿﻮن داراي ﻓﯿﺒﺮوﺑﻼﺳﺖ آﻟﻮﮔﺮاﻓﺖ ﭘﺲ از ﺟﺮاﺣﯽ آزاد ﮐﺮدن ﭼﺴﺒﻨﺪﮔﯽ دﺳﺖ ﺑﯿﻤﺎران ﻣﺒﺘﻼ ﺑﻪ EB ﺑﻮده اﺳﺖ. ﻣﻮاد و روش ﻫﺎ: ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ ﻧﻮﻋﯽ ﻣﻄﺎﻟﻌﻪ ﻣﺪاﺧﻠﻪاي ﺑﻮده ﮐﻪ ﺑﺮ روي 6 ﺑﯿﻤﺎر ﻣﺒﺘﻼ ﺑﻪ اﭘﯿﺪرﻣﻮﻻﯾﺰﯾﺲ ﺑﻮﻟﻮﺳﺎ ﺑﺎ دﻓﻮرﻣﯿﺘﯽ و ﭼﺴﺒﻨﺪﮔﯽ دﺳﺖ اﻧﺠﺎم ﺷﺪ. ﺑﺎ اﺳﺘﻔﺎده از ﻧﻤﻮﻧﻪ ﭘﻮﺳﺖ از ﭘﺸﺖ ﮔﻮش ﯾﮑﯽ از واﻟﺪﯾﻦ ﺑﯿﻤﺎر، ﻓﯿﺒﺮوﺑﻼﺳﺖ ﺟﺪا و ﮐﺸﺖ داده ﺷﺪ و ﺑﻪ ﭘﺮده آﻣﻨﯿﻮن ﻣﻨﺘﻘﻞ ﮔﺮدﯾﺪ. ﺑﻌﺪ از آزاد ﮐﺮدن ﮐﺎﻣﻞ ﭼﺴﺒﻨﺪﮔﯽﻫﺎي دﺳﺖ، ﺗﻤﺎم ﻣﻨﺎﻃﻖ ﺑﺪون ﭘﻮﺳﺖ ﺑﺎ آﻣﻨﯿﻮن داراي ﻓﯿﺒﺮوﺑﻼﺳﺖ آﻟﻮﮔﺮاﻓﺖ ﭘﻮﺷﺎﻧﺪه ﺷﺪ. ﺳﭙﺲ ﺳﺮﻋﺖ و ﮐﯿﻔﯿﺖ ﺗﺮﻣﯿﻢ زﺧﻢ، ﻣﺪت زﻣﺎن ﺑﻬﺒﻮدي و ﻫﻤﭽﻨﯿﻦ داﻣﻨﻪ ﺣﺮﮐﺘﯽ ﻣﻔﺎﺻﻞ اﻧﮕﺸﺘﺎن و ﺗﺤﻤﻞ ﻓﺸﺎر ﭘﻮﺳﺖ ﻣﻮرد ﺑﺮرﺳﯽ ﻗﺮار ﮔﺮﻓﺘﻨﺪ. ﯾﺎﻓﺘﻪ ﻫﺎ: ﻧﺘﺎﯾﺞ ﺣﺎﺻﻞ از ﻣﻄﺎﻟﻌﻪ ﻧﺸﺎن داد ﮐﻪ ﺗﺮﻣﯿﻢ زﺧﻢ ﺑﻪ ﺧﻮﺑﯽ اﻧﺠﺎم ﺷﺪه و ﻣﺪت ﺗﺮﻣﯿﻢ زﺧﻢ ﺑﯿﻦ 15 ﺗﺎ 29 روز ﻣﺘﻔﺎوت و ﻣﯿﺎﻧﮕﯿﻦ ﻣﺪت ﺗﺮﻣﯿﻢ 23/1 روز ﺑﺎ اﻧﺤﺮاف ﻣﻌﯿﺎر 3/77 ﺑﻮده اﺳﺖ. ﭘﻮﺳﺖ ﺗﺮﻣﯿﻢ ﺷﺪه ﺑﻪ ﺧﻮﺑﯽ ﻓﺸﺎر ﻧﺎﺷﯽ از ﻓﻌﺎﻟﯿﺖﻫﺎي ﺗﻮاﻧﺒﺨﺸﯽ دﺳﺖ و اﺳﭙﻠﯿﻨﺖ را ﺗﺤﻤﻞ ﻧﻤﻮده اﺳﺖ. ﻧﺘﯿﺠﻪ ﮔﯿـﺮي: ﻓﯿﺒﺮوﺑﻼﺳﺖ آﻟﻮﮔﺮاﻓﺖ ﺑﻪ ﻫﻤﺮاه اﺳﮑﺎﻓﻮﻟﺪ ﻣﺎﻧﻨﺪ آﻣﻨﯿﻮن ﻣﯽﺗﻮاﻧﺪ ﻧﯿﺎز ﺑﻪ ﭘﯿﻮﻧﺪ ﭘﻮﺳﺖ در ﺑﯿﻤﺎران اﭘﯿﺪرﻣﻮﻻﯾﺰﯾﺲ ﺑﻮﻟﻮﺳﺎ را ﮐﺎﻫﺶ دﻫﺪ. ﻧﺮﻣﺎل ﺑﻮدن ﻓﯿﺒﺮوﺑﻼﺳﺖ آﻟﻮﮔﺮاﻓﺖ و ﺗﺮﺷﺢ ﮐﻼژن ﻧﻮع ﻫﻔﺖ ﮐﻪ در اﯾﻦ ﺑﯿﻤﺎران وﺟﻮد ﻧﺪارد ﻣﯽﺗﻮاﻧﺪ ﻋﺎﻣﻞ ﺗﺮﻣﯿﻢ ﺑﻬﺘﺮ زﺧﻢﻫﺎ ﺑﺎﺷﺪ و از ﻓﯿﺒﺮوﺑﻼﺳﺖﻫﺎي اﺗﻮﮔﺮاﻓﺖ ﻧﺘﺎﯾﺞ ﺑﻬﺘﺮي داﺷﺘﻪ ﺑﺎﺷﺪ. ﻣﻄﺎﻟﻌﺎت ﺗﮑﻤﯿﻠﯽ ﮐﻤﮏﮐﻨﻨﺪه اﺳﺖ.

Introduction & Objective: Epidermplysis bullosa (EB) is a genetic disease with skin fragility and instability at the junction of dermis to epidermis. Severe deformity of hands because of scars and adhesions leads to lose the proper function of hand which affects the quality of patients’ life. Covering the wound after opening adhesion is the major problem in the way of reconstructive surgeons. Our purpose in this study is to use allogeneic fibroblasts amnion after surgery as a cover in patients to prevent further adhesion. Materials & Methods: This study was an experimental study that was done on six Epidermplysis bullosa Patients with hand deformity and Adhesion. We took a skin sample from back of one of parents’ ear. Then fibroblast was separated, cultured and transferred to the amniotic membrane. After separating the full adhesion, all parts without skin were covered with the allogeneic fibroblast amnion. Furthermore, speed, quality, recovery time of wound were examined as well as range of motion in finger joints and the pressure on skin. Results: The results of the study showed that wound healing well done and for wound healing varies between 15 to 29 days and the average length of treatment was 1.23 days with a standard deviation 77.3. Skin repair and rehabilitation activities as well as the pressure of splint has endured. Conclusions: Allogeneic fibroblast with a scaffold like amnion can reduce the need for skin graft in patients with Epidermolysis Bullosa. Normal allogeneic fibroblast and disability of releasing collagen seven in these patients can be effective factors in wound healing and be better than autogenic fibroblasts