Comparison Of Keloid Treatment Methods And Discussion Of Pathogenesis

Objective:To analyze and compare the clinical effecacy of surgery combined with electron beam irradiation,local injection of glucocorticoid,and surgery for keloids,and to explore the epigenetic mechanism of wound healing of patients with keloids preliminarily,providing new ideas for early diagnosis and joint intervention of keloids.Method1.Ninety-eight patients with keloids treated in Changzhou No.2 People's Hospital from January 2008 to January 2020 were collected for a retrospective analysis and divided into hormone group,surgery group,and surgery combined with radiotherapy group according to different treatment methods,including 31 patients in hormone group,33 patients in surgery group and 34 patients in the surgery combined with radiotherapy group.According to the total dose of radiotherapy,the group of surgery combined with radiotherapy was divided into subgroups of?20Gy and<20Gy.The clinical efficacy of the three groups of patients was analyzed and compared according to keloid efficacy standard.The Vancouver scar scale(VSS)score was used to compare the appearance changes before and after treatment of keloids.2.At the same time,GEO database was used to obtain the data set GSE113621 for studying the expression of miRNAs in the formation of keloids,and 16 samples of patients with keloids were divided into control group and experimental group.The control group was the normal skin tissue of 8 keloids patients.The experimental group was developing keloid of the same site.The limma package of R language was used to select differential expressed miRNAs of the two groups by using the criterion|log FC|>2,adj P<0.05.log FC>2 represented up-regulated miRNAs,log FC<-2 represented down-regulated miRNAs.Funrich was used to predict transcription factors of differentially expressed miRNAs,and at the same time biological process,molecular function,cell component and biological pathway enrichment analysis were performed.R,Funrich,Image GP tools were used to visualize results of differential expressed miRNAs and their enrichment analysis.Result1.The effective rate of different methods for treating patients with keloid is different.The effective rate of hormone group is 58.06%,surgery group is 48.48%,surgery combined with radiotherapy group is 91.18%.The difference in clinical efficacy of the three treatment methods is statistically significant(?~2=18.675,P<0.05),the difference in VSS score of the three groups of patients after treatment is statistically significant(H=19.631,P<0.05).In the surgery combined with radiotherapy group,the total radiotherapy dose?20Gy and<20Gy subgroup analysis shows that the total radiotherapy dose<20Gy subgroup improves the appearance of patients better than?20Gy subgroup,and the difference is statistically significant(U=80.000,P<0.05).However,the difference in clinical efficacy between the two groups is not statistically significant(P>0.05).2.There are 83 differential expressed miRNAs in the group of experimental and control.hsa-miR-31-5p,hsa-miR-503-5p,hsa-miR-424-3p,hsa-miR-382-5p,hsa-miR-4269,hsa-miR-432-5p,hsa-miR-542-5p,hsa-miR-370-3p,hsa-miR-433-3p,hsa-miR-21-5p are the most 10 up-regulated miRNAs,hsa-miR-6824-5p,hsa-miR-141-3p,hsa-miR-1224-5p,hsa-miR-371b-5p,hsa-miR-6800-3p,hsa-miR-6838-5p,hsa-miR-6068,hsa-miR-200a-3p,hsa-miR-6777-5p,hsa-miR-572 are the most 10 down-regulated miRNAs;The significant transcription factors are EGR1,SP1,POU2F1,SP4,MEF2A,NKX6-1,FOXA1,SOX1,YY1,ZFP161,NFIC,PDX1,HOXA5,RORA,RREB1,HOXA3,GATA1,HNF4A,GFI1,PBX1;Differential expressed miRNAs has molecular function such as Transcription factor activity,Transcription regulator activity,Ubiquitin-specific protease activity,RNA binding,Protein serine/threonine kinase activity,Receptor signaling complex scaffold activity,GTPase activity,Transferase activity,Protein serine/threonine phosphatase activity,Receptor signaling protein serine/threonine kinase activity.Participating in biological process of Signal transduction,Cell communication,Regulation of nucleic acid metabolism,Regulation of cell cycle,Cell motility,Regulation of translation,Nucleic acid transport,Mitosis.Mainly through the signaling pathways of Plasma membrane estrogen receptor,PI3K/Akt,Insulin,various growth factor and inflammatory factor play a role.Conclusion1.Surgery combined with electron bean irradiation is effective in treating keloids,with a low recurrence rate and high patient satisfaction with appearance.When the total dose of radiotherapy is less than 20Gy,the appearance of patients is better repaired,which can be used as the preferred clinical treatment for keloids.2.Bioinformatic analysis of differential expressed miRNAs in keloid and normal skin tissue suggests that miRNAs are involved in the regulatory mechanism of the occurrence and development of keloid.Some differential expressed miRNAs may be used as potential markers for early diagnosis of keloid,and providing a new insight for combined interventional treatment of keloid.