| 摘要: | 背景 震波之產生是在水中產生爆炸且引發高能之聲波，此聲波藉由半橢圓之反射面聚焦再傳遞到特定組織位置。人類間質幹細胞存在於成人骨髓中，它可以像未分化細胞複製且有分化成各種細胞，如骨頭、軟骨、脂肪、韌帶及骨基質。過去30年在泌尿科，體外震波碎石已成為治療泌尿系統結石之標準治療方式。這種世界性進化之方法已完全取代侵襲性手術。最近體外震波治療被應用在骨科疾病上，如骨折癒合不良、肘外上髁炎、足底筋膜炎以及肩鈣化性肌腱炎，並可得到骨折癒合及肌腱之修復。然而，震波如何促進骨折癒合及肌腱修復之機轉以及理想之震波劑量仍是未知。 方法 為了探究人體間質幹細胞對於震波之反應以及它對於不同能量密度及震波次數之關係我們分別使用0.14、0.29、0.55、mJ/mm2，以及0、250、500、750、1000次分別作用於幹細胞，每種試驗均進行三次。為了測量人類間質幹細胞經過震波治療之生存能力，我們採取MTT分析。且於震波治療後1小時來測定。另外於震波治療後6、12、24、48小時來淬取懸浮液，利用ELISA方法來測量TGF-β1、basic FGF、VEGF 濃度。 結果 MTT分析中其結果可發現在0.14 mJ/mm2作用250次其Viability和對照組並無統計學上之意義p值大於0.05。而其餘條件下其Viability和對照組併有統計學上之意義p值小於0.05。 另外於震波治療後6、12、24、48小時來淬取懸浮液，利用ELISA方法來測量TGF-β1、basic FGF、VEGF 濃度。我們可發現體外震波對於人體間質幹細胞，均可促進細胞分泌TGF-β1, basic FGF 和VEGF。此外我們可發現在不同劑量下，其basic FGF、VEGF ,TGF-β1於24小時所得到之濃度可達到高峰。 結論 本研究中顯示體外震波治療依據不同之能階次數對於人類間質幹細胞產生不同之結果。就細胞存活率而言，其在0.14 mJ/mm2作用250次，震波治療下，其細胞存活率不受影響。且體外震波治療對於人類間質幹細胞具有促進分泌TGF-β1、VEGF、b-FGF之效果，其濃度約於24小時可達到高峰。; Background Shock wave is created by high voltage spark discharge under the water causing an explosive evaporation of water and producing high-energy acoustic waves. The acoustic waves are focused on a semiellipsoid reflector and therefore can be transmitted into a specific tissue site. Human mesenchymal stem cells are present in adult marrow, that can replicate as undifferentiated cells and that have the potential to differentiate to lineages of mesenchymal tissues, including bone, cartilage, fat, tendon, muscle, and bone stroma. Over the past 30 years in the field of urology, extracorporneal shock wave lithotripsy is considered to be the golden standard in stone therapy. The worldwide revolutionary method has almost completely replaced invasive surgery. More recently extracorporeal shock wave therapy (ESWT) has been used in the treatment of conditions of the locomotor system such as nonunion of fractures, lateral epicondylitis, plantar fascitis, and calcifying tendonitis of the shoulders and has a promising effect on promotion of bone fracture healing and repair of tendenopathies. The mechanism by which shock wave enhances fracture healing and repair of tendenopathies are still unclear. Methods To gain insight in the effects of shockwaves on human mesenchymal stem cells the relationship between the energy flux density and the number of shockwaves as well as their effect on normal mesenchymal stem cells was studied. At energy flux density of 0.14, 0.29, and 0.55 mJ/mm2 were subjected to 0, 250, 500, 750, and 1000 impluses. Each test was performed three times. At 1 hour after shock waves treatment, we used MTT assay to analysis the viability. In the other hand, at 6、12、24 and 48 hours after shock waves treatment, the cultured supernatants were harvested for measurement of TGF-β1、VEGF and basic FGF. The productions of TGF-β1、VEGF and basic FGF were determined by ELISA. Results In MTT assay, it showed there was statistically difference between the viability of treatment group and the control group except when the energy density is at 0.14 mJ/mm2 and impulses are 250 (p>0.05). In the other hand, at 6、12、24 and 48 hours after shock waves treatment, the cultured supernatants were harvested for measurement of TGF-β1、VEGF and basic FGF. The productions of TGF-β1、VEGF and basic FGF were determined by ELISA. It showed shock wave treatment group could induce the production of TGF-β1, basic FGF and VEGF. We also could find at different dosage, the production of TGF-β1, basic FGF and VEGF could reach the highest level at post-shock wave treatment 24 hours. Conclusion Our study showed the shock waves treatment could induce different results according the different energy density and impulses. To the cell viability, it showed there was no statistically difference between the treatment group and the control group when the energy density is at 0.14 mJ/mm2 and impulses are 250 (P>0.05). In the other hand, shock waves treatment could induce the production of TGF-β1, ba |
