PDF(Pubmed)
Abstract：
The etiology and pathophysiology of delayed inflammatory reactions caused by hyaluronic acid fillers have not yet been elucidated. Previous studies have suggested that the etiology can be attributed to the hyaluronic acid filler itself, patient\'s immunological status, infection, and injection technique. Hyaluronic acid fillers are composed of high-molecular weight hyaluronic acids that are chemically cross-linked using substances such as 1,4-butanediol diglycidyl ether (BDDE). The mechanism by which BDDE cross-links the two hyaluronic acid disaccharides is still unclear and it may exist as a fully reacted cross-linker, pendant cross-linker, deactivated cross-linker, and residual cross-linker. The hyaluronic acid filler also contains impurities such as silicone oil and aluminum during the manufacturing process. Impurities can induce a foreign body reaction when the hyaluronic acid filler is injected into the body. Aseptic hyaluronic acid filler injections should be performed while considering the possibility of biofilm formation or delayed inflammatory reaction. Delayed inflammatory reactions tend to occur when patients experience flu-like illnesses; thus, the patient\'s immunological status plays an important role in delayed inflammatory reactions. Large-bolus hyaluronic acid filler injections can induce foreign body reactions and carry a relatively high risk of granuloma formation.
摘要：
透明质酸填充剂引起的迟发性炎症反应的病因和病理生理学尚未阐明。以前的研究表明，病因可以归因于透明质酸填料本身，患者的免疫状态，感染,注射技术。透明质酸填料由使用物质如1,4-丁二醇二缩水甘油醚(BDDE)化学交联的高分子量透明质酸组成。BDDE交联两种透明质酸二糖的机制尚不清楚，它可能作为完全反应的交联剂存在，悬垂的交联剂，失活的交联剂，和残余交联剂。透明质酸填充剂在制造过程中还含有诸如硅油和铝的杂质。当将透明质酸填充剂注射到体内时,杂质可以引起异物反应。无菌透明质酸填充剂注射应在考虑生物膜形成或延迟炎症反应的可能性的同时进行。当患者经历流感样疾病时，往往会发生延迟的炎症反应；因此，患者的免疫状态在迟发性炎症反应中起重要作用。大剂量透明质酸填充剂注射可引起异物反应，并具有相对较高的肉芽肿形成风险。
