“清法”对湿热毒盛糖尿病足坏疽急性创面局部炎症因子的影响  

Effect of Clearing Method on Inflammatory Factors in Acute Wounds Fluid of Diabetic Foot Gangrene with Dampness Heat Toxic Syndrome

作　　者：杨沁彤[1] 方豫东[1] 赵普庆[2] 曹烨民[1] 王伟灵[3] 尹凌峰[1] 徐洪涛[1] 胡高武[4] 杨建飞[1] 张国奇[1] 

机构地区：[1]上海市中医药大学附属上海市中西医结合医院脉管病科,上海200082 [2]上海市中医药大学附属上海市中西医结合医院内科,上海200082 [3]上海市中医药大学附属上海市中西医结合医院检验科,上海200082 [4]上海市中医药大学附属上海市中西医结合医院外科,上海200082

出　　处：《中国中西医结合外科杂志》2017年第4期339-343,共5页Chinese Journal of Surgery of Integrated Traditional and Western Medicine

基　　金：上海市科委中医引导类资助项目(13401905600)

摘　　要：目的:探讨"清法"治疗糖尿病足坏疽急性期湿热毒盛证的作用机制。方法:80例糖尿病足坏疽急性期湿热毒盛证、Wagner分级4级的患者,随机分为"清法"治疗组和西医对照组各40例,均采用相同的基础治疗。治疗组基础治疗同时给予奚九一经验方—陈兰花颗粒、三黄消炎颗粒内服,并行祛腐清筋术;西医对照组同时行常规清创术。两组分别计算清创术后2周、4周创面治疗有效率,并收集清创前及清创后第1、7、14、28 d的创面渗出液,ELISA法检测肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)和细胞间黏附分子-1(ICAM-1)的含量。结果:治疗组清创后4周的创面治疗有效率明显高于对照组(67.5%vs27.5%,χ~2=12.832,P<0.001);治疗组清创前及清创术后第1、7、14、28 d创面渗出液TNF-α分别为(132 551.2678±69467.8635)pg/mL和(120 472.4313±85 215.3433)pg/mL,(99 812.8301±78 081.8376)pg/mL,(90 345.3259±74 386.5024)pg/mL,(74 491.4063±61 588.1498)pg/mL;IL-6分别为(67 583.2999±26 329.1573)pg/mL,(58 222.3824±25 733.9665)pg/mL,(55 535.6338±22 380.2142)pg/mL,(50 220.2076±19 794.5744)pg/mL,(43 185.8820±20 904.6316)pg/mL;ICAM-1分别为(6399.4579±2833.9183)pg/mL,(5811.0572±2792.3656)pg/mL,(4722.0211±2200.8927)pg/mL,(4231.5074±1988.8923)pg/mL,(3407.6614±2031.0389)pg/mL;3个炎症因子清创后比清创前明显降低,且治疗组在清创后各时间点的TNF-α、IL-6比对照组降低。结论:"清法"治疗糖尿病足坏疽急性期湿热毒盛证,通过降低创面局部炎症因子水平,可以减轻创面炎症反应,促进伤口愈合。Objective To explore the mechanism of ＂Clearing Method＂ in treatment of the patients with di-abetic foot gangrene and dampness heat toxic syndrome in the acute phase. Methods Eighty patients with dia-betic foot gangrene and acute dampness heat toxic syndrome （Wagner 4 level） were randomly divided into＂Clear-ing Method＂treatment group （n=40） and western medicine control group （n=40）. All patients received basic treat-ment. In addition, the patients in treatment group received Xi Jiuyi＆#39;s prescriptions—Chenlanhua granules, San-huangxiaoyan granules and Qufuqingjin debridement for dispelling putridity and clearing sinew. The patients in control group experienced surgical debridement. The effectiveness of wound healing was examined 2 weeks and 4 weeks after debridement. At the same time, wound fluids were collected before debridement, and on the 1st, 7th, 14th and 28th days after debridement. The levels of tumor necrosis factor-a （TNF-a）, interleukin （IL）-6 and intercellular adhesion molecule （ICAM）-1 in the acute wound fluid were assessed to evaluate the severity of the was （132551.2678±69467.8635） pg/mL,（120472.4313±85215.3433）pg/mL,（99812.8301±78081.8376）pg/mLl,（90345.3259±74386.5024）pg/mL and（74491.4063±61588.1498）pg/mL before debridement and on the 1st, 7th, 14th and 28th days after debridement, while IL-6 was （67583.2999 ± 26329.1573） pg/mL, （58222.3824 ± 25733.9665） pg/mL,（55535.6338 ± 22380.2142） pg/mL, （50220.2076 ± 19794.5744） pg/mL and （43185.8820±20904.6316）pg/mL, ICAM-1 was（6399.4579±2833.9183）pg/mL,（5811.0572±2792.3656）pg/mL, （4722.0211 ± 2200.8927） pg/mL, （4231.5074 ± 1988.8923） pg/mL, （3407.6614 ± 2031.0389） pg/mL respec-tively. The levels of three inflammatory factors in each group at each time after debridement were significantly lower than those before debridement, while the levels of TNF-α and IL-6 in treatment group at each time after debridement were lower than those in control grou

关 键 词：糖尿病足 清法 渗出液 炎症因子 湿热毒盛证 

分 类 号：R587.1[医药卫生—内分泌]