中药熏蒸治疗炎症坏死期糖尿病足溃疡的疗效及对创面渗出液中TGF-β1、IL-1β、MMP-9、TIMP-1水平的影响  

Effect of Traditional Chinese Medicine Fumigation on Diabetes Foot Ulcer in Inflammatory Necrotic Stage and Its Effect on Levels of TGF-β1,IL-1β,MMP-9 and TIMP-1 in Wound Exudate

作　　者：于文霞[1] 姚彬 姜文慧 苏秀海[1] 高娟娟 王猛 刘爱茹 何青敏 李秀贞 YU Wenxia;YAO Bin;JIANG Wenhui;SU Xiuhai;GAO Juanjuan;WANG Meng;LIU Airu;HE Qingmin;LI Xiuzhen(Endocrinology Department,Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine,Cangzhou 061001,Hebei,China)

机构地区：[1]沧州中西医结合医院内分泌科,河北沧州061001

出　　处：《辽宁中医杂志》2024年第5期94-98,共5页Liaoning Journal of Traditional Chinese Medicine

基　　金：河北省中医药管理局科技计划项目(2021346)

摘　　要：目的 探讨自拟中药复方熏蒸治疗炎症坏死期糖尿病足溃疡(diabetic foot ulcer, DFU)的临床疗效以及其对患者创面渗出液中转化生长因子(TGF)-β1、白细胞介素(IL)-1β、基质金属蛋白酶(matrix metalloproteinase, MMP)-9、基质金属蛋白酶组织抑制因子-1(tissue inhibitor of matrix metalloproteinase-1,TIMP-1)水平的影响。方法 选取2018年3月—2019年12月该院收治的96例炎症坏死期DFU患者,采取简单随机数字表法将其随机分成观察组48例与对照组48例。其中对照组采取西医常规治疗,观察组在此基础上联合笔者自拟中药复方(由大黄、土茯苓、毛冬青、金银花、黄芪、败酱草、连翘、苦参等十六味中药组成)熏蒸治疗。连续治疗14 d后评估两组疗效及安全性。观察两组治疗前及治疗7、14 d后创面面积、创面中医证候积分及创面渗出液中TGF-β1、IL-1β、MMP-9和TIMP-1水平的变化情况,并进行统计分析。结果 观察组疾病总有效率和创面中医证候总有效率分别为91.7%(44/48)、85.4%(41/48),均较对照组[75.0%(36/48)、66.7%(32/48)]显著提高(P<0.05)。随治疗时间的延长,两组创面面积均逐渐缩小(P<0.05),创面中医证候积分均逐渐降低(P<0.05);但与同期对照组相比,观察组治疗7、14 d后创面面积均显著更小(P<0.05),创面中医证候积分则均显著更低(P<0.05)。随治疗时间的延长,两组创面渗出液中TGF-β1、TIMP-1浓度均逐渐升高(P<0.05),IL-1β、MMP-9含量则均逐渐降低(P<0.05);且观察组治疗7、14 d后创面渗出液中TGF-β1、TIMP-1水平均显著高于对照组同期(P<0.05),IL-1β、MMP-9水平则均较对照组同期显著更低(P<0.05)。两组不良反应均较少且轻微。结论 自拟中药复方熏蒸治疗炎症坏死期DFU的整体疗效确切,能明显减轻患者创面局部症状,加快创面愈合速度,其作用机制可能是通过进一步上调创面渗出液中TGF-β1、TIMP-1表达水平及下调IL-1β、MMP-9表达水�Objective To investigate the clinical efficacy of self-designed traditional Chinese medicine compound fumigation in the treatment of diabetic foot ulcer(DFU)in inflammatory necrosis stage and its effect on the levels of transforming growth factor(TGF)-β1,interleukin(IL)-1β,matrix metalloproteinase(MMP)-9 and tissue inhibitor of matrix metalloproteinase-1(TIMP-1)in wound exudate of patients.Methods From March 2018 to December 2019,96 patients with DFU in the inflammatory and necrotic stage admitted to the hospital were selected and randomly divided into observation group(48 cases)and control group(48 cases)by simple random number table method.The control group was treated with conventional Western medicine,and the observation group was fumigated with self-designed Chinese herbal compound[composed of Dahuang(Rhei Radix Et Rhizoma),Tufuling(Smilacis Glabrae Rhizoma),Maodongqing(Leaf of Pubescent Holly),Jinyinhua(Lonicerae Japonicae Flos),Huangqi(Astragali Radix),Baijiangcao(Patriniae Herba),Lianqiao(Forsythiae Fructus),Kushen(Sophorae Flavescentis Radix),etc.]on this basis.After continuous treatment for 14 days,the efficacy and safety of the two groups were evaluated.The changes of wound area,wound TCM syndrome scores,and the levels of TGF-β1,IL-1β,MMP-9 and TIMP-1 in wound exudate were observed before treatment and 7 and 14 days after treatment in the two groups,and the statistical analysis was performed.Results The total effective rate of disease and the total effective rate of TCM syndrome in the observation group were 91.7%(44/48)and 85.4%(41/48),respectively,which were significantly higher than those in the control group[75.0%(36/48)and 66.7%(32/48)](P<0.05).With the extension of treatment time,the wound area of the two groups was gradually reduced(P<0.05),and the TCM syndrome score of the wound was gradually decreased(P<0.05).However,compared with that of the control group at the same period,the wound area of the observation group was significantly smaller after 7 and 14 days of treatment(P<0.05),and the T

关 键 词：糖尿病足溃疡 中药熏蒸 创面渗出液 TGF-Β1 IL-1Β MMP-9 TIMP-1 

分 类 号：R255.4[医药卫生—中医内科学]