基于创面肉芽生长情况及血清炎症因子评估疮愈膏在肛痈术后患者中的应用价值  

Evaluation of the Clinical Application Value of Chuangyu Ointment in Postoperative Perianal Abscess Patients Based on Wound Granulation Tissue Growth and Serum Inflammatory Factors

作　　者：李晓洁[1] 杨会举[2] LI Xiaojie;YANG Huiju(Department of Anorectal Surgery,the Fifth Clinical College of Henan University of Chinese Medicine(Zhengzhou People’s Hospital),Zhengzhou 450000,China;Anorectal Disease Hospital,the Third Affiliated Hospital of Henan University of Traditional Chinese Medicine,Zhengzhou 450000,China)

机构地区：[1]河南中医药大学第五临床医学院(郑州人民医院)肛肠外科,河南郑州450000 [2]河南中医药大学第三附属医院肛肠病医院,河南郑州450000

出　　处：《河南医学研究》2025年第6期1086-1093,共8页Henan Medical Research

基　　金：河南省中医药科学研究专项课题(2023ZY2116)。

摘　　要：目的分析疮愈膏治疗肛痈的效果与患者创面肉芽生长情况以及血清炎症因子水平之间的关系。方法选取2022年2月至2023年2月于郑州人民医院肛肠外科接受治疗的100例肛痈患者作为研究对象,根据疮愈膏疗效将其分为治疗有效组(78例)和治疗无效组(22例)。采用Spearman相关性、Kaplan-Meier曲线,多变量Cox回归分析,限制性立方样条(RCS)来分析创面肉芽生长评分与疮愈膏疗效的相关性,采用亚组森林图进一步分析影响疮愈膏疗效的血清炎症因子[血管内皮生长因子(VEGF)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)以及C反应蛋白(CRP)水平]。结果100例肛痈患者中疮愈膏治疗有效率为78.00%,创面肉芽生长评分为0、1、2、3分患者治疗有效率分别为100.00%、100.00%、97.14%、34.38%。Spearman分析创面面积缩小的百分比与时间为负相关关系,创面肉芽生长评分与创面面积缩小百分比之间存在很强的负相关关系。Kaplan-Meier曲线表明,随着不同创面肉芽生长评分增高,患者术后累积治疗有效率显著降低(P<0.05)。组间比较发现,治疗无效组患者年龄、创面愈合时间、创面相对面积、肛门疼痛评分、创面肉芽生长评分以及IL-6、IL-8、TNF-α水平均高于治疗有效组(P<0.05),VEGF则更低(P<0.05)。进一步通过单因素、多因素logistic分析发现,创面肉芽生长评分(OR=1.162,P=0.016)、IL-6(OR=1.952,P=0.036)、TNF-α(OR=1.036,P=0.042)、VEGF(OR=0.756,P=0.025)为治疗无效的独立预测因子。多因素Cox比例风险模型分析发现,未调整模型时[组1作为参考;组2 HR(95%CI)=1.843(1.147~1.934),P=0.042]和调整后[组1作为参考;组2 HR(95%CI)=1.648(1.526~1.967),P=0.005]随着创面肉芽生长评分增加,患者治疗无效风险增加。RCS模型对创面肉芽生长评分与治疗无效发生存在非线性正相关。亚组分析显示,在VEGF<3.24 g·L^(-1)、IL-6≥35.18 ng·L^(-1)和TNF-α≥156.27Objective To analyze the relationship between the efficacy of Chuangyu Ointment in treating perianal abscess and wound granulation tissue growth as well as serum inflammatory factor levels.Methods A total of 100 patients with perianal abscess treated in the Anorectal Surgery Department of Zhengzhou People’s Hospital from February 2022 to February 2023 were enrolled and divided into an effective treatment group(78 cases)and an ineffective treatment group(22 cases)based on therapeutic outcomes.Spearman correlation,Kaplan-Meier curves,multivariate Cox regression,restricted cubic spline(RCS),and subgroup forest plots were used to analyze the correlation between wound granulation scores and treatment efficacy.Subgroup analyses further evaluated serum inflammatory factors influencing efficacy,including vascular endothelial growth factor(VEGF),interleukin-6(IL-6),interleukin-8(IL-8),tumor necrosis factor-α(TNF-α),and C-reactive protein(CRP).Results The effective rate of Chuangyu Ointment was 78.00% among 100 patients.Treatment efficacy rates for wound granulation scores of 0,1,2,and 3 were 100.00%,100.00%,97.14%,and 34.38%,respectively.Spearman analysis revealed a negative correlation between the percentage reduction in wound area and time,as well as a strong negative correlation between granulation scores and wound area reduction.Kaplan-Meier curves showed significantly lower cumulative efficacy rates with increasing granulation scores(P<0.05).Compared to the effective group,the ineffective group had higher age,wound healing time,relative wound area,anal pain scores,granulation scores,and IL-6,IL-8,and TNF-α levels(P<0.05),but lower VEGF levels(P<0.05).Multivariate logistic analysis identified granulation score(OR=1.162,P=0.016),IL-6(OR=1.952,P=0.036),TNF-α(OR=1.036,P=0.042),and VEGF(OR=0.756,P=0.025)as independent predictors of treatment inefficacy.Multivariate Cox regression confirmed that higher granulation scores increased the risk of inefficacy in both unadjusted[group 1 for reference;group 2 HR(95%CI)=1.843

关 键 词：肛痈 疮愈膏 创面肉芽生长情况 血清炎症因子 

分 类 号：R657.1[医药卫生—外科学]