摘要
目的:探讨象皮生肌膏联合成纤维细胞生长因子(FGF)对克罗恩病(CD)肛瘘患者瘘管切开术后创面及肉芽组织中Bax、p53和半胱氨酸天冬氨酸蛋白酶-3(Caspase-3)水平的影响。方法:将83例接受肛瘘手术治疗的CD肛瘘患者随机分为对照组41例和治疗组42例,对照组患者在常规治疗基础上予FGF药物喷涂创面,治疗组患者在此基础上予象皮生肌膏填塞创腔。比较两组患者疗效、腐肉脱落时间、创面愈合时间、创面渗液评分、肉芽组织生长评分、创面面积减少率、肛管最大收缩压(AMCP)、肛管静息压(ARP)和肛管最长收缩时间(ALCT);检测并比较两组患者肉芽组织中Bax、p53、Caspase-3蛋白水平,创面渗出液中肿瘤坏死因子(TNF-α)、γ-干扰素(IFN-γ)、白细胞介素-10(IL-10)水平。结果:治疗组总有效率为95.24%(40/42),对照组总有效率为80.49%(33/41),治疗组高于对照组(P<0.05);治疗组患者腐肉脱落时间、创面愈合时间均显著短于对照组,创面渗液评分、肉芽组织生长评分均显著低于对照组,创面面积减少率显著高于对照组,差异均有统计学意义(P<0.05);术后7 d,两组患者AMCP、ARP均较术前1 d升高,ALCT均较术前1 d延长,且治疗组患者术后7 d AMCP、ARP均高于对照组,ALCT长于对照组,差异均有统计学意义(P<0.05);术后7 d,两组患者肉芽组织中Bax、p53和Caspase-3蛋白水平均显著降低,且治疗组患者肉芽组织中Bax、p53和Caspase-3蛋白水平均显著低于对照组,差异均有统计学意义(P<0.05);术后7 d,两组患者创面渗出液中TNF-α、IFN-γ水平均显著降低,IL-10水平均显著升高,且治疗组患者创面渗出液中TNF-α、IFN-γ水平显著低于对照组,IL-10水平显著高于对照组,差异均有统计学意义(P<0.05)。结论:象皮生肌膏联合FGF治疗CD肛瘘瘘管切开术后患者可有效抑制肉芽组织细胞凋亡,减轻创面炎症反应,促进创面愈合,改善肛门功能。
Objective:To investigate the effect of Xiangpi Shengji Ointment combined with fibrocell growth factor(FGF)on the level of Bax,p53 and Caspase-3 in wound and granulation tissue of patients with Crohn's disease(CD)after fistula incision.Methods:83 patients with CD anal fistula who underwent anal fistula surgery were randomly divided into 2 groups,41 cases in the control group and 42 cases in the treatment group.The patients in the control group were sprayed with FGF on the wound on the basis of routine treatment,and the patients in the treatment group were filled with Xiangpi Shengji Ointment on this basis.The curative effect,carrion shedding time,wound healing time,wound exudation score,granulation tissue growth score,wound area reduction rate,anal maximum systolic pressure(AMCP),anal resting pressure(ARP)and anal maximum systolic time(alct)were compared between two groups.The levels of Bax,p53 and Caspase-3 protein in granulation tissue were detected.The levels of tumor necrosis factor(TNF-α),γ-interferon(IFN-γ)and interleukin-10(IL-10)in wound exudate were detected.Results:The total effective rate was 95.24%(40/42)in the treatment group and 80.49%(33/41)in the control group,which was higher in the treatment group than in the control group(P<0.05).The time of carrion shedding and wound healing in the treatment group were significantly shorter than those in the control group,the score of wound exudation and the score of granulation tissue growth were significantly lower than those in the control group,and the reduction rate of wound area was significantly higher than that in the control group(P<0.05).7 days after operation,AMCP and ARP of the two groups were higher than that of the 1st day before operation,and ALCT was longer than that of the 1st day before operation.Moreover,AMCP and ARP of the treatment group were higher than that of the control group on the 7th day after operation,and ALCT was longer than that of the control group,with significant difference(P<0.05).7 days after operation,the levels of Bax,p53 and Caspase-3 protein in granulation tissue of the two groups were significantly reduced,and the levels of Bax,p53 and Caspase-3 protein in granulation tissue of the treatment group were significantly lower than those of the control group,the difference was statistically significant(P<0.05).7 days after operation,the levels of TNF-αand IFN-γin wound exudates of the two groups decreased significantly on average,and the levels of IL-10 increased significantly.The levels of TNF-αand IFN-γin wound exudates of the treatment group were significantly lower than those of the control group,and the levels of IL-10 were significantly higher than those of the control group(P<0.05).Conclusion:Xiangpi Shengji Ointment combined with FGF can effectively inhibit the apoptosis of granulation tissue cells,reduce the inflammatory reaction of wound surface,promote wound healing and improve anal function in patients with CD after anal fistula fistulotomy.
作者
刘梦竹
宾东华
赵丹
LIU Mengzhu;BIN Donghua;ZHAO Dan(The First Affiliated Hospital of Hunan University of Chinese Medicine,Changsha Hunan 410007,China)
出处
《中医药导报》
2022年第7期101-105,共5页
Guiding Journal of Traditional Chinese Medicine and Pharmacy
基金
国家自然科学基金青年项目(81603634)
湖南省教育厅课题(16C1224)
湖南省临床医疗技术创新引导项目(2020SK51404)
湖南中医药大学校级课题重点项目(2019XJJJ034)
湖南中医药大学中西医结合一流学科开放课题重点项目(2020ZXYJH05)。
关键词
克罗恩病
肛瘘
瘘管切开术
象皮生肌膏
成纤维细胞生长因子
创面
促凋亡蛋白
肛门功能
Crohn's disease
anal fistula
fistulotomy
Xiangpi Shengji Ointment
fibroblast growth factor
wound
aral function
pro-apoptotic protein
作者简介
通信作者:赵丹,E-mail:350058539@qq.com。
