温和灸对大鼠慢性难愈性创面组织修复微循环的影响

Effect of Mild-warm Moxibustion on Microcirculation in the Raw Surface Tissue of Chronic Refractory Wound in Skin Ulcer Rats

目的:研究温和灸对慢性难愈性创面动态血流、微血管数(MVC)及血管内皮生长因子(VEGF)表达的影响,探讨温和灸促进难愈性创面愈合的效果及可能的作用机制。方法:在104只雄性SD大鼠背部制造全层皮肤损伤开放性创面。随机分为对照组(8只)、模型组(32只)、TDP组(32只)、温灸组(32只),除对照组外,其余各组动物均予以肌肉注射氢化可的松琥珀酸钠,建立慢性难愈性创面模型。TDP组、温灸组取创面局部及双侧"肾俞""足三里"穴,分别以TDP照射或艾条温灸,每穴15 min,每日1次。观察创面愈合时间及第37、、10、14天创面愈合率,以激光多普勒血流仪测量治疗前及第3、7、14天创面动态血流,免疫组化法检测第3、7、14天大鼠肉芽组织中MVC和VEGF表达情况。结果:模型组与对照组比较,创面愈合率降低(P<0.01),愈合时间明显延长(P<0.01);与模型组比较,温灸组、TDP组创面愈合率提高(P<0.05,P<0.01),愈合时间缩短(P<0.01);与TDP组比较,温灸组创面愈合率提高(P<0.01),愈合时间缩短(P<0.01)。温灸组和TDP组在创面修复前期(第3、7天),创面血流及创面肉芽组织中MVC、VEGF表达均呈升高趋势,而在创面修复后期(第14天)则呈下降趋势,温灸组较TDP组表现明显(P<0.05,P<0.01)。结论:温和灸能促进创面愈合,其作用机制与调节不同时间点的创面动态血流、MVC及VEGF表达有关。

Objective To observe the effects of mild-warm moxibustion on dynamic blood flow,microvessel count（MVC）and vascular endothelial growth factor（VEGF） expression in the wound tissue of the chronic skin ulcer in rats,so as to reveal its underlying mechanism in promoting wound recovery.Methods A total of 104 male SD rats with skin injury were randomly divided into control group（n=8）,model group（n=32）,TDP（far-infrared heating device） group（n=32） and moxibustion group（n=32）.Chronic refractory raw surface wound model was established by muscular injection of Hydrocortisone Sodium Succinate.For rats of the TDP and moxibustion groups,TDP irridiation and mild-warm moxibustion were applied to the raw surface,bilateral ＂Shenshu＂（BL 23） and ＂Zusanli＂（ST 36） for 15 min,once daily for 3,7 and 14 days respectively.The healing rate and the healing time of raw surface of the wound were observed.The blood flow of the raw surface of the wound tissue was measured by laser Doppler flowmeter and the MVC in granulation tissue of chronic skin ulcer was counted under light microscope.VEGF expression was detected by immunohistochemistry.Results In comparison with the control group,the healing rate of the wound raw surface was significantly lower and the healing time was prolonged in the model group（P0.01）.Compared with the model group,the healing rates on day 3,7,10 and 14 were significantly higher and the healing time was strikingly faster in both TDP and moxibustion groups（P0.01,P0.05）,and the effects of the moxibustion group in increasing the healing rate and shortening the healing time were significantly better than those of TDP group（P0.01）.In comparison with the model group,the blood flow volume,MVC and VEGF expression levels on day 3 and 7 were upregulated significantly in both TDP and moxibustion groups（P0.01,P0.05）;while the blood flow volume,MVC and VEGF expression level in the moxibustion group and the blood flow volume and VEGF expression level in the TDP group downregulated considerably on day 14（P0.01）.No significant difference was found between the TDP and moxibustion groups in the MVC on day 14 after the treatment（P0.05）.ConclusionMild-warm moxibustion can promote wound healing,which is closely with its effects in increasing blood flow and MVC,and upre-gulating VEGF expression in the wound granulation tissue of the chronic skin ulcer.