艾灸对糖尿病性皮肤溃疡大鼠创面愈合的影响及其作用机制

Effect of moxibustion on wound healing in rats with diabetic skin ulcer and its mechanism

目的探讨艾灸对糖尿病性皮肤溃疡大鼠创面愈合的影响及其作用机制。方法通过链脲佐菌素腹腔注射诱导糖尿病大鼠模型,8周后糖尿病造模成功大鼠共90只,分为模型组、艾灸组及TDP红外线治疗组(TDP组)各30只,另选取30只大鼠为空白组,对各组大鼠进行皮肤溃疡创面模型制备,创面模型制备成功后,艾灸组于溃疡创面正中(阿是穴)施灸,TDP组于溃疡面正中用红外线治疗仪治疗,空白组及模型组局部用生理盐水换药。于创面造模后3 d、6 d及12 d,各组分别取10只大鼠,观察创面愈合速率,检测血清及创面组织匀浆肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)含量,并镜下观察创面组织炎症细胞浸润,检测CD68的表达情况。结果与模型组比较,艾灸及TDP组各时间段的创面愈合速率均显著升高(P<0.05);与空白组比较,模型组创面造模后3 d创面组织中IL-6、TNF-α含量均明显下降,而创面造模后6 d、12 d血清及创面组织中IL-6、TNF-α含量显著升高(P<0.05);与模型组比较,艾灸组创面造模后6 d、12 d血清及创面组织中TNF-α、IL-6含量均有降低(P<0.05);病理结果显示模型组创面造模后3 d炎性细胞浸润数量少,创面造模后6 d炎性细胞浸润显著增加,创面造模后12 d仍保持较高水平且CD68+细胞表达水平最高,而创面造模后12 d艾灸组CD68+细胞表达水平最低(P<0.05)。结论艾灸可能通过调控创面炎症因子TNF-α、IL-6含量、降低巨噬细胞活化水平及改善创面炎症细胞浸润来促进大鼠糖尿病性皮肤溃疡创面的愈合。

Objective To explore the effect of moxibustion on wound healing in rats with diabetic ulcer and its mechanism. Methods A diabetic rat model was induced by intraperitoneal injection of streptozotocin. Ninety rats with successful modeling were divided into model group,moxibustion group and TDP infrared therapy group（ TDP group） 8 weeks after the modeling, with 30 rats in each group. Thirty noruml rats were also chosen as blank group. Wound model with skin ulcer was established in all groups. After establishment of the would model,moxibustion group was treated with moxibustiun at the center of the ulcer wound（ Ashi point） ,while TDP group with infrared therapy apparatus at the center of the ulcer wound. Model group and blank group were dressing with normal saline locally. Ten rats of each group were selected to calculate the wound healing rate and detect the levels of tumor necrosis factor（ TNF） -α and interleukin（IL）-6 in the serum and wound tissue homogenates on the 3rd,6th and 12th day after wound modeling. The infiltration of inflammatory cells in the wound tissues was observed under microscope,and the expression levels of CD68 in the wound tissues were also detected. Results The wound healing rates of moxibustion group and TDP group were obviously higher than that of model group（P 〈 0.05 ）. Compared to blank group, model group obtained significantly lower IL-6 and TNF-α levels in the wound tissues three days after wound modeling, but significantly higher IL-6 and TNF-α levels in the serum and wound tissues 6 and 12 days after wound modeling（P 〈 0. 05 ）. Compared to model group, moxibustion group obtained lower TNF-α and IL-6 levels in the serum and wound tissues 6 and 12 days after wound modeling（ P 〈 0. 05 ）. Pathological results showed that the number of inflammatory cells decreased on the 3rd day after wound modeling, increased significantly on the 6th day after wound modeling,and kept a high level on the 12th day after wound modeling in the model group;On the 12th day afterwound modeling, model group obtained the highest level of CD68 ＋ expression, while moxibustion group gained the lowest level（ P 〈 0.05 ）. Conclusion Moxibustion might promote the wound healing of rats with diabetic skin ulcer by regulating the levels of TNF-α and IL-6 in the wound tissues,reducing the activation of macrophages and improving the inflammatory cell infiltration of the wounds.