负压封闭引流对高位肛周脓肿炎症细胞因子及mRNA表达的影响

Effect of vacuum sealing drainage on inflammatory cytokines and expression of mRNA in high perianal abscess

【目的】观察负压封闭引流(vacuum sealing drainage,VSD)技术在高位肛周脓肿治疗中对炎症细胞因子(IL-1α、IL-6、TNF-α、IL-4、IL-10)及m RNA表达的影响。【方法】对40例高位肛周脓肿患者根据随机数字表法分为2组,每组20例。实验组行肛周脓肿内口封闭+VSD技术,对照组行肛周脓肿传统低位切开高位挂线术。术后采用ELISA检测血清炎症细胞因子及RT-PCR检测m RNA表达。【结果】两组血清炎症细胞因子术后1 d均明显下降(P<0.05),研究组促炎因子术后第7 d降低更明显,抗炎因子上升明显,与术后1d比较差异具有显著性意义(P<0.05)。术后7 d,研究组促炎因子IL-1α(58.32±3.47)pg/ml、IL-6(5.97±2.92)pg/ml、TNF-α(78.57±27.64)pg/ml分别较对照组IL-1α(94.21±2.54)pg/ml、IL-6(9.87±2.19)pg/ml、TNF-α(87.43±32.27)pg/ml降低明显(P<0.05),抗炎因子IL-4(47.32±8.52)pg/ml、IL-10(16.17±3.97)pg/ml分别较对照组IL-4(37.25±3.78)pg/ml、IL-10(13.89±3.65)pg/ml升高明显,差异具有显著性意义(P<0.05)。血清炎症细胞因子m RNA表达趋势与血清中细胞因子变化一致,研究组与对照组比较,差异具有显著性意义(P<0.05)。【结论】高位肛周脓肿治疗中应用VSD技术,通过抑制促炎细胞因子(IL-1α、IL-6、TNF-α)和促进抗炎细胞因子(IL-4、IL-10)m RNA的表达,调节血清炎症细胞因子恢复正常,对高位肛周脓肿术后机体免疫功能的恢复和炎症反应的控制具有重要作用,显著促进创面愈合。

【Objective】To investigate the effect of vacuum sealing drainage（VSD）on inflammatory cytokines（IL-1α, IL-6, TNF-α,IL-4, IL-10） and expression of m RNA in high perianal abscess.【Methods】Forty patients with high perianal abscess were divided into2 groups according to random number table, 20 cases in each group. Patients in the intervention group were treated with closure of internal orifice plus VSD. Patients in the control group were treated with traditional low incision and high thread-drawing operation for perianal abscess. Serum inflammatory cytokines by ELISA and expression of m RNA by RT-PCR were detected after operation.【Results】The level of serum inflammatory cytokines in two groups was obviously decreased（P〈0.05） the first day after operation. On the 7th day after operation, proinflammatory factors had a more evident decrease, while anti-inflammatory factors had an obvious increase in the intervention group, there was a significant difference the first and the 7th day（P〈0.05）. On the 7th day after operation, proinflammatory factor [IL-1α（58.32 ±3.47） pg/ml, IL-6（5.97 ± 2.92） pg/ml, TNF-α（78.57 ± 27.64） pg/ml] in the intervention group decreased obviously（P〈0.05） compared with that in control group [IL-1α（94.21 ± 2.54） pg/ml, IL-6（9.87 ± 2.19） pg/ml, TNF-α（87.43 ± 32.27）pg/ml]（all P〈0.05）. Anti-inflammatory factor [IL-4（47.32 ± 8.52）pg/ml、IL-10（16.17 ± 3.97）pg/ml] in the intervention group increased significantly compared with that in the control group [IL-4（37.25 ± 3.78）pg/ml、IL-10（13.89 ± 3.65）pg/ml]（all P〈0.05）.The expression of inflammatory cytokines m RNA in serum and the cytokines in the serum changed concordantly. there was a significant difference between the intervention group and the control group（P〈0.05）.【Conclusion】VSD in the treatment of high perianal abscess regulates serum inflammatory cytokines to normal state by inhibiting m RNA expression of proinflammatory cytokines（IL-1α, IL-6, TNF-α） and promoting m RNA expression of anti-inflammatory cytokines（IL-4, IL-10）. VSD has an important effect on the recovery of the immune function after operation, control of inflammatory reaction, and great promotion of wound healing in the treatment of high perianal abscess.