中药熏蒸联合西医常规治疗对糖尿病足溃疡愈合及创面渗出液中VEGF、MMP-2及TIMP-1的影响

Effects of Traditional Chinese Medicine Fumigation Combined with Conventional Treatment on Healing of Diabetic Foot Ulcer and VEGF,MMP-2 and TIMP-1 in Wound Exudation

目的探讨中药熏蒸联合西医常规治疗糖尿病足溃疡的疗效及作用机制。方法糖尿病足溃疡患者64例随机分为对照组与观察组,每组32例。对照组实施西医常规治疗,观察组在常规治疗的基础上结合中药熏蒸治疗,两组均治疗14天。治疗前后收集患者创面渗出液,测定治疗前、治疗7天、治疗14天创面渗出液中血管内皮生长因子(VEGF)、基质金属蛋白酶2(MMP-2)及基质金属蛋白酶抑制剂1(TIMP-1)的含量,并比较治疗后两组患者的创面愈合率。结果两组治疗14天的创面愈合率均高于治疗7天(P<0.05),观察组治疗7天和14天的愈合率均高于对照组(P<0.05)。治疗7天和14天,对照组VEGF及TIMP-1水平均低于治疗前(P<0.05),MMP-2高于治疗前(P<0.05);观察组VEGF及TIMP-1水平均高于治疗前(P<0.05),MMP-2低于治疗前(P<0.05),且观察组治疗7天和14天的VEGF及TIMP-1含量高于对照组(P<0.05),MMP-2含量低于对照组(P<0.05)。两组治疗14天VEGF、MMP-2及TIMP-1含量与治疗7天比较,差异无统计学意义(P>0.05)。结论中药熏蒸治疗可有效促进糖尿病足溃疡创面的愈合,这可能与降低创面渗出液中的MMP-2含量,增加VEGF及TIMP-1的含量有关。

Objective To explore the clinical efficacy and mechanism of traditional Chinese medicine（ TCM）fumigation combined with conventional treatment on healing of diabetic foot ulcer. Methods A total of 64 patients with diabetic foot ulcer were randomly divided into control group and observation group,with 32 cases in each group.Control group was treated with conventional method while observation group was additionally treated with TCM fumigation on the basis of the same treatment for 14 days. The wound exudation was collected before and after treatment,and the vascular endothelial growth factor（ VEGF）,matrix metalloproteinase 2（ MMP-2） and matrix metalloproteinase inhibitor 1（ TIMP-1） were detected before and after treatment on the 7 th day and the 14 th day of treatment,and the wound healing rate of both groups after treatment were compared. Results The wound healing rate of both groups on the 7 th day treatment was higher than that on the 14 th day of treatment（ P〈0. 05）,and the healing rate of observation group was higher than that of control group on the 7 th day and 14 th day treatment（ P〈0. 05）. After 7 and 14 days of treatment,the levels of VEGF and TIMP-1 in the control group were decreased（ P〈0. 05）,and the content of MMP-2 was increased（ P〈0. 05）. The VEGF and TIMP-1 levels in the observation group were increased more than that in the observation group（ P〈0. 05）,and the content of MMP-2 was decreased（ P〈0. 05）. The levels of VEGF and TIMP-1 in the observation group were increased more than those in the control group at 7 th and 14 th day treatment（ P〈0. 05）,and the content of MMP-2 decreased more than that of the control group（ P〈0. 05）.There was no significant difference in the levels of VEGF,MMP-2 and TIMP-1 between the 2 groups at 14 days after treatment（ P〉0. 05）. Conclusion TCM fumigation treatment can effectively promote the healing of diabetic foot ulcer wounds,which may be related to reducing MMP-2 content and increasing VEGF and TIMP-1 levels in wound exudation.