以“生肌三法”为代表的方药对糖尿病足伴慢性疮面作用机制的探讨

Exploration on the Mechanism of Prescriptions of“Three Methods of Promoting Granulation”on Diabetic Foot with Chronic Sores

目的:紫色疽疮膏、回阳生肌膏、朱红膏是我科生肌三法的代表方药,通过临床研究观察疮面修复中起重要作用的细胞因子TNF-α、VEGF、bFGF变化情况,初步探讨其作用机制。方法:选取2015年1月至2016年5月北京中医医院收治的糖尿病伴慢性疮面患者90例作研究对象,按照局部辨证分为活血生肌组、回阳生肌组和去腐生肌组,每组30例。溃疡中医证侯积分观察治疗0、6、12 d。留取治疗0、3、6 d局部组织及疮面渗出物,检测其中TNF-α、VEGF、bFGF 3种生长因子在渗出物中含量变化,组织中蛋白及mRNA相对量的变化。结果:中医证候积分部有效率为53.3%,组间差异无统计学意义(P=0.428);中医外用药应用于疮面后,渗出物、组织中蛋白和组织中mRNA表达,TNF-α、VEGF、bFGF 3种生长因子,有着较为一致的检测结果。紫色疽疮膏治疗3 d VEGF、bFGF升高明显,后有所下降,而对TNF-α无明显影响;回阳生肌膏治疗3 d后bFGF、TNF-α后升高明显,6 d时稍有下降,而对VEGF无明显影响;朱红膏对TNF-α、VEGF、bFGF 3种生长因子有缓慢持续的升高作用。结论:观察到紫色疽疮膏影响了VEGF、bFGF;回阳生肌膏方对TNF-α、bFGF有较强的升高作用;朱红膏方对TNF-α、VEGF、bFGF均有缓慢持续的升高,通过调整这些重要的细胞因子,从而改变疮面的状态。

Objective:Zise Juchuang Ointment,Huiyang Shengji Ointment and Zhuhong Ointment are representative prescriptions of“three methods of promoting granulation”in my department.To preliminarily explore the mechanism through clinical study and observation on changes of TNF-α,VEGF and bFGF that play important roles in sore repair.Methods:A total of 90 patients of diabetes with chronic sores admitted in Beijing Hospital of Traditional Chinese Medicine from January 2015 to May 2016 were selected as study objects.According to local syndrome differentiation,they were divided into invigorating blood and promoting granulation(IBPG)group,restoring yang and promoting granulation(RYPG)group and eliminating necrosis and promoting granulation(ENPG)group,with 30 cases in each group.Ulcer syndrome scores in traditional Chinese medicine(TCM)were observed before the treatment,and on the 6th and 12th days.Local tissue and sore surface exudate were collected before the treatment,and on the 3th and 6th days.Content changes of the 3 growth factors-TNF-α,VEGF and bFGF in the exudate,and relative amount changes of protein and mRNA in the tissue were detected.Results:Effective rate of TCM syndrome score was 53.3%,and there was no statistical significance in the difference between the groups(P=0.428).After TCM external application to sores,in the expressions of mRNA in the tissue and protein in the tissue and exudate,as well as in the 3 kinds of growth factors(TNF-α,VEGF and bFGF),the detection results were relatively consistent.After the treatment with Zise Juchuang Ointment for 3 d,VEGF and bFGF were increased significantly,but they were decreased later,and there was no significant effect on TNF-α.After 3 d of the treatment with Huiyang Shengji Ointment,bFGF and TNF-αwere increased significantly,and they were decreased on the 6th d,but there was no significant effect on VEGF.Zhuhong Ointment had a slow and sustained increasing effect on the 3 kinds of growth factors(TNF-α,VEGF and bFGF).Conclusion:It can be observed that Zise Juchuang Ointment may affect VEGF and bFGF;Huiyang Shengji Ointment may strongly increase TNF-αand bFGF;Zhuhong Ointment has a slow and continuous increasing effect on TNF-α,VEGF and bFGF.By adjusting these important cytokines,the state of sores is changed.