万应膏外敷联合手术对浆细胞性乳腺炎病人炎性因子、免疫因子及细胞间黏附分子-1、可溶性细胞间黏附分子-1的影响

Effects of external application of Wannying ointment with surgical therapy on inflammatory factors,immune factors,ICAM-1 and sICAM-1 in patients with plasma cell mastitis

目的研究万应膏外敷联合手术对浆细胞性乳腺炎(PCM)病人炎性因子、免疫因子及细胞间黏附分子-1(ICAM-1)、可溶性细胞间黏附分子-1(sICAM-1)的影响。方法随机纳入2013年7月至2019年6月石家庄市中医院收治的PCM女性病人120例,依照随机数字表法分为试验组(n=60)与对照组(n=60)。对照组行单纯肿物切除术或乳腺区段切除术治疗,试验组行单纯肿物切除术或乳腺区段切除术^(+)万应膏外敷治疗。观察两组术后引流时间、拆线时间、换药时间、切口愈合时间、住院时间等临床指标。术后7 d疼痛程度,术前、术后7 d血清超敏C反应蛋白(hs-CRP)、白介素-6(IL-6)、肿瘤坏死因子(TNF-α)等炎性因子,血清分化簇3(CD3^(+))、分化簇4(CD4^(+))、分化簇8(CD8^(+))、CD4^(+)/CD8^(+)等免疫因子水平,血清ICAM-1、sICAM-1水平。结果试验组引流时间(6.07±0.63)d、拆线时间(9.44±0.97)d、换药时间(7.94±0.83)d、切口愈合时间(8.22±0.94)d、住院时间(11.36±1.28)d及术后7 d视觉模拟评分法(VAS)评分(5.46±0.55)分均小于对照组引流时间(4.63±0.48)d、拆线时间(7.58±0.78)d、换药时间(5.85±0.62)d、切口愈合时间(6.53±0.68)d、住院时间(8.96±0.93)d及术后7 d VAS评分(3.63±0.39)分(P<0.05)。术后7 d,试验组hs-CRP(14.85±1.58)mg/L、IL-6(198.79±21.53)pg/mL、TNF-α(38.27±4.15)pg/mL低于对照组hs-CRP(20.64±2.19)mg/L、IL-6(259.52±27.19)pg/mL、TNF-α(49.22±5.17)pg/mL(P<0.05),试验组CD3^(+)(0.96±0.11)%、CD4^(+)(0.77±0.09)%、CD4^(+)/CD8^(+)(1.97±0.21)高于对照组CD3^(+)(0.87±0.10)%、CD4^(+)(0.68±0.08)%、CD4^(+)/CD8^(+)(1.55±0.16),CD8^(+)(0.39±0.04)%低于对照组CD8^(+)(0.44±0.05)%(P<0.05),试验组ICAM-1(238.62±25.29)μg/L、sICAM-1(489.52±50.65)μg/L低于对照组(281.39±30.17)μg/L、sICAM-1(426.96±44.54)μg/L(P<0.05)。试验组总有效率95.00%(57/60)高于对照组总有效率70.00%(42/60)(P<0.05)。治疗期间两组均无显著不良反应。结论万应膏外敷联合手术可有效清除病变组织,改善炎性免疫反应,抑制ICAM-1、sICAM-1生成,缓解疼痛,促进病人转归。

Objective To study the effects of external application of Wannying ointment with surgical therapy on inflammatory factors,immune factors,intercellular adhesion molecule-1(ICAM-1)and soluble intercellular adhesion molecule-1(sICAM-1)in patients with plasma cell mastitis(PCM).Methods One hundred and twenty female patients with PCM admitted to Shijiazhuang City Hospital of Traditional Chinese Medicine from July 2013 to June 2019 were enrolled and assigned into the experimental group(n=60)and the control group(n=60)according to the random number table.The control group received simple mass resection or segmental mastectomy treatment,while the experimental group received simple mass resection or segmental mastectomy treatment and Wannying ointment external treatment.Clinical indicators such as postoperative drainage time,removal time,dressing change time,wound healing time,and length of stay in the two groups were observed.The pain degree on the 7 d after surgery,the levels of serum hypersensitive C-reactive protein(hs-CRP),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)and other inflammatory factors before and after surgery,the levels of serum clusters differentiation 3(CD3^(+)),clusters differentiation 4(CD4^(+)),clusters differentiation 8(CD8^(+)),CD4^(+)/CD8^(+),serum ICAM-1 and sICAM-1 were analyzed and compared.Results Drainage time[(6.07±0.63)d vs.(4.63±0.48)d],removal time[(9.44±0.97)d vs.(7.58±0.78)d],dressing change time[(7.94±0.83)d vs.(5.85±0.62)d],wound healing time[(8.22±0.94)d vs.(6.53±0.68)d],length of stay[(11.36±1.28)d vs.(8.96±0.93)d]and Visual Analogue Scale/Score(VAS)score[(5.46±0.55)score vs.(3.63±0.39)score]at 7 d after surgical in the experimental group were all lower than those in the control group(P<0.05).hs-CRP[(14.85±1.58)mg/L vs.(20.64±2.19)]mg/L,IL-6[(198.79±21.53)pg/mL vs.(259.52±27.19)pg/mL],TNF-α[(38.27±4.15)pg/mL vs.(49.22±5.17)pg/mL]at 7 d after the surgical in the experimental group were lower than those in the control group(P<0.05).CD3^(+)[(0.96±0.11)%vs.(0.87±0.10)%],CD4^(+)[(0.77±0.09)%vs.(0.68±0.08)%],CD4^(+)/CD8^(+)[(1.97±0.21)vs.(1.55±0.16)]at 7 d after surgical in the experimental group were higher than those in the control group,and CD8^(+)(0.39±0.04)%was lower than(0.44±0.05)%of the control group(P<0.05).ICAM-1[(238.62±25.29)μg/L vs.(281.39±30.17)μg/L]and sICAM-1[(489.52±50.65)μg/L vs.(426.96±44.54)μg/L]at 7 d after the surgical in the experimental group were lower than those in the control group(P<0.05).The total effective rate 95.00%(57/60)of the experimental group was higher than 70.00%(42/60)of the control group(P<0.05).There were no significant adverse reactions in the two groups during the treatment.Conclusion improve inflammatory immune response,inhibit the generation of ICAM-1 and sICAM-1,relieve pain and promote patient prognosis.