中医药治疗肛瘘术后创面愈合相关信号通路研究进展

Research Progress on Signaling Pathways Related to Wound Healing after TCM Treatment of Anal Fistula

肛瘘为肛肠科第二大疾病。由于现代饮食结构、生活习惯等的改变,肛瘘发病率不断升高。手术为目前公认根治肛瘘的唯一方式。但肛瘘术后创面愈合周期长,疼痛明显,容易感染。肛瘘术后创面难愈是肛瘘术后患者主要痛苦所在。部分患者可能会出现创面延迟愈合,反复感染,瘢痕严重挛缩等情况。肛瘘术后创面愈合情况是肛瘘治疗效果的重要指标之一。中医药在治疗肛瘘术后创面愈合上以其疗效好,患者痛苦少,治疗费用低等特点在临床上广受好评。目前发现部分中草药,中药复方,以及中草药化合物的有效成分能有效促进肛瘘术后创面愈合,其相关机制的研究也陆续开展。信号通路参与并连接了创面愈合的各个阶段,是肛瘘术后创面愈合病理机制,药物药理研究的主要靶点之一。通过检索发现中医药可通过调控磷脂酰肌醇-3激酶蛋白激酶B(phosphoinositide3-kinese/protein kinase B,PI3K/Akt)信号通路、Hippo信号通路、缺氧诱导因子1(hypoxia-inducible factor-1,HIF-1)信号通路、TGF-β/Smad信号通路等通路,减轻炎症反应,促进新血管生成,加速创面纤维化,促进肛瘘术后创面愈合,改善创面愈合质量。文章归纳了中医治疗肛瘘术后创面愈合相关信号及其作用机制,旨在为中医药治疗肛瘘术后创面愈合的进一步研究和探索提供理论参考以及新的思路与方向。

Anal fistula is the second most common disease in anorectal department.Due to changes in modern dietary structure and living habits,the incidence of anal fistula is increasing.Surgery is currently recognized as the only way to cure anal fistula.However,the wound healing period after anal fistula surgery is long,the pain is obvious,and it is easy to be infected.Refractory wounds after anal fistula surgery are the main pain points for patients after anal fistula surgery.Some patients may experience delayed wound healing,repeated infection,and severe scar contracture.The wound healing after anal fistula surgery is one of the traditional Chinese medicine indicators of the treatment effect of anal fistula.Traditional Chinese medicine is widely acclaimed in clinic for its good curative effect,less pain for patients and low treatment cost in the treatment of postoperative wound healing of anal fistula.At present,it has been found that Chinese herbal medicines,Chinese medicine compounds,and active ingredients of Chinese herbal medicine compounds can effectively promote wound healing after anal fistula surgery,and research on its related mechanisms has been carried out one after another.Signaling pathways are involved in and connect various stages of wound healing,and are one of the main targets of pharmacological research on the pathological mechanism of wound healing after anal fistula surgery.Through searching,it was found that traditional Chinese medicine can reduce inflammation,promote new blood vessel formation,accelerate wound fibrosis,and promote anal fistula by regulating PI3K/Akt signaling pathway,Hippo signaling pathway,HIF-1 signaling pathway,TGF-β/Smad signaling pathway and other pathways.Postoperative wound healing improves the quality of wound healing.This paper summarizes the related signals and mechanisms of wound healing after TCM treatment of anal fistula,aiming to provide theoretical references and new ideas and directions for further research and exploration of TCM treatment of postoperative wound healing.