曲尼司特辅助治疗烧伤后瘢痕疗效及对胶原纤维和MMPs的调节效应

Curative Effect of Tranilast in the Adjuvant Treatment of Scar after Burn and Its Modulating Effect on Collagen Fibers and MMPs

目的:探究曲尼司特联合疤痕止痒软化膏超声导入治疗烧伤后瘢痕的美学效果及对胶原纤维指标、基质金属蛋白酶(Matrix metalloproteinase,MMPs)的调节效应。方法:选取2017年8月-2020年8月笔者医院106例烧伤后瘢痕患者,采用随机数字表法分为对照组(n=53)、联合组(n=53)。两组均采取常规治疗,对照组采取疤痕止痒软化膏超声导入,联合组在对照组基础上使用曲尼司特,均治疗3个月。统计两组临床疗效、不良反应发生率,对比治疗前后改良温哥华瘢痕量表(Vancouver scar scale,VSS)及超声指标、胶原纤维指标(Ⅰ型胶原纤维、Ⅲ型胶原纤维)、基质金属蛋白酶-2(Matrix metalloproteinase-2,MMP-2)、基质金属蛋白酶-9(Matrix metalloproteinase-9,MMP-9)、促血管生成因子(Vascular endothelial growth factor,VEGF)水平。结果:治疗3个月后,联合组治疗总有效率90.57%高于对照组71.70%(P<0.05);治疗3个月后联合组色泽、血管分布、厚度、柔软度评分低于对照组,瘢痕厚度小于对照组,瘢痕血流阻力指数高于对照组(P<0.05);治疗3个月后联合组疼痛、瘙痒评分低于对照组(P<0.05);治疗3个月后联合组Ⅰ型胶原纤维、Ⅲ型胶原蛋白及组织MMP-2、VEGF、MMP-9水平均低于对照组(P<0.05);治疗3个月后联合组患者美观满意度92.45%高于对照组75.47%(P<0.05);联合组不良反应发生率3.77%与对照组7.55%比较,差异无统计学意义(P>0.05)。结论:曲尼司特、疤痕止痒软化膏超声导入联合用于烧伤后瘢痕疗效确切,同时具有良好美容效果,可发挥对胶原纤维指标、MMPs的调节效应,改善瘢痕严重程度、疼痛、瘙痒等情况,该治疗方案安全可靠。

Objective To explore the aesthetic effect of tranilast combined with scar anti-itch softening ointment in the treatment of scar after burn and its regulatory effect on collagen fiber index and Matrix metalloproteinase(MMPs).Methods A total of 106 patients with scar after burn in the author's hospital from August 2017 to August 2020 were selected and divided into a control group(n=53)and a combination group(n=53)by a random number table.Both groups were treated with conventional treatment.The control group was treated with scar Zhiyang softening ointment by ultrasound,and the combination group was treated with tranilast based on the control group.Both groups were treated for 3 months.Statistics of the clinical efficacy and incidence of adverse reactions of the 2 groups,and comparison of the degree of scars(VSS)before and after treatment,ultrasound index,collagen fiber index(typeⅠcollagen fiber,typeⅢcollagen fiber),matrix metalloproteinase-2(MMP-2),matrix metalloproteinase-9(MMP-9),angiogenesis factor(VEGF).Results After 3 months of treatment,the total effective rate of treatment in the combination group was 90.57%higher than that of the control group 71.70%(P<0.05),after 3 months of treatment,the color,vascular distribution,thickness,and softness scores of the combination group were lower than those of the control group.The thickness is smaller than that of the control group,and the scar blood flow RI is higher than that of the control group(P<0.05),the pain and itching scores of the combined group after 3 months of treatment are lower than those of the control group(P<0.05),after 3 months of treatment,the combined group type I collagen The levels of fiber,typeⅢcollagen and tissue MMP-2,VEGF,and MMP-9 were lower than those of the control group(P<0.05),after 3 months of treatment,the aesthetic satisfaction of patients in the combined group was 92.45%higher than that of the control group 75.47%(P<0.05).The incidence of adverse reactions in the combined group was 3.77%compared with 7.55%in the control group,and the difference was not statistically significant(P>0.05).Conclusion The combination of Tranilast and scar anti-itch softening ointment with ultrasonic introduction for scar after burns has a definite effect,and has a good cosmetic effect.It can play a regulating effect on collagen fiber indexes and MMPs,and improve scar severity,pain,itching,etc.Circumstances,the treatment plan is safe and reliable.