回阳生肌膏对慢性皮肤溃疡脾肾阳虚证患者创面巨噬细胞的影响
|
摘要
目的探讨回阳生肌膏促进慢性皮肤溃疡脾肾阳虚证患者创面愈合的可能作用机制。方法将70例慢性皮肤溃疡脾肾阳虚证患者随机分为治疗组34例与对照组36例,治疗组采用回阳生肌膏覆盖创面,对照组采用莫匹罗星软膏覆盖创面,疗程均为14天。分别于治疗前及治疗3、7、14天切取创面中心肉芽及提取创面分泌物,采用免疫组织化学法检测创面组织巨噬细胞数量(CD68阳性细胞)、M1型巨噬细胞[CD86、诱导型一氧化氮合酶(i NOS)阳性细胞]、M2型巨噬细胞[CD206、精氨酸(Argi)阳性细胞]。使用ELISA法测定创面巨噬细胞分泌的肿瘤坏死因子α(TNF-α)与白细胞介素10 (IL-10)相对含量。结果治疗组治疗第7天M1型巨噬细胞(CD86、i NOS阳性细胞)数量和TNF-α相对含量较治疗前明显增加(P <0. 05);治疗第14天M1型巨噬细胞数量和TNF-α相对含量较治疗第7天明显减少,M2型巨噬细胞(CD206、Argi阳性细胞)数量和IL-10相对含量较治疗前明显增加(P <0. 05);对照组治疗第7天CD68、CD86、i NOS阳性细胞数量及TNF-α相对含量均明显低于治疗前(P <0. 05),治疗第14天IL-10相对含量明显低于治疗前(P <0. 05);治疗组CD68阳性细胞数量、TNF-α相对含量治疗第3、7、14天,CD86、i NOS阳性细胞数量治疗第3、7天,CD206、Argi阳性细胞数量及IL-10相对含量治疗第14天均明显高于同时间对照组(P <0. 05)。结论回阳生肌膏促进慢性皮肤溃疡脾肾阳虚证患者创面愈合的作用机制可能是促进创面巨噬细胞的分泌及表型转化,并且其作用明显优于莫匹罗星软膏。
Objective To explore the possible mechanism of Huiyang Shengji Ointment( 回阳生肌膏) in promoting wound healing in patients of chronic skin ulcer with spleen and kidney yang deficiency syndrome. Methods A total of 20 patients with chronic skin ulcers with spleen and kidney yang deficiency syndrome were randomly divided into a treatment group of 34 cases and a control group of 36 cases. The treatment group was given Huiyang Shengji Ointment and the control group was treated with Mupirocin Ointment to cover the wound. The course of treatment was both 14 days. The central granulation and the secretion of the wound were extracted before treatment,on the 3 rd,7 th and 14 th day of the treatment. Immunohistochemistry was used to detect the number of macrophages in the wound tissue( CD68 positive cells),M1 macrophages [CD86,inducible nitric oxide synthase( i-NOS) positive cells],M2 macrophages [CD206,arginine( Argi) positive cells]. The relative content of tumor necrosis factor-α( TNF-α) and interleukin 10( IL-10) secreted by macrophages in the wound was measured by ELISA. Results In the treatment group,the number of M1 macrophages( CD86,i-NOS positive cells) and the relative content of TNF-α on the 7 th day of treatment was significantly increased compared with those before treatment( P < 0. 05). On the 14 th day of treatment,the number of M1 macrophages and the relative content of TNF-α were significantly reduced compared with those on the 7 th day of treatment,and the number of M2 macrophages( CD206,Argi-positive cells) and the relative content of IL-10 were significantly increased compared with those before treatment( P < 0. 05). In the control group,the number of CD68,CD86,i-NOS positive cells and relative content of TNF-α on the 7 th day of treatment were significantly lower than those before treatment( P < 0. 05). On the 14 th day,the relative content of IL-10 was significantly lower than that before treatment( P < 0. 05). The number of CD68 positive cells and the relative content of TNF-a on the 3 rd,7 th and 14 th day of treatment,the number of CD86 and i-NOS positive cells on the 3 rd and 7 th day of treatment,the number of CD206 and Argi positive cells and the relative content of IL-10 on the 14 th day after treatment in the treatment group were significantly higher than those in the control group( P < 0. 05). Conclusion Huiyang Shengji Ointment promote wound healing in patients with chronic skin ulcer with spleen and kidney yang deficiency syndrome probably through promoting the secretion of macrophages and the transformed phenotype,and its effects are better than Mupirocin Ointment.
Objective To explore the possible mechanism of Huiyang Shengji Ointment( 回阳生肌膏) in promoting wound healing in patients of chronic skin ulcer with spleen and kidney yang deficiency syndrome. Methods A total of 20 patients with chronic skin ulcers with spleen and kidney yang deficiency syndrome were randomly divided into a treatment group of 34 cases and a control group of 36 cases. The treatment group was given Huiyang Shengji Ointment and the control group was treated with Mupirocin Ointment to cover the wound. The course of treatment was both 14 days. The central granulation and the secretion of the wound were extracted before treatment,on the 3 rd,7 th and 14 th day of the treatment. Immunohistochemistry was used to detect the number of macrophages in the wound tissue( CD68 positive cells),M1 macrophages [CD86,inducible nitric oxide synthase( i-NOS) positive cells],M2 macrophages [CD206,arginine( Argi) positive cells]. The relative content of tumor necrosis factor-α( TNF-α) and interleukin 10( IL-10) secreted by macrophages in the wound was measured by ELISA. Results In the treatment group,the number of M1 macrophages( CD86,i-NOS positive cells) and the relative content of TNF-α on the 7 th day of treatment was significantly increased compared with those before treatment( P < 0. 05). On the 14 th day of treatment,the number of M1 macrophages and the relative content of TNF-α were significantly reduced compared with those on the 7 th day of treatment,and the number of M2 macrophages( CD206,Argi-positive cells) and the relative content of IL-10 were significantly increased compared with those before treatment( P < 0. 05). In the control group,the number of CD68,CD86,i-NOS positive cells and relative content of TNF-α on the 7 th day of treatment were significantly lower than those before treatment( P < 0. 05). On the 14 th day,the relative content of IL-10 was significantly lower than that before treatment( P < 0. 05). The number of CD68 positive cells and the relative content of TNF-a on the 3 rd,7 th and 14 th day of treatment,the number of CD86 and i-NOS positive cells on the 3 rd and 7 th day of treatment,the number of CD206 and Argi positive cells and the relative content of IL-10 on the 14 th day after treatment in the treatment group were significantly higher than those in the control group( P < 0. 05). Conclusion Huiyang Shengji Ointment promote wound healing in patients with chronic skin ulcer with spleen and kidney yang deficiency syndrome probably through promoting the secretion of macrophages and the transformed phenotype,and its effects are better than Mupirocin Ointment.
引文
[1]高博闻,何际洲,李青峰.干细胞在治疗慢性皮肤溃疡中的应用进展[J].组织工程与重建外科杂志,2017,13(4):234-237.
[2]杨涛,谭杨,陈劲奕,等.慢性皮肤溃疡的诊治进展[J].中国医学文摘(皮肤科学),2017,34(3):308-312,261.
[3]王广宇,王伏声,丁毅,等.回阳生肌膏对慢性皮肤溃疡形态变化的初步研究[J].中国医药导报,2014,11(22):90-93.
[4]BARTLETT A,SANDERS AJ,RUGE F,et al. Potential implications of interleukin-7 in chronic wound healing[J].Exp Ther Med,2016,12(1):33-40.
[5]BOINK MA,ROFFEL S,NAZMI K,et al. The influence of chronic wound extracts on inflammatory cytokine and histatin stability[J]. PLo S One,2016,11(3):e0152613.
[6]国家中医药管理局.中医病证诊断疗效标准[S].北京:中国医药科技出版社,2012:140-143.
[7]郑莜萸.中药新药临床研究指导原则(试行)[M].中国医药科技出版社,2002:361-388.
[8]徐旭英,杨博华,李友山,等.复方黄柏液涂剂治疗外伤感染的临床疗效研究[J].中国新药杂志,2016,25(20):2349-2352.
[9]李明辉,刘洋,陈冲,等.自体脂肪源性干细胞联合无菌生物护创膜对慢性创面愈合的影响[J].解放军医学杂志,2016,41(12):1025-1030.
[10]余墨声,朱占永,赵月强,等.慢性创面的临床治疗进展[J].临床外科杂志,2016,24(3):165-167.
[11]严龙宗,陈斌.慢性创面愈合的细胞治疗[J].中国组织工程研究,2013,17(46):8096-8101.
[12]李俊亮,巴特.慢性创面发病的分子机制[J].中国冶金工业医学杂志,2011,28(1):1-3.
[13]林才,罗旭.细胞缺氧与创面难愈的相关性思考[J].中华损伤与修复杂志(电子版),2010,5(3):298-301.
[14]LUCAS TW,AISMAN A,RANJAN R,et al. Differential roles of macrophages in diverse phases of skin repair[J]. J Immunol,2010,184(7):3964-3977.
[15]BRANCATO SK,ALBINA JE. Wound macrophages as key regulators of repair:origin,phenotype and function[J].Am J Pathol,2011,178(1):19-25.
[16]黄康,陈玉林.创面愈合评价指标进展[J].中国修复重建外科杂志,2001,15(2):126-129.
[17]贾连城,吕培文.吕培文应用回阳生肌法治疗慢性难愈性皮肤溃疡经验总结[J].中国医药导报,2015,12(28):85-88.
[18]李媛,赵光明,董建勋,等.回阳生肌膏及其拆方对糖尿病慢性皮肤溃疡大鼠血清白细胞介素-1α和血栓素B2含量的影响[J].中国中医药信息杂志,2014,21(7):43-46.
[19]张旭辉,董建勋,李健,等.回阳生肌方药对慢性皮肤溃疡大鼠创面愈合及炎症因子的影响[J].北京中医药大学学报,2013,36(3):170-173.
[2]杨涛,谭杨,陈劲奕,等.慢性皮肤溃疡的诊治进展[J].中国医学文摘(皮肤科学),2017,34(3):308-312,261.
[3]王广宇,王伏声,丁毅,等.回阳生肌膏对慢性皮肤溃疡形态变化的初步研究[J].中国医药导报,2014,11(22):90-93.
[4]BARTLETT A,SANDERS AJ,RUGE F,et al. Potential implications of interleukin-7 in chronic wound healing[J].Exp Ther Med,2016,12(1):33-40.
[5]BOINK MA,ROFFEL S,NAZMI K,et al. The influence of chronic wound extracts on inflammatory cytokine and histatin stability[J]. PLo S One,2016,11(3):e0152613.
[6]国家中医药管理局.中医病证诊断疗效标准[S].北京:中国医药科技出版社,2012:140-143.
[7]郑莜萸.中药新药临床研究指导原则(试行)[M].中国医药科技出版社,2002:361-388.
[8]徐旭英,杨博华,李友山,等.复方黄柏液涂剂治疗外伤感染的临床疗效研究[J].中国新药杂志,2016,25(20):2349-2352.
[9]李明辉,刘洋,陈冲,等.自体脂肪源性干细胞联合无菌生物护创膜对慢性创面愈合的影响[J].解放军医学杂志,2016,41(12):1025-1030.
[10]余墨声,朱占永,赵月强,等.慢性创面的临床治疗进展[J].临床外科杂志,2016,24(3):165-167.
[11]严龙宗,陈斌.慢性创面愈合的细胞治疗[J].中国组织工程研究,2013,17(46):8096-8101.
[12]李俊亮,巴特.慢性创面发病的分子机制[J].中国冶金工业医学杂志,2011,28(1):1-3.
[13]林才,罗旭.细胞缺氧与创面难愈的相关性思考[J].中华损伤与修复杂志(电子版),2010,5(3):298-301.
[14]LUCAS TW,AISMAN A,RANJAN R,et al. Differential roles of macrophages in diverse phases of skin repair[J]. J Immunol,2010,184(7):3964-3977.
[15]BRANCATO SK,ALBINA JE. Wound macrophages as key regulators of repair:origin,phenotype and function[J].Am J Pathol,2011,178(1):19-25.
[16]黄康,陈玉林.创面愈合评价指标进展[J].中国修复重建外科杂志,2001,15(2):126-129.
[17]贾连城,吕培文.吕培文应用回阳生肌法治疗慢性难愈性皮肤溃疡经验总结[J].中国医药导报,2015,12(28):85-88.
[18]李媛,赵光明,董建勋,等.回阳生肌膏及其拆方对糖尿病慢性皮肤溃疡大鼠血清白细胞介素-1α和血栓素B2含量的影响[J].中国中医药信息杂志,2014,21(7):43-46.
[19]张旭辉,董建勋,李健,等.回阳生肌方药对慢性皮肤溃疡大鼠创面愈合及炎症因子的影响[J].北京中医药大学学报,2013,36(3):170-173.