外用中药瘢痕膏促进创面愈合、防治瘢痕的实验研究
|
摘要
目的:探讨瘢痕膏对创面是否有促进愈合作用,对瘢痕是否有防治作用,为其临床应用提供理论和实践依据。
方法:①实验一:选用新西兰大耳白兔12只,适应性喂养24小时,建立兔耳瘢痕模型,每只兔耳建立6个创面,共计72个创面,随机分为三组,分别为实验组,药物对照组和空白组,实验组和药物对照组于瘢痕模型建立后24小时开始用药,实验组采用瘢痕膏涂抹创面(瘢痕膏为一种外用中药制剂。其主要成分为丹参酮、积雪甙、黄芪甙、甘草酸、苦参碱等,按3:3:2:2:1的比例加基质制作而成),对照组采用湿润烧伤膏涂抹,空白对照组涂抹基质。连续用药30天,于动物模型建立后第7、14、21、28天切取创面,制作标本。分别观察创面愈合情况,观察组织学结构,对生长因子(EGF、bFGF)进行检测。
②实验二:选用新西兰大耳白兔8只,适应性喂养24小时,建立兔耳增生瘢痕模型,每只兔耳建立6个创面,共计48个创面,随机分为两组,分别为实验组和远期疗效组,实验组于瘢痕模型建立后24小时开始用药,远期疗效组于创面上皮化(即模型建立后第21天)开始用药,两组都采用瘢痕膏涂抹创面,连续用药90天。于第90天用游标卡尺测量瘢痕增生厚度,第90天用Periflux5000激光多普勒血流仪检测瘢痕组织微循环血流灌注,第90天切取创面,制作标本,进行VG染色。分别观察瘢痕增生情况,瘢痕微血管计数,瘢痕胶原面面积比的测定。
结果:实验一:①用药第28天,实验组瘢痕略高于兔耳皮肤表面,颜色稍红,接近兔耳正常皮肤颜色,触之质软;其余两组明显高于兔耳皮肤表面,颜色较红,质地硬;②用药第24天,实验组兔耳的创面愈合情况要好于其他两组;③用药第14天和第28天,三组间创面的白细胞计数没有差别;④用药第21天的EGF检测,实验组和药物对照组无差别,但这两组都高于空白组;对bFGF检测,第7、14、21天的数据显示,实验组和药物对照组皆无差别,这两组计数都高于空白组。
实验二:①用药第90天,实验组和远期疗效组的瘢痕增生厚度之间没有差别;②用药第90天,实验组和远期疗效组瘢痕微血管计数之间无差别;③用药第90天,实验组和远期疗效组瘢痕组织的胶原面面积之间无差别。
结论:①此外用中药在创伤早期应用,对创面的愈合具有促进作用。
②尚不能证实何时应用瘢痕膏对增生性瘢痕的抑制作用最为理想。
Objective:To investigate the effect of Compound Traditional Chinese Medicine Unguent on the wound surface and scar.
Methods:1.①To choose 12 New Zealand rabbits(3-4 months years old)as experiment animals.②The models of hypertrophic scar(HS)in ears were reproduced.Compartmentalizemeasure off the 12 rabbits to 3 groups randomly,the groups are experiment group,medicine control group and blank group.There are 8 ears(48 wound surfaces)in every group.③On the 7,14,21, 28 day after the model setting up,taking the scar and flatting exemplar.④To observe the condition of wounds,the architectonic of histology and the growth factor(EGF,bFGF).
2.①To choose 8 New Zealand rabbits(3-4 months years old)as experiment animals.②The models of hypertrophic scar(HS)in ears were reproduced.Compartmentalizemeasure off the 8 rabbits to 2 groups randomly,the groups are experiment group and prostecdtive efficacy group.There are 8 ears(48 wound surfaces)in every group.③On the 90 day after the model setting up,the micro-circulation of scars are detected with laser Doppler flowmetry.To observe the condition of wounds,the architectonic of histology and the areas of collagen.
Results:1.①Change of appearance:After use of the drug,the scars of the experiment group became depauperate markedly,higher than the skin slightly,close to the normal skin in colour and soft when touching;but they appeared proliferative in the other groups and were higher than the skin obviously with red colour and hard when touching.②Condition of wound surfaces:The experiment group is better than the other groups.③Lencocyte count:There is no difference from the three groups.④EGF:There is no difference from the experiment group and medicine control group,but their numbers are more than the blank group on the 21 day;bFGF:There is no difference from the experiment group and medicine control group,but their numbers are more than the blank group.
2.①The thickness of the scars:There is no difference from the three groups.②Micro-vessel counting:There is no difference from the three groups.③The area density of collagen fibers:There is no difference from the three groups.
Conclusions:①The Traditional Chinese Unguent can promote the wound surfaces to heal if using it early.
②It can't find the best time when use The Traditional Chinese Unguent.
方法:①实验一:选用新西兰大耳白兔12只,适应性喂养24小时,建立兔耳瘢痕模型,每只兔耳建立6个创面,共计72个创面,随机分为三组,分别为实验组,药物对照组和空白组,实验组和药物对照组于瘢痕模型建立后24小时开始用药,实验组采用瘢痕膏涂抹创面(瘢痕膏为一种外用中药制剂。其主要成分为丹参酮、积雪甙、黄芪甙、甘草酸、苦参碱等,按3:3:2:2:1的比例加基质制作而成),对照组采用湿润烧伤膏涂抹,空白对照组涂抹基质。连续用药30天,于动物模型建立后第7、14、21、28天切取创面,制作标本。分别观察创面愈合情况,观察组织学结构,对生长因子(EGF、bFGF)进行检测。
②实验二:选用新西兰大耳白兔8只,适应性喂养24小时,建立兔耳增生瘢痕模型,每只兔耳建立6个创面,共计48个创面,随机分为两组,分别为实验组和远期疗效组,实验组于瘢痕模型建立后24小时开始用药,远期疗效组于创面上皮化(即模型建立后第21天)开始用药,两组都采用瘢痕膏涂抹创面,连续用药90天。于第90天用游标卡尺测量瘢痕增生厚度,第90天用Periflux5000激光多普勒血流仪检测瘢痕组织微循环血流灌注,第90天切取创面,制作标本,进行VG染色。分别观察瘢痕增生情况,瘢痕微血管计数,瘢痕胶原面面积比的测定。
结果:实验一:①用药第28天,实验组瘢痕略高于兔耳皮肤表面,颜色稍红,接近兔耳正常皮肤颜色,触之质软;其余两组明显高于兔耳皮肤表面,颜色较红,质地硬;②用药第24天,实验组兔耳的创面愈合情况要好于其他两组;③用药第14天和第28天,三组间创面的白细胞计数没有差别;④用药第21天的EGF检测,实验组和药物对照组无差别,但这两组都高于空白组;对bFGF检测,第7、14、21天的数据显示,实验组和药物对照组皆无差别,这两组计数都高于空白组。
实验二:①用药第90天,实验组和远期疗效组的瘢痕增生厚度之间没有差别;②用药第90天,实验组和远期疗效组瘢痕微血管计数之间无差别;③用药第90天,实验组和远期疗效组瘢痕组织的胶原面面积之间无差别。
结论:①此外用中药在创伤早期应用,对创面的愈合具有促进作用。
②尚不能证实何时应用瘢痕膏对增生性瘢痕的抑制作用最为理想。
Objective:To investigate the effect of Compound Traditional Chinese Medicine Unguent on the wound surface and scar.
Methods:1.①To choose 12 New Zealand rabbits(3-4 months years old)as experiment animals.②The models of hypertrophic scar(HS)in ears were reproduced.Compartmentalizemeasure off the 12 rabbits to 3 groups randomly,the groups are experiment group,medicine control group and blank group.There are 8 ears(48 wound surfaces)in every group.③On the 7,14,21, 28 day after the model setting up,taking the scar and flatting exemplar.④To observe the condition of wounds,the architectonic of histology and the growth factor(EGF,bFGF).
2.①To choose 8 New Zealand rabbits(3-4 months years old)as experiment animals.②The models of hypertrophic scar(HS)in ears were reproduced.Compartmentalizemeasure off the 8 rabbits to 2 groups randomly,the groups are experiment group and prostecdtive efficacy group.There are 8 ears(48 wound surfaces)in every group.③On the 90 day after the model setting up,the micro-circulation of scars are detected with laser Doppler flowmetry.To observe the condition of wounds,the architectonic of histology and the areas of collagen.
Results:1.①Change of appearance:After use of the drug,the scars of the experiment group became depauperate markedly,higher than the skin slightly,close to the normal skin in colour and soft when touching;but they appeared proliferative in the other groups and were higher than the skin obviously with red colour and hard when touching.②Condition of wound surfaces:The experiment group is better than the other groups.③Lencocyte count:There is no difference from the three groups.④EGF:There is no difference from the experiment group and medicine control group,but their numbers are more than the blank group on the 21 day;bFGF:There is no difference from the experiment group and medicine control group,but their numbers are more than the blank group.
2.①The thickness of the scars:There is no difference from the three groups.②Micro-vessel counting:There is no difference from the three groups.③The area density of collagen fibers:There is no difference from the three groups.
Conclusions:①The Traditional Chinese Unguent can promote the wound surfaces to heal if using it early.
②It can't find the best time when use The Traditional Chinese Unguent.
引文
1.徐荣祥,许增禄.烧伤湿性医疗技术对表皮再生干细胞作用的研究.中国烧伤创疡科技中心,2000,3:42
2.腊蕾,蒋雪涛,霍启录.复方磺胺嘧啶银胶原蛋白烧伤膜的药效学研究.中国药学杂志,2002,37(9):672
3.李荟元,刘建波,夏炜,等.增生性瘢痕动物实验模型的建立与应用.中华整形外科杂志,2001,17(5):276-278
4.刘文阁,李素娟.瘢痕预防治疗学[M].北京:学苑出版社,2000:15.
5.Lekic P,McCulloch CA.Periodontal ligament cell populations:the central role of fibroblasts in creating a unique tissue[J].Anat Rec,1996,245(2):327-341.
6.Amadeu TP,Coulomb B,Desmouliere A.Cutaneous wound healing:myofibroblasdc differentiation and in vitro models[J].Lower Extrem Wounds,2003,2(2):60-68.
7.张玄,李世荣,李荟元,等.丹参对增生性瘢痕成纤维细胞形态的影响及增殖抑制初探.中华医学美容杂志,1999,5(2):73-76.
8.吴志远,罗少军,汤少明,等.丹参酮ⅡA对兔耳增生性瘢痕组织形成的影响.广东医学院学报,2002,20(4),255-259.
9.陈建常,史振满,周雪峰,等.丹参外用促进创面愈合的实验与临床研究.中国中西医结合外科杂志,1998,4(4):209-210.
10.陈建常,史振满,周雪峰,等.丹参注射液外用对创面愈合影响的实验研 究.新疆医学,1997,27(2):70-71.
11.商庆新,张涤生,关文祥,等.丹参和川芎嗪对瘢痕成纤维细胞DNA含量及细胞周期进程的影响.中国修复重建外科杂志,1998,12(6):325-328
12.祁少海,谢举临,利天增,等.积雪草甙对烧伤增生性瘢痕作用的实验研究.中华烧伤杂志,2000,16(1):53-56
13.宋清华,狄春晖,崔鸣,等.积雪甙对伤口愈合作用的基础研究.中国医药导刊,2000,2(5):37-39.
14.张罗修,王梦,钱云,等.丹参素、黄芩甙等对大鼠腹腔巨噬细胞产生PGE2、TXB2的影响.中药药理与临床,1990,6(4):31-33.
15.刘德伍,苏子毅.当归对兔耳增生性瘢痕的治疗作用.中药药理与临床,1998,14(6):30-31
16.汤苏阳,蔡宝仁,黄高升,等.苦参碱对人增生性瘢痕成纤维细胞增殖的影响.中国美容医学,2001,10(1):6-8.
17.汤苏阳,徐获荣,王强,等.苦参碱对人增生性瘢痕成纤维细胞细胞周期和DNA含量的影响.中华医学美学美容,2002,8(1):30-32.
18.汤苏阳,黄高升,蔡宝仁.苦参碱对人增生性瘢痕成纤维细胞超微结构的影响.中国美容医学,2001,10(2):100-102.
19.汤苏阳,蔡宝仁,黄高升,等.苦参碱对人增生性瘢痕成纤维细胞合成胶原的影响.实用美容整形外科杂志,2000,12(6):330-331.
1 Berman B,Bieley HC.Adjunet therapies to surcal management of keloid.Dermatol Surg,1996;22(1):126-130.
2 Brissett AE,Sherris DA.Scar contractures,hypertrophic sear,and keloids.Facial plast Surg,2001:17(4):263-272.
3 Lee Y,Minn KW,Baek RM,et al.A new surgical treatment of keloid:keloid core Excision,Ann Plast Surg,2001;46(2):135-140.
4 Danielsen CC,Wiggcrs H.Andersen HR.Increased amounts of collagenase and gelatinase in porcine myecardium foiling ischemia and reperfusion.J Mol cell Cardiol,1998;30(4):1431-1437.
5 Cheng W,Saing H,Zhou H,et al.Ultrasound assessment of scaid sars in Asian children receiving pressure garment therapy.J Pediatr Surg,2001;36(3):466-469.
6 Henderson DL.Crem well TA,Mcs LG.Argon and carbon dioxide laser treatment of hypertrophic and keloid scars.Lasers Surg Med,1984;3(2):271.
7 Alster TS.Laser treatment of hypertrophic scars,keloids and striae(JV).Dermatol Clin 1997;3(2):419-425.
8 Lawrence WT.In search of the optimal treatment of keloids:report of a series and a review of the literature.Ann Plast Surg,1997;27:164.
9 Stucker FJ.An approach of management of kcloid.Arch Otolaryngol.Head Neck Surg,1992;118:63.
10 董兰华,马嘉敏,李勇义.液氮冷冻治疗瘢痕疙瘩255例[J].青海医药杂志,1996:26(1):69-70.
11 Phillips TJ,Gerstein AD,Lordan V.A randomized controlled trial of hydrocolloid,dressing in the treatment of hypertrophic'scars and keloids.Dermatol Surg,1996;22(9):775-778.
12 Lee SM,Ngim CK,Chan YY,et al.A comparison of Sil-k and epiderm in scar management.Burns,1996;22(6):483-487.
13 Wong TW,Chiu HC,Chang CH,et al.Silicone cream occlusive dressing a novel noninvasivc regimen in the treatment of keloid.Dermatolgy,1996;192(4):327-333.
14 De Oliverirgt GV,Nunes TA,Magna LA,et al.Silicone versus nonsilicone gel Dressings:a controlled trial.Dermotol Surg,2001;27(8):721-726.
15 Suetak T,Sasai S,Zhcn YX,et al.Efects of silicone gel sheet on the stratum corncum hydration.Br J Plast Surg,2000;53(6):503-507.
16 Sayah DN,Soo C,Shaw WW,et al.Downregulation of apoptosis-related genes in kekid tissues.J Surg Res,1999;87:209-216.
17 鲍卫许,徐少骏.激素治疗瘢痕的机理研究[J].中华外科杂志,2000:38(5):378-381.
18 李荟元.瘢痕的药物治疗进展[J].中国临床复,2002:6(8):1090-1092.
19 shah M.Control of scarring in adult wounds by neutralizing antibody to transforming growth factor- β.Lancet,1992;339;213.
20 Grastein RD,Flotle TJ,Amento EP.Interferon and collagen production.J Invest Dermatol,1990;95:75.
21 郭传勇,李定国,田字彬,等.丹参及川穹嗪对人成纤维细胞DNA和胶原合成的影响[J].上海第二医科大学学报,1996:16(3):217-218.
22 Delimpens J.The local treatment of hypertrophic scars and keloids with topical retinoie acid.Br J Dermatol,1980;103:319.
23 Daly TJ,Golitz LE,Weston WL.A double-blind placebo-controlled eflicacy study of tretinoin cream 0.05%in the treatment of keloids and hypertrophic scars.J~Invest Dermatol,1986;86:470.
24 Fitzpatrick RE.Treatment of inflamed hypertrophic scars using intralesional 5-Fu.Dermatol Surg,1999;25:142-146.
2.腊蕾,蒋雪涛,霍启录.复方磺胺嘧啶银胶原蛋白烧伤膜的药效学研究.中国药学杂志,2002,37(9):672
3.李荟元,刘建波,夏炜,等.增生性瘢痕动物实验模型的建立与应用.中华整形外科杂志,2001,17(5):276-278
4.刘文阁,李素娟.瘢痕预防治疗学[M].北京:学苑出版社,2000:15.
5.Lekic P,McCulloch CA.Periodontal ligament cell populations:the central role of fibroblasts in creating a unique tissue[J].Anat Rec,1996,245(2):327-341.
6.Amadeu TP,Coulomb B,Desmouliere A.Cutaneous wound healing:myofibroblasdc differentiation and in vitro models[J].Lower Extrem Wounds,2003,2(2):60-68.
7.张玄,李世荣,李荟元,等.丹参对增生性瘢痕成纤维细胞形态的影响及增殖抑制初探.中华医学美容杂志,1999,5(2):73-76.
8.吴志远,罗少军,汤少明,等.丹参酮ⅡA对兔耳增生性瘢痕组织形成的影响.广东医学院学报,2002,20(4),255-259.
9.陈建常,史振满,周雪峰,等.丹参外用促进创面愈合的实验与临床研究.中国中西医结合外科杂志,1998,4(4):209-210.
10.陈建常,史振满,周雪峰,等.丹参注射液外用对创面愈合影响的实验研 究.新疆医学,1997,27(2):70-71.
11.商庆新,张涤生,关文祥,等.丹参和川芎嗪对瘢痕成纤维细胞DNA含量及细胞周期进程的影响.中国修复重建外科杂志,1998,12(6):325-328
12.祁少海,谢举临,利天增,等.积雪草甙对烧伤增生性瘢痕作用的实验研究.中华烧伤杂志,2000,16(1):53-56
13.宋清华,狄春晖,崔鸣,等.积雪甙对伤口愈合作用的基础研究.中国医药导刊,2000,2(5):37-39.
14.张罗修,王梦,钱云,等.丹参素、黄芩甙等对大鼠腹腔巨噬细胞产生PGE2、TXB2的影响.中药药理与临床,1990,6(4):31-33.
15.刘德伍,苏子毅.当归对兔耳增生性瘢痕的治疗作用.中药药理与临床,1998,14(6):30-31
16.汤苏阳,蔡宝仁,黄高升,等.苦参碱对人增生性瘢痕成纤维细胞增殖的影响.中国美容医学,2001,10(1):6-8.
17.汤苏阳,徐获荣,王强,等.苦参碱对人增生性瘢痕成纤维细胞细胞周期和DNA含量的影响.中华医学美学美容,2002,8(1):30-32.
18.汤苏阳,黄高升,蔡宝仁.苦参碱对人增生性瘢痕成纤维细胞超微结构的影响.中国美容医学,2001,10(2):100-102.
19.汤苏阳,蔡宝仁,黄高升,等.苦参碱对人增生性瘢痕成纤维细胞合成胶原的影响.实用美容整形外科杂志,2000,12(6):330-331.
1 Berman B,Bieley HC.Adjunet therapies to surcal management of keloid.Dermatol Surg,1996;22(1):126-130.
2 Brissett AE,Sherris DA.Scar contractures,hypertrophic sear,and keloids.Facial plast Surg,2001:17(4):263-272.
3 Lee Y,Minn KW,Baek RM,et al.A new surgical treatment of keloid:keloid core Excision,Ann Plast Surg,2001;46(2):135-140.
4 Danielsen CC,Wiggcrs H.Andersen HR.Increased amounts of collagenase and gelatinase in porcine myecardium foiling ischemia and reperfusion.J Mol cell Cardiol,1998;30(4):1431-1437.
5 Cheng W,Saing H,Zhou H,et al.Ultrasound assessment of scaid sars in Asian children receiving pressure garment therapy.J Pediatr Surg,2001;36(3):466-469.
6 Henderson DL.Crem well TA,Mcs LG.Argon and carbon dioxide laser treatment of hypertrophic and keloid scars.Lasers Surg Med,1984;3(2):271.
7 Alster TS.Laser treatment of hypertrophic scars,keloids and striae(JV).Dermatol Clin 1997;3(2):419-425.
8 Lawrence WT.In search of the optimal treatment of keloids:report of a series and a review of the literature.Ann Plast Surg,1997;27:164.
9 Stucker FJ.An approach of management of kcloid.Arch Otolaryngol.Head Neck Surg,1992;118:63.
10 董兰华,马嘉敏,李勇义.液氮冷冻治疗瘢痕疙瘩255例[J].青海医药杂志,1996:26(1):69-70.
11 Phillips TJ,Gerstein AD,Lordan V.A randomized controlled trial of hydrocolloid,dressing in the treatment of hypertrophic'scars and keloids.Dermatol Surg,1996;22(9):775-778.
12 Lee SM,Ngim CK,Chan YY,et al.A comparison of Sil-k and epiderm in scar management.Burns,1996;22(6):483-487.
13 Wong TW,Chiu HC,Chang CH,et al.Silicone cream occlusive dressing a novel noninvasivc regimen in the treatment of keloid.Dermatolgy,1996;192(4):327-333.
14 De Oliverirgt GV,Nunes TA,Magna LA,et al.Silicone versus nonsilicone gel Dressings:a controlled trial.Dermotol Surg,2001;27(8):721-726.
15 Suetak T,Sasai S,Zhcn YX,et al.Efects of silicone gel sheet on the stratum corncum hydration.Br J Plast Surg,2000;53(6):503-507.
16 Sayah DN,Soo C,Shaw WW,et al.Downregulation of apoptosis-related genes in kekid tissues.J Surg Res,1999;87:209-216.
17 鲍卫许,徐少骏.激素治疗瘢痕的机理研究[J].中华外科杂志,2000:38(5):378-381.
18 李荟元.瘢痕的药物治疗进展[J].中国临床复,2002:6(8):1090-1092.
19 shah M.Control of scarring in adult wounds by neutralizing antibody to transforming growth factor- β.Lancet,1992;339;213.
20 Grastein RD,Flotle TJ,Amento EP.Interferon and collagen production.J Invest Dermatol,1990;95:75.
21 郭传勇,李定国,田字彬,等.丹参及川穹嗪对人成纤维细胞DNA和胶原合成的影响[J].上海第二医科大学学报,1996:16(3):217-218.
22 Delimpens J.The local treatment of hypertrophic scars and keloids with topical retinoie acid.Br J Dermatol,1980;103:319.
23 Daly TJ,Golitz LE,Weston WL.A double-blind placebo-controlled eflicacy study of tretinoin cream 0.05%in the treatment of keloids and hypertrophic scars.J~Invest Dermatol,1986;86:470.
24 Fitzpatrick RE.Treatment of inflamed hypertrophic scars using intralesional 5-Fu.Dermatol Surg,1999;25:142-146.