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目的:探讨“清法”治疗糖尿病足坏疽急性期湿热毒盛证的作用机制。方法:80例糖尿病足坏疽急性期湿热毒盛证、Wagner分级4级的患者,随机分为“清法”治疗组和西医对照组各40例,均采用相同的基础治疗。治疗组基础治疗同时给予奚九一经验方—陈兰花颗粒、三黄消炎颗粒内服,并行祛腐清筋术;西医对照组同时行常规清创术。两组分别计算清创术后2周、4周创面治疗有效率,并收集清创前及清创后第1、7、14、28 d的创面渗出液,ELISA法检测肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)和细胞间黏附分子-1(ICAM-1)的含量。结果:治疗组清创后4周的创面治疗有效率明显高于对照组(67.5%vs27.5%,χ~2=12.832,P<0.001);治疗组清创前及清创术后第1、7、14、28 d创面渗出液TNF-α分别为(132 551.2678±69467.8635)pg/mL和(120 472.4313±85 215.3433)pg/mL,(99 812.8301±78 081.8376)pg/mL,(90 345.3259±74 386.5024)pg/mL,(74 491.4063±61 588.1498)pg/mL;IL-6分别为(67 583.2999±26 329.1573)pg/mL,(58 222.3824±25 733.9665)pg/mL,(55 535.6338±22 380.2142)pg/mL,(50 220.2076±19 794.5744)pg/mL,(43 185.8820±20 904.6316)pg/mL;ICAM-1分别为(6399.4579±2833.9183)pg/mL,(5811.0572±2792.3656)pg/mL,(4722.0211±2200.8927)pg/mL,(4231.5074±1988.8923)pg/mL,(3407.6614±2031.0389)pg/mL;3个炎症因子清创后比清创前明显降低,且治疗组在清创后各时间点的TNF-α、IL-6比对照组降低。结论:“清法”治疗糖尿病足坏疽急性期湿热毒盛证,通过降低创面局部炎症因子水平,可以减轻创面炎症反应,促进伤口愈合。
Objective: To investigate the mechanism of “Qing Fa” treating damp-heat and nourishing syndrome in acute stage of diabetic foot gangrene. Methods: Eighty patients with diabetic foot gangrene were randomly divided into “Qingfa” treatment group and 40 cases of Western medicine control group, all using the same basic treatment. The treatment group, while giving the basic treatment of Xi Jiuyi prescription - Chen Orchid particles, Sanhuang anti-inflammatory particles oral administration, parallel Qufu Qing reinforcement surgery; Western medicine at the same time routine debridement. Two groups were calculated at 2 weeks after debridement, 4 weeks wound treatment efficiency, and collect pre-debridement and debridement on the 1st, 7th, 14th, 28th day after wound debridement, ELISA detection of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and intercellular adhesion molecule-1 (ICAM-1) Results: The wound healing efficiency of the treatment group 4 weeks after debridement was significantly higher than that of the control group (67.5% vs27.5%, χ ~ 2 = 12.832, P <0.001) The TNF-α of wound exudate were (132 551.2678 ± 69467.8635) pg / mL and (120 472.4313 ± 85 215.3433) pg / mL and (99 812.8301 ± 78 081.8376) pg / mL on days 7, 345.3259 ± 74 386.5024) pg / mL, (74 491.4063 ± 61 588.1498) pg / mL, and IL-6 was 67 583.2999 ± 26 329.1573 pg / mL and 58 222.3824 ± 25 733.9665 pg / ± 22 380.2142) pg / mL, (50 220.2076 ± 19 794.5744) pg / mL, (43 185.8820 ± 20 904.6316) pg / mL respectively; ICAM-1 was 6399.4579 ± 2833.9183 pg / mL and 5811.0572 ± 2792.3656 pg (4722.0211 ± 2200.8927) pg / mL, (4231.5074 ± 1988.8923) pg / mL, (3407.6614 ± 2031.0389) pg / mL; 3 inflammatory cytokines were significantly lower than those before debridement after debridement, TNF-α and IL-6 at each time point decreased compared with the control group. Conclusion: “Qingfa” treatment of diabetic foot gangrene acute damp-heat poisoning card, by reducing the level of local inflammatory cytokines, can reduce the wound inflammatory response and promote wound healing.