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[1]楊洪杰,周利,吳海紅,等.清熱解毒中藥外敷治療外傷感染創(chuàng)面的療效觀察及作用機(jī)制研究[J].中醫(yī)正骨,2016,28(08):13-18.
　YANG Hongjie,ZHOU Li,WU Haihong,et al.A clinical study on the curative effect and mechanism of action of external applications of antipyretic-detoxicate traditional Chinese drugs for treatment of traumatic infected wounds[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2016,28(08):13-18.
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清熱解毒中藥外敷治療外傷感染創(chuàng)面的療效觀察及作用機(jī)制研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第28卷
期數(shù):
2016年08期
頁(yè)碼:
13-18
欄目:
臨床研究
出版日期:
2016-08-20

文章信息/Info

Title:
A clinical study on the curative effect and mechanism of action of external applications of antipyretic-detoxicate traditional Chinese drugs for treatment of traumatic infected wounds
作者:
楊洪杰; 周利; 吳海紅; 胡紀(jì)文
廣東省深圳市羅湖區(qū)中醫(yī)院,廣東 深圳 518001
Author(s):
YANG Hongjie; ZHOU Li; WU Haihong; HU Jiwen
Luohu Hospital of Traditional Chinese Medicine,Shenzhen 518001,Guangdong,China
關(guān)鍵詞:
清熱解毒藥;  中藥外敷;  呋喃西林;  傷口感染;  Toll樣受體4;  腫瘤壞死因子α;  白細(xì)胞介素1β;  白細(xì)胞介素6;  臨床試驗(yàn)
Keywords:
antipyretic-detoxicate drugs;  external applications(TCD);  nitrofurazone;  wound infection;  toll-like receptor 4;  tumor necrosis factor-alpha;  interleukin-1 beta;  interleukin-6;  clinical trial
摘要:
目的:觀察清熱解毒中藥外敷治療外傷感染創(chuàng)面的療效并探討其作用機(jī)制。方法:將100例外傷感染創(chuàng)面患者隨機(jī)分為2組,每組50例,分別采用清熱解毒中藥外敷和呋喃西林外敷治療,連續(xù)治療至創(chuàng)面愈合。比較治療前及治療第7天和第14天2組患者感染創(chuàng)面面積、外周血單個(gè)核細(xì)胞表面Toll樣受體4(toll-like receptor 4,TLR4)的表達(dá)情況及外周血血清中腫瘤壞死因子-α(tumor necrosis factor-α,TNF-α)、白細(xì)胞介素1β(interleukin-1 beta,IL-1β)、白細(xì)胞介素6(interleukin-6,IL-6)的表達(dá)情況,并于治療開始后2周比較2組患者的臨床療效。結(jié)果:清熱解毒中藥組的感染創(chuàng)面愈合時(shí)間短于呋喃西林組[(16.10±3.15)d,(18.26±3.72)d, t=3.133,P=0.002]。治療前后不同時(shí)間點(diǎn)感染創(chuàng)面面積比較,差異有統(tǒng)計(jì)學(xué)意義,存在時(shí)間效應(yīng),治療后創(chuàng)面面積逐漸縮小(F=13.250,P=0.002); 2組患者感染創(chuàng)面面積比較,差異有統(tǒng)計(jì)學(xué)意義,存在分組效應(yīng)(t=2.040,P=0.044); 治療前2組患者感染創(chuàng)面面積比較,差異無(wú)統(tǒng)計(jì)學(xué)意義[(12.80±1.61)cm2,(13.00±2.21)cm2,t=0.517,P=0.606]; 治療第7天和第14天清熱解毒中藥組的感染創(chuàng)面面積均小于呋喃西林組[(6.50±0.97)cm2,(8.30±0.94)cm2,t=9.422,P=0.000;(3.00±0.66)cm2,(5.70±0.67)cm2,t=20.300,P=0.000]; 時(shí)間因素與分組因素存在交互效應(yīng)(F=6.830,P=0.003)。治療前后不同時(shí)間點(diǎn)TLR4表達(dá)量比較,差異有統(tǒng)計(jì)學(xué)意義,存在時(shí)間效應(yīng),治療后TLR4表達(dá)量逐漸減少(F=6.864,P=0.017); 2組患者TLR4表達(dá)量比較,差異有統(tǒng)計(jì)學(xué)意義,存在分組效應(yīng)(t=2.185,P=0.031); 治療前2組患者TLR4表達(dá)量比較,差異無(wú)統(tǒng)計(jì)學(xué)意義[(5.81±0.78)ng·mL-1,(5.79±0.73)ng·mL-1,t=0.132,P=0.890]; 治療第7天和第14天清熱解毒中藥組的TLR4表達(dá)量均低于呋喃西林組[(4.10±0.33)ng·mL-1,(4.69±0.27)ng·mL-1,t=9.784,P=0.000;(2.82±0.55)ng·mL-1,(3.80±0.59)ng·mL-1,t=8.591,P=0.000]; 時(shí)間因素與分組因素存在交互效應(yīng)(F=6.012,P=0.005)。治療前后不同時(shí)間點(diǎn)TNF-α表達(dá)量比較,差異有統(tǒng)計(jì)學(xué)意義,存在時(shí)間效應(yīng),治療后TNF-α表達(dá)量逐漸減少(F=38.313,P=0.000); 2組患者TNF-α表達(dá)量比較,差異有統(tǒng)計(jì)學(xué)意義,存在分組效應(yīng)(t=2.195,P=0.030); 治療前2組患者TNF-α表達(dá)量比較,差異無(wú)統(tǒng)計(jì)學(xué)意義[(97.55±6.27)ng·mL-1,(97.66±7.07)ng·mL-1,t=0.082,P=0.934]; 治療第7天和第14天清熱解毒中藥組的TNF-α表達(dá)量均低于呋喃西林組[(52.46±6.84)ng·mL-1,(74.10±4.49)ng·mL-1,t=18.701,P=0.000;(25.72±3.95)ng·mL-1,(40.43±2.42)ng·mL-1,t=22.454,P=0.000]; 時(shí)間因素與分組因素存在交互效應(yīng)(F=38.812,P=0.000)。治療前后不同時(shí)間點(diǎn)IL-1β表達(dá)量比較,差異有統(tǒng)計(jì)學(xué)意義,存在時(shí)間效應(yīng),治療后IL-1β表達(dá)量逐漸減少(F=28.000,P=0.000); 2組患者IL-1β表達(dá)量比較,差異有統(tǒng)計(jì)學(xué)意義,存在分組效應(yīng)(t=2.361,P=0.020); 治療前2組患者IL-1β表達(dá)量比較,差異無(wú)統(tǒng)計(jì)學(xué)意義[(61.13±5.60)pg·mL-1,(61.90±5.35)pg·mL-1,t=0.703,P=0.483]; 治療第7天和第14天清熱解毒中藥組的IL-1β表達(dá)量均低于呋喃西林組[(31.03±3.06)pg·mL-1,(38.69±4.40)pg·mL-1,t=10.106,P=0.000;(12.44±1.36)pg·mL-1,(21.91±2.05)pg·mL-1,t=27.210,P=0.000]; 時(shí)間因素與分組因素存在交互效應(yīng)(F=7.431,P=0.002)。治療前后不同時(shí)間點(diǎn)IL-6表達(dá)量比較,差異有統(tǒng)計(jì)學(xué)意義,存在時(shí)間效應(yīng),治療后IL-6表達(dá)量逐漸減少(F=24.492,P=0.001); 2組患者IL-6表達(dá)量比較,差異有統(tǒng)計(jì)學(xué)意義,存在分組效應(yīng)(t=2.078,P=0.040); 治療前2組患者IL-6表達(dá)量比較,差異無(wú)統(tǒng)計(jì)學(xué)意義[(127.92±10.51)pg·mL-1,(123.56±11.45)pg·mL-1,t=1.983,P=0.050]; 治療第7天和第14天清熱解毒中藥組的IL-6表達(dá)量均低于呋喃西林組[(52.56±3.59)pg·mL-1,(68.93±4.88)pg·mL-1,t=19.106,P=0.000;(31.37±2.37)pg·mL-1,(42.64±2.89)pg·mL-1,t=21.324,P=0.000]; 時(shí)間因素與分組因素存在交互效應(yīng)(F=10.670,P=0.000)。治療開始后2周,采用自擬標(biāo)準(zhǔn)評(píng)價(jià)臨床療效,清熱解毒中藥組痊愈27例、顯效11例、有效12例,呋喃西林組痊愈12例、顯效10例、有效23例、無(wú)效5例; 清熱解毒中藥組的臨床療效優(yōu)于呋喃西林組(Z=2 026.000,P=0.000)。結(jié)論:清熱解毒中藥外敷治療外傷感染創(chuàng)面可以減小創(chuàng)面面積、縮短創(chuàng)面愈合時(shí)間,其臨床療效優(yōu)于呋喃西林外敷; 其作用機(jī)制可能是通過抑制外周血單個(gè)核細(xì)胞表面TLR4的表達(dá),使TNF-α、IL-1β及IL-6的表達(dá)受到抑制,從而減輕了炎癥反應(yīng)。
Abstract:
Objective:To study the curative effect and mechanism of action of external applications of antipyretic-detoxicate traditional Chinese drugs(TCD)for treatment of traumatic infected wounds.Methods:One hundred patients with traumatic infected wounds were randomly divided into 2 groups,50 cases in each group.The patients were treated with external applications of antipyretic-detoxicate TCD(group A)and nitrofurazone(group B)continuously until the wounds healed.The infected wound areas,the expression of toll-like receptor 4(TLR4)on the surface of peripheral blood mononuclear cell and the expression of tumor necrosis factor-α(TNF-α),interleukin-1 beta(IL-1β)and interleukin-6(IL-6)in peripheral blood serum were compared between the 2 groups before treatment and at the 7th and 14th day after the beginning of the treatment respectively,and the clinical effects were evaluated and compared between the 2 groups at 2 weeks after the begining of treatment.Results:The healing time of infected wounds were shorter in group A compared to group B(16.10+/-3.15 vs 18.26+/-3.72 days,t=3.133,P=0.002).There was statistical difference in the infected wound areas between different timepoints before and after the treatment,in other words,there was time effect,and the wound areas decreased gradually after treatment(F=13.250,P=0.002).There was statistical difference in the infected wound areas between the 2 groups in general,in other words,there was group effect(t=2.040,P=0.044).There was no statistical difference in the infected wound areas between the 2 groups before treatment(12.80+/-1.61 vs 13.00+/-2.21 cm(2),t=0.517,P=0.606).The infected wound areas were smaller in group A compared to group B at the 7th and 14th day after the beginning of the treatment(6.50+/-0.97 vs 8.30+/-0.94 cm(2),t=9.422,P=0.000; 3.00+/-0.66 vs 5.70±0.67 cm(2),t=20.300,P=0.000).There was interaction between time factor and group factor(F=6.830,P=0.003).There was statistical difference in the expression levels of TLR4 between different timepoints before and after the treatment,in other words,there was time effect,and the expression levels of TLR4 decreased gradually after treatment(F=6.864,P=0.017).There was statistical difference in the expression levels of TLR4 between the 2 groups in general,in other words,there was group effect(t=2.185,P=0.031).There was no statistical difference in the expression levels of TLR4 between the 2 groups before treatment(5.81+/-0.78 vs 5.79+/-0.73 ng/ml,t=0.132,P=0.890).The expression levels of TLR4 were lower in group A compared to group B at the 7th and 14th day after the beginning of the treatment(4.10+/-0.33 vs 4.69+/-0.27 ng/ml.t=9.784,P=0.000; 2.82+/-0.55 vs 3.80+/-0.59 ng/ml,t=8.591,P=0.000).There was interaction between time factor and group factor(F=6.012,P=0.005).There was statistical difference in the expression levels of TNF-α between different timepoints before and after the treatment,in other words,there was time effect,and the expression levels of TNF-α decreased gradually after treatment(F=38.313,P=0.000).There was statistical difference in the expression levels of TNF-α between the 2 groups in general,in other words,there was group effect(t=2.195,P=0.030).There was no statistical difference in the expression levels of TNF-α between the 2 groups before treatment(97.55+/-6.27 vs 97.66+/-7.07 ng/ml,t=0.082,P=0.934).The expression levels of TNF-α were lower in group A compared to group B at the 7th and 14th day after the beginning of the treatment(52.46+/-6.84 vs 74.10+/-4.49 ng/ml,t=18.701,P=0.000; 25.72+/-3.95 vs 40.43+/-2.42 ng/ml,t=22.454,P=0.000).There was interaction between time factor and group factor(F=38.812,P=0.000).There was statistical difference in the expression levels of IL-1β between different timepoints before and after the treatment,in other words,there was time effect,and the expression levels of IL-1β decreased gradually after treatment(F=28.000,P=0.000).There was statistical difference in the expression levels of IL-1β between the 2 groups in general,in other words,there was group effect(t=2.361,P=0.020).There was no statistical difference in the expression levels of IL-1β between the 2 groups before treatment(61.13+/-5.60 vs 61.90+/-5.35 pg/ml,t=0.703,P=0.483).The expression levels of IL-1β were lower in group A compared to group B at the 7th and 14th day after the beginning of the treatment(31.03+/-3.06 vs 38.69+/-4.40 pg/ml,t=10.106,P=0.000; 12.44+/-1.36 vs 21.91+/-2.05 pg/ml,t=27.210,P=0.000).There was interaction between time factor and group factor(F=7.431,P=0.002).There was statistical difference in the expression levels of IL-6 between different timepoints before and after the treatment,in other words,there was time effect,and the expression levels of IL-6 decreased gradually after treatment(F=24.492,P=0.001).There was statistical difference in the expression levels of IL-6 between the 2 groups in general,in other words,there was group effect(t=2.078,P=0.040).There was no statistical difference in the expression levels of IL-6 between the 2 groups before treatment(127.92+/-10.51 vs 123.56+/-11.45 pg/ml,t=1.983,P=0.050).The expression levels of IL-6 were lower in group A compared to group B at the 7th and 14th day after the beginning of the treatment(52.56+/-3.59 vs 68.93+/-4.88 pg/ml,t=19.106,P=0.000; 31.37+/-2.37 vs 42.64+/-2.89 pg/ml,t=21.324,P=0.000).There was interaction between time factor and group factor(F=10.670,P=0.000).At 2 weeks after the begining of the treatment,the clinical curative effect were evaluated according to the self-designed therapeutic effect evaluation standard.Twenty-seven patients were cured,11 got a good result and 12 fair in group A; while 12 patients were cured,10 got a good result,23 fair and 5 poor in group B.The group A surpassed the group B in the clinical curative effect(Z=2 026.000,P=0.000).Conclusion:External applications of antipyretic-detoxicate traditional Chinese drugs can reduce the wound area and shorten the wound healing time in the treatment of traumatic infected wounds,and it surpasses the external applications of nitrofurazone in the clinical curative effect.It can inhibit the expression of TNF-α,IL-1β and IL-6 through inhibiting the expression of TLR4 on the surface of peripheral blood mononuclear cells,which may be the mechanisms of action for reducing the inflammatory reaction.

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備注/Memo

備注/Memo:
基金項(xiàng)目:深圳市羅湖區(qū)科技創(chuàng)新局軟科學(xué)項(xiàng)目(2015-55)
更新日期/Last Update: 1900-01-01