紫朱软膏干预糖尿病足愈合过程中细胞因子表达

目的观察糖尿病足溃疡患者中炎症及生长相关细胞因子表达的变化及紫朱软膏外用对其的影响。方法糖尿病足溃疡患者72例,随机分为紫朱软膏组和凡士林组各36例,另予体检患者36例作为对照组。在治疗前及治疗第5、10天收集外周血,检测血清中炎症及生长细胞因子的表达变化,同时观察创面愈合情况。结果紫朱软膏组和凡士林组经过治疗后溃疡面积逐渐缩小,在第10天出现显著差异(P<0.05)。治疗前,与对照组相比,紫朱软膏组和凡士林组白细胞介素(IL)-1β、肿瘤坏死因子(TNF)-α、终末糖基化产物(AGEs)等炎症指标明显偏高,表皮细胞生长因子(bFGF)、血管内皮生长因子(VEGF)表达明显偏低,差异有统计学意义(P<0.05)。治疗后,糖尿病足溃疡两组IL-1β、TNF-α、AGEs明显降低,bFGF、VEGF明显增高(P<0.05),且两组IL-1β、AGEs及bFGF有统计学差异(P<0.05),而TNF-α、VEGF并无明显差异(P>0.05)。经Spearman秩相关分析发现,患者治疗前后血清中IL-1β、TNF-α表达量差值与溃疡愈合率呈负相关(P<0.05);AGEs表达量差值与溃疡愈合率呈显著负相关(P<0.001)。结论糖尿病足溃疡患者存在炎症反应持续,生长因子表达不足的状态,紫朱软膏能促进糖尿病足溃疡的愈合,并能降低炎症细胞因子,增加生长细胞因子的表达。紫朱软膏可能通过调节细胞因子的表达促进糖尿病溃疡的愈合。

Changes of cytokines in the healing process of diabetic foot and the effect of Zizhu ointment

Objective To observe the changes of inflammatory and growth related cytokine expression in diabetic foot ulcers and the influence of Zizhu ointment on it.Methods 72 patients with diabetic foot ulcer were randomly divided into Zizhu ointment group and Vaseline group, and 36 patients who underwent physical examination were selected into control group. Peripheral blood was collected before treatment and on the 5 th and 10 th day after treatment to detect the changes of inflammatory and growth cytokine in serum, and to observe the wound healing. Results The ulcer area of Zizhu ointment group and Vaseline group decreased gradually after treatment, and there was significant difference on the 10 th day after treatment(P<0.001). Compared with the control group, the inflammatory indexes such as IL-1β, TNF-α and AGEs were higher, while the expressions of growth factor bFGF and VEGF were lower in the diabetic foot ulcer group before treatment, there were significant differences(P<0.05). After treatment, the inflammation indexes decreased and growth factors increased in diabetic foot ulcer groups, there were significant differences on the 5 th and 10 th day in the two groups between before and after treatment(P<0.05). There were significant differences in IL-1β, AGEs and bFGF(P<0.001), while there were no significant differences in TNF-α and VEGF(P>0.05) between the Zizhu ointment group and the Vaseline group. Spearman rank correlation analysis showed that the differences of serum IL-1β and TNF-α before and after treatment were negatively correlated with ulcer healing rate(r=-0.245, P=0.038;r=-0.259, P=0.028);the difference of AGEs expression between before and after treatment was negatively correlated with ulcer healing rate(r=-0.477, P<0.001). Conclusions Diabetic foot ulcer patients have persistent inflammatory reaction and insufficient expression of growth factors. Zizhu ointment could promote the healing of diabetic foot ulcer, reduce inflammatory cytokines and increase the expression of growth cytokines. Zizhu ointment might promote the healing of diabetic ulcer by regulating the expression of cytokines.