The influence of wet compress of Yanghe Decoction on wound healing in ulcerative-stage lower limb varicose veins under wet healing theory
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摘要:
目的 探讨湿性愈合理论下阳和汤湿敷在溃疡期下肢静脉曲张患者术后促创面愈合中的应用效果，为此类患者术后促进创面愈合提供更充分的理论依据。 方法 选取2022年9月—2024年8月于绍兴文理学院附属医院治疗的溃疡期下肢静脉曲张患者96例，根据随机数字表法分为观察组和基线组，各48例。基线组术后实施常规治疗，观察组在基线组基础上实施湿性愈合理论下阳和汤湿敷。评估2组疗效、中医证候积分、溃疡面积，统计术后创面愈合时间、并发症发生率，检测血管内皮生长因子(VEGF)、缺氧诱导因子-1α(HIF-1α)、转化生长因子β1(TGF-β1)。 结果 观察组疗效优于基线组(P＜0.05)。观察组治疗后各项中医证候主症评分及总积分低于基线组(P＜0.05)；观察组治疗后溃疡面积、溃疡深度均小于基线组(P＜0.05)；观察组创面愈合时间[(28.33±4.08)d]短于基线组[(30.25±4.14)d，t=2.289，P＜0.05]；观察组治疗后血清VEGF、TGF-β1水平高于基线组，血清HIF-1α水平低于基线组(P＜0.05)；观察组并发症发生率[6.25%(3/48)]低于基线组[20.83%(10/48), χ2=4.360，P=0.037]。 结论 湿性愈合理论下阳和汤湿敷应用于溃疡期下肢静脉曲张术后患者能有效提高治疗效果，减轻患者症状，促进术后创面愈合，调节VEGF、TGF-β1、HIF-1α水平，减少并发症。 Abstract:Objective This study aims to evaluate the application of Yanghe Decoction wet dressing based on wet healing theory, promoting wound healing in postoperative patients with lower extremity varicose veins at the ulcer stage. Methods A total of 96 patients with ulcerated lower extremity varicose veins, admitted to the Affiliated Hospital of Shaoxing University from September 2022 to August 2024, were selected and divided into an observation group and a baseline group based on a random number table method, with 48 patients in each group. The baseline group received postoperative treatment, while the observation group received Yanghe Decoction wet dressing based on the wet healing theory in addition to the baseline treatment. The treatment efficacy, traditional Chinese medicine (TCM) syndrome scores, ulcer area, postoperative wound healing time, and complication rates were evaluated in both groups. Vascular endothelial growth factor (VEGF), hypoxia-inducible factor-1α (HIF-1α), and transforming growth factor-β1 (TGF-β1) were also measured. Results The observation group demonstrated significantly better therapeutic efficacy compared to the baseline group (P < 0.05). After treatment, the scores for the main symptoms of TCM syndromes and the total score in the observation group were lower than those in the baseline group (P < 0.05). The ulcer area and ulcer depth in the observation group after treatment were smaller than those in the baseline group (P < 0.05). The wound healing time in the observation group [(28.33±4.08) days] was shorter than that in the baseline group [(30.25±4.14) days, t=2.289, P < 0.05]. After treatment, the levels of VEGF and TGF-β1 in the observation group were higher than those in the baseline group, while the level of HIF-1αwas lower (P < 0.05). The incidence of complications in the observation group was 6.25% (3/48), which was lower than in the baseline group (20.83%, 10/48, χ2=4.360, P=0.037). Conclusion Under the theory of wet healing, the application of Yanghe Decoction wet compress can effectively improve treatment effect, reduce symptoms of patients, promote postoperative wound healing, regulates the levels of VEGF, TGF-β1, and HIF-1α, and reduce complications in patients with ulcer-stage lower extremity varicose veins. -
Key words:
- Wet healing theory /
- Yanghe Decoction /
- Wet compress /
- Ulcer stage /
- Lower limb varicose veins /
- Wound healing
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表 1 2组溃疡期下肢静脉曲张患者一般资料比较
Table 1. Comparison of general information between two groups of patients with lower extremity varicose veins in the ulcer stage
组别 例数 性别(男性/女性，例) 年龄(x±s，岁) 静脉曲张部位(左下肢/右下肢，例) 下肢静脉曲张病程(x±s，年) 溃疡病程(x±s，月) 溃疡面积(x±s，cm2) 观察组 48 25/23 47.98±7.96 27/21 14.31±3.70 10.03±2.05 22.01±5.27 基线组 48 26/22 48.69±8.19 24/24 15.16±3.38 9.76±2.11 20.78±5.04 统计量 0.042a 0.431b 0.377a 1.175b 0.636b 1.169b P值 0.838 0.668 0.540 0.243 0.526 0.246 组别 例数 溃疡深度(x±s，mm) CEAP分级(C6级/C6r级，例) 长期吸烟史[例(%)] 长期饮酒史[例(%)] 糖尿病[例(%)] 创面感染[例(%)] 观察组 48 8.05±1.84 28/20 13(27.08) 15(31.25) 6(12.50) 18(37.50) 基线组 48 7.92±1.76 30/18 11(22.92) 13(27.08) 5(10.42) 20(41.67) 统计量 0.354b 0.174a 0.222a 0.202a 0.103a 0.174a P值 0.724 0.676 0.637 0.653 0.749 0.676 注：a为χ2值，b为t值。 
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表 2 2组溃疡期下肢静脉曲张患者疗效比较[例(%)]
Table 2. Comparison of curative effects pre- and post-treatment between two groups of patients with lower extremity varicose veins at ulcer stage[case (%)]
组别 例数 临床痊愈 显效 有效 无效 观察组 48 11(22.92) 24(50.00) 12(25.00) 1(2.08) 基线组 48 6(12.50) 13(27.08) 19(39.58) 10(20.83) 注：2组疗效比较，Z=3.197，P=0.001。
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表 3 2组溃疡期下肢静脉曲张患者治疗前后中医证候积分比较(x±s，分)
Table 3. Comparison of TCM syndrome scores before and after treatment between two groups of patients with lower extremity varicose veins at ulcer stage (x±s, points)
组别 例数 脓水清稀，淋漓不尽 创面肉色淡白或紫暗不鲜 创周肤色暗黑、板硬 总积分 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 观察组 48 4.00±1.02 2.02±0.41b 4.04±0.92 2.08±0.45b 4.17±0.89 2.13±0.44b 14.94±3.20 8.00±1.80b 基线组 48 4.13±0.99 2.31±0.50b 4.17±0.90 2.40±0.49b 4.08±0.91 2.35±0.48b 15.17±3.12 9.85±1.90b 统计量 0.634a 16.873c 0.700a 19.371c 0.490a 19.033c 0.357a 20.813c P值 0.528 ＜0.001 0.486 ＜0.001 0.625 ＜0.001 0.722 ＜0.001 注：a为t值，c为F值；与同组治疗前比较，bP＜0.05。
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表 4 2组溃疡期下肢静脉曲张患者治疗前后溃疡面积、溃疡深度及创面愈合时间比较(x±s)
Table 4. Comparison of ulcer area, depth, and healing duration before and after treatment between two groups in patients with lower extremity varicose veins at ulcer stage (x±s, points)
组别 例数 溃疡面积(cm2) 溃疡深度(mm) 创面愈合时间(d) 治疗前 治疗后 治疗前 治疗后 观察组 48 22.01±5.27 7.77±1.32b 8.05±1.84 4.02±1.19b 28.33±4.08 基线组 48 20.78±5.04 8.52±1.53b 7.92±1.76 5.21±1.22b 30.25±4.14 统计量 1.169a 16.278c 0.354a 17.393c 2.289a P值 0.246 ＜0.001 0.724 ＜0.001 0.024 注：a为t值，c为F值；与同组治疗前比较，bP＜0.05。
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表 5 2组溃疡期下肢静脉曲张患者治疗前后血清VEGF、HIF-1α、TGF-β1水平比较(x±s，pg/mL)
Table 5. Comparison of serum levels of VEGF, HIF-1α, and TGF-β1 before and after treatment between two groups of patients with lower limb varicose veins (x±s, pg/mL)
组别 例数 VEGF HIF-1α TGF-β1 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 观察组 48 541.49±70.84 635.94±52.28b 178.23±34.28 123.72±20.15b 50.34±8.25 94.18±11.58b 基线组 48 528.60±65.71 604.71±53.19b 181.64±36.71 138.16±22.48b 52.07±8.89 86.28±10.33b 统计量 0.924a 20.389c 0.470a 19.845c 0.988a 19.036c P值 0.358 ＜0.001 0.639 ＜0.001 0.326 ＜0.001 注：a为t值，c为F值；与同组治疗前比较，bP＜0.05。
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表 6 2组溃疡期下肢静脉曲张患者并发症发生率比较[例(%)]
Table 6. Comparison of the complication incidences between two groups of patients with lower extremity varicose veins at the ulcer stage[cases (%)]
组别 例数 血栓性浅静脉炎 穿刺点硬结 皮下局部红肿 创面感染 总发生 观察组 48 1(2.08) 1(2.08) 1(2.08) 0 3(6.25) 基线组 48 2(4.17) 2(4.17) 3(6.25) 3(6.25) 10(20.83) 注：2组并发症发生率比较，χ2=4.360，P=0.037。
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[1] 潘建立. 微波消融联合泡沫硬化剂治疗下肢静脉曲张溃疡的临床疗效观察[J]. 山西医药杂志, 2023, 52(13): 967-970.PAN J L. Clinical observation of microwave ablation combined with foam hardener in the treatment of varicose ulcer of lower limbs[J]. Shanxi Medical Journal, 2023, 52(13): 967-970. [2] 王刚, 刘振斌, 李梦虎, 等. 微波消融联合泡沫硬化剂治疗下肢静脉曲张溃疡的临床疗效研究[J]. 中华血管外科杂志, 2021, 6(2): 111-115.WANG G, LIU Z B, LI M H, et al. Effectiveness of microwave ablation combined with foam sclerotherapy in treatment of varicose ulcer of lower extremity[J]. Chinese Journal of Vascular Surgery, 2021, 6(2): 111-115. [3] 何甜. 手术联合新型功能性敷料治疗下肢静脉性溃疡的临床疗效研究[D]. 苏州: 苏州大学, 2023.HE T. Clinical study on the therapeutic effect of surgery combined with new functional dressings in the treatment of venous leg ulcers[D]. Suzhou: Soochow University, 2023. [4] 张申, 凡会霞, 刘思琦, 等. "偎脓长肉"理论与"湿性愈合"理论在创伤修复中的相关性探究[J]. 中医学报, 2023, 38(3): 556-566.ZHANG S, FAN H X, LIU S Q, et al. Correlation between theory of "Wei Nong Zhang Rou" and "Healing with Wet Skin Environment" in wound repairment[J]. Journal of Chinese Medicine, 2023, 38(3): 556-566. [5] XIE B. Wet-theory intervention on lower extremity ulcer: a case report[J]. Asian J Surg, 2023, 46(3): 1234-1235. doi: 10.1016/j.asjsur.2022.08.040 [6] 朱粟意, 张相安, 黄芳芳, 等. 基于网络药理学研究阳和汤促进肛瘘术后创面组织修复的作用机制[J]. 现代中西医结合杂志, 2021, 30(31): 3477-3482.ZHU S Y, ZHANG X A, HUANG F F, et al. Study on the mechanism of Yanghe Decoction in promoting wound tissue repair after anal fistula surgery based on network pharmacology[J]. Modern Journal of Integrated Traditional Chinese and Western Medicine, 2021, 30(31): 3477-3482. [7] 陈红风. 中医外科学[M]. 4版. 北京: 中国中医药出版社, 2016: 308-310.CHEN H F. Surgery in Traditional Chinese Medicine[M]. 4th Edition. Beijing: China Press of Traditional Chinese Medicine, 2016: 308-310. [8] 上海市中西医结合学会周围血管病专业委员会. 下肢慢性溃疡中医诊治与疗效评价专家共识[J]. 上海中医药杂志, 2022, 56(2): 1-5, 44.Shanghai Integrated Traditional Chinese and Western Medicine Society, Peripheral Vascular disease Professional Committee. Expert consensus on traditional Chinese medicine diagnosis, treatment and efficacy evaluation of lower limb chronic ulcer[J]. Shanghai Journal of Traditional Chinese Medicine, 2022, 56(2): 1-5, 44. [9] 中国微循环学会周围血管疾病专业委员会. 下肢静脉性溃疡伤口管理专家共识[J]. 血管与腔内血管外科杂志, 2023, 9(1): 1-6, 19.Chinese Society of Microcirculation, Professional Committee of Peripheral Vascular Diseases. Expert consensus on wound management in venous leg ulcer[J]. Journal of Vascular and Endovascular Surgery, 2023, 9(1): 1-6, 19. [10] 谢亚娟. 曲张静脉抽剥术配合利湿通瘀中药湿敷治疗下肢静脉曲张伴淤积性皮炎的疗效及对近期预后的影响[J]. 现代中西医结合杂志, 2020, 29(16): 1734-1737, 1757.XIE Y J. Curative effect of varicose vein stripping operation combined with Chinese medicine for disinhibiting wetness and unblocking stasis on varicose veins with stasis dermatitis of lower extremities and its impact on short-term prognosis[J]. Modern Journal of Integrated Traditional Chinese and Western Medicine, 2020, 29(16): 1734-1737, 1757. [11] 冯海霞, 彭新宇, 董峰. 阳和汤加减联合银离子敷料治疗糖尿病足溃疡临床研究[J]. 陕西中医, 2021, 42(7): 900-902.FENG H X, PENG X Y, DONG F. Clinical study on the treatment of diabetic foot ulcers with modified Yanghe Decoction combined with silver ion dressing[J]. Shaanxi Journal of Traditional Chinese Medicine, 2021, 42(7): 900-902. [12] 吴熙, 方庆霞, 陈瑞雪. 陈瑞雪运用阳和汤治疗卵巢储备功能低下的临床经验[J]. 中国中医基础医学杂志, 2019, 25(12): 1751-1753.WU X, FANG Q X, CHEN R X. Chen Ruixue's clinical experience in treating low ovarian reserve function with Yanghe Decoction[J]. Chinese Journal of Basic Medicine in Traditional Chinese Medicine, 2019, 25(12): 1751-1753. [13] PENG W X, HE P X, LIU L J, et al. LncRNA GAS5 activates the HIF1A/VEGF pathway by binding to TAF15 to promote wound healing in diabetic foot ulcers[J]. Lab Invest, 2021, 101(8): 1071-1083. doi: 10.1038/s41374-021-00598-2 [14] AHMED M, HUH J R. Cutting edge: interleukin-17a prompts HIF1α for wound healing[J]. Trends Immunol, 2022, 43(11): 861-863. doi: 10.1016/j.it.2022.09.013 [15] XIAOJIE W, BANDA J, QI H, et al. Scarless wound healing: current insights from the perspectives of TGF-β, KGF-1, and KGF-2[J]. Cytokine Growth Factor Rev, 2022, 66(1): 26-37. http://pubmed.ncbi.nlm.nih.gov/35690568/ [16] 刘阳阳, 张学兰, 孔庆悦, 等. 生地黄与熟地黄补血与免疫调节作用研究[J]. 中药材, 2022, 45(8): 1853-1856.LIU Y Y, ZHANG X L, KONG Q Y, et al. Study on the blood-enriching and immune-regulating effects of Rehmanniae Radix and Prepared Rehmanniae Radix[J]. Chinese Herbal Medicines, 2022, 45(8): 1853-1856. [17] 牛明了, 吕秋霞, 唐诚馨, 等. 阳和汤联合西药对Ⅱ~Ⅲ期直肠癌术后免疫功能及炎症因子的影响[J]. 中医研究, 2024, 37(1): 30-34.NIU M L, LYU Q X, TANG C X, et al. Effects of Yanghe Decoction combined with western medicine on immune function and inflammatory factors in patients with stage Ⅱ-Ⅲ rectal cancer after surgery[J]. Journal of Traditional Chinese Medical Research, 2024, 37(1): 30-34. [18] GUERRA F Q, MENDES J M, SOUSA J P, et al. Increasing antibiotic activity against a multidrug-resistant Acinetobacter spp by essential oils of Citrus limon and Cinnamomum zeylanicum[J]. Nat Prod Res, 2012, 26(23): 2235-2238. doi: 10.1080/14786419.2011.647019 [19] 屈尧, 戎菲, 佟旭, 等. 基于中医药标准文献的痰瘀互结证治疗体系可视化研究[J]. 中华全科医学, 2023, 21(4): 689-692. doi: 10.16766/j.cnki.issn.1674-4152.002961QU Y, RONG F, TONG X, et al. Visualisation of syndrome and treatment system of phlegm and blood stasis based on TCM standard literature[J]. Chinese Journal of General Practice, 2023, 21(4): 689-692. doi: 10.16766/j.cnki.issn.1674-4152.002961 [20] 王学芹. 炮姜中6-姜酚的炮制转化规律及其转化产物活性机制研究[D]. 合肥: 安徽中医药大学, 2023.WANG X Q. Study on the transformation rule of 6-gingerol in processed ginger (zingiberis rhizoma carbonizatum) and the activity mechanism of its transformation products[D]. Hefei: Anhui University of Chinese Medicine, 2023. [21] 王晓明, 许良葵, 罗佳波. 麻黄-桂枝药对抗炎、镇痛作用研究[J]. 中药新药与临床药理, 2020, 31(2): 179-184.WANG X M, XU L K, LUO J B. Research on anti-inflammatory and analgesic effects of Ephedrae Herba-Cinnamomi Ramulus Herb Pair[J]. Chinese Journal of New Drugs and Clinical Pharmacology, 2020, 31(2): 179-184. [22] 张晴, 穆金霞, 屈玉明, 等. 发酵白芥子穴位敷贴对支气管哮喘大鼠气道炎症和Th17/Treg免疫失衡的影响[J]. 现代中西医结合杂志, 2024, 33(2): 173-178.ZHANG Q, MU J X, QU Y M, et al. Effect of acupoint application of fermented white mustard seed on airway inflammation and Th17/Treg immune imbalance in rats with bronchial asthma[J]. Modern Journal of Integrated Traditional Chinese and Western Medicine, 2024, 33(2): 173-178. -
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