疮灵液外用调控乳腺癌手术创面炎症临床研究

发布时间：2018-04-21 17:03

本文选题：疮灵液 + 乳腺癌　；参考：《南京中医药大学》2017年硕士论文

【摘要】：目的:本课题旨在揭示疮灵液对乳腺癌手术创面炎症反应的调控以影响乳腺癌细胞生物学行为,为中医药外治提高乳腺癌手术疗效做初步的探索。方法:将30例乳腺癌患者随机分设治疗组与对照组。治疗组在基础治疗的同时在术中于创腔常规冲洗后予疮灵液冲洗,每次20ml,10min后通过引流管吸除。对照组仅予以基础治疗。分别于乳腺癌术后第1日、第4日、第7日评估创面炎症与全身炎症症状积分,同时测定腋窝引流液的量,以及引流液中炎症应激相关因子IL-2、IL-4、IL-6、TNF-α的水平和血液中炎症应激相关因子白细胞计数、CRP的水平。细胞实验部分以MTT法测定浓度为0.5%和1%引流液培养MDA-MB-231细胞和MCF-7细胞对其增殖率的影响。结果:1.治疗组创面局部炎症症状明显改善,积分显著低于对照组。(实验组D1积分8.21±1.40,对照组 D1 积分 9.09±2.02,p = 0.186;实验组 D4 积分 3.26±1.65,对照组 D4积分4.55±1.88,p = 0.07;实验组D7积分2.33±1.33,对照组D7积分4.45±2.31,术后第7天出现显著性统计学差异,p=0.004)2.治疗组术后第7天引流液中IL-4、IL-6、TNF-α的含量显著低于对照组,有统计学差异。IL-4组(实验组D1数值2.08±1.32,对照组D1数值3.37±1.71,p=0.034;实验组 D4 数值 1.90±1.44,对照组 D4 数值 4.04±2.85,p=0.025;实验组 D7 数值 1.29±0.96,对照组D7数值4.16±2.88,p = 0.04);IL-6组(实验组D1数值52.66± 8.13,对照组D1数值 55.54 ±5.70,p = 0.002;实验组 D4 数值 48.33 ±4.78,对照组 D4 数值 53.38 ±6.21,p = 0.001;实验组 D7 数值 47.62±8.78,对照组 D7 数值 54.31±6.42,p = 0.001);TNF-α组(实验组D1数值37.98±7.02,对照组D1数值67.71±36.88,p=0.008;实验组D4数值36.85±9.62,对照组 D4 数值 58.75±22.51,p = 0.001;实验组 D7 数值 36.17±9.26,对照组D7数值56.58±23.80,p = 0.007);IL-2的含量显著高于对照组,术后第4、7天有统计学差异(实验组D1数值7.57±1.61,对照组D1数值7.35±2.01,p = 0.977;实验组D4数值7.57±1.36,对照组D4数值6.54±1.18,p = 0.042;实验组D7数值7.61±1.46,对照组D7 数值 6.40±0.92,p = 0.007)。3.疮灵液对血清中CRP水平的下降有明显作用,实验组术后第7天CRP水平明显低于对照组(实验组术前数值3.62±1.43,对照组术前数值3.66±1.34,p = 0.929;实验组D1数值 13.51±7.48,对照组 D1 数值 12.16±9.85,p=0.719;实验组 D4 数值 9.15±6.54,对照组D4数值10.76±6.61,p = 0.616;实验组D7数值4.50±2.37,对照组D7数值9.03±4.29,p = 0.007);疮灵液对血清中白细胞计数水平的作用有降低趋势,尚未见统计学差异(实验组术前数值4.19±0.34,对照组术前数值4.42±0.63,p = 0.310;实验组D1数值 9.49±3.65,对照组 D1 数值 12.16±9.85,p = 0.880;实验组 D4 数值 5.75±1.28,对照组 D4 数值 6.25±2.04,p = 0.488;实验组 D7 数值 5.56±0.97,对照组 D7 数值 6.25±1.51,p = 0.242)。4.疮灵液干预MDA-MB-231细胞增殖,术后第1、4、7天组均出现统计学差异。0.5%浓度24小时组(实验组D1数值115.44±25.89,对照组D1数值127.79±14.25,p =0.027;实验组 D4 数值 112.11±26.13,对照组 D4 数值 130.40±16.63,p=0.001;实验组 D7数值 108.55±23.99,对照组 D7 数值 131.12±13.54,p0.001);1.0%浓度 24 小时组(实验组 D1 数值 115.68±20.19,对照组 D1 数值 115.44±25.89,p=0.001;实验组 D4 数值110.45±22.57,对照组 D4 数值 119.48±13.54,p0.001;实验组 D7 数值 104.75±20.43,对照组D7数值122.33±16.15,p0.001);0.5%浓度48小时组(实验组D1数值135.96±40.36,对照组 D1 数值 174.81±11.23,p = 0.001;实验组 D4 数值 142.03±22.15,对照组D4数值177.39±8.19,p=0.001;实验组D7数值120.79±42.64,对照组D7数值172.69±15.33,p0.001);1.0%浓度 48 小时组(实验组 D1 数值 140.52±30.05,对照组 D1数值 173.75±10.62,p = 0.031;实验组 D4 数值 139.15±17.45,对照组 D4 数值169.65±2.28,p = 0.034;实验组 D7 数值 120.94±27.16,对照组 D7 数值 168.89±11.53,p= 0.018)。5.疮灵液干预MCF-7细胞增殖,术后第1、4、7天组均出现统计学差异。0.5%浓度24小时组(实验组D1数值103.73±10.37,对照组D1数值119.92±21.99,p = 0.003;实验组D4数值104.98±6.22,对照组D4数值117.43±17.01,p=0.003;实验组D7数值103.32±9.13,对照组 D7 数值 119.92±19.09,p=0.001);1.0%。浓度 24 小时组(实验组 D1数值 105.39±9.96,对照组 D1 数值 133.61±21.99,p0.001;实验组 D4 数值 103.32±9.54,对照组D4数值125.73±13.28,p0.001;实验组D7数值103.32±14.94,对照组D7数值119.92±19.09,p0.001);0.5%浓度 48 小时组(实验组 D1 数值 108.96±22.64,对照组 D1数值 121.38±15.13,p = 0.031;实验组 D4 数值 104.48±26.62,对照组 D4 数值120.89±12.17,p=0.010;实验组 D7 数值 97.26±29.10,对照组 D7 数值 124.34±14.16,p0.008);1.0%浓度48小时组(实验组D1数值118.41±19.40,对照组D1数值172.04±40.79,p0.001;实验组 D4 数值 114.43±20.40,对照组 D4 数值 169.74±29.93,p0.001;实验组 D7 数值 109.20±21.39,对照组 D7 数值 169.08±46.05,p0.001)。6.疮灵液对减少引流液量有作用趋势,统计学尚未见明显差异,但术后第1、4、7天两组引流液量差异有增大趋势(实验组D1数值76.88±35.26,对照组D1数值84.09±40.27,p=0.639;实验组 D4 数值 31.31±20.16,对照组 D4 数值 38.18±25.16,p=0.478;实验组D7 数值 17.20±13.78,对照组 D7 数值 23.46±21.99,p=0.401)。结论:疮灵液外治显著改善乳腺癌手术创面炎症症状,调控乳腺癌术后患者血清中炎症因子及引流液中刺激肿瘤生长相关炎症因子水平,改善乳腺癌术后创面微环境,抑制乳腺癌细胞生长,可以起到促进机体修复与抗肿瘤双重作用。
[Abstract]:Objective: the purpose of this study is to reveal the effects of sores on the inflammatory response of breast cancer surgical wounds in order to affect the biological behavior of breast cancer cells, and to make a preliminary exploration for the treatment of breast cancer by external treatment of traditional Chinese medicine. Methods: 30 cases of breast cancer were randomly assigned to the treatment group and the control group. The cavity was flushed with sore fluid after 20ml and 10min. The control group was treated with drainage tube after each time. The control group was only treated with basic treatment. The scores of inflammation and systemic inflammation were evaluated on the first day, fourth day, seventh day after the operation of breast cancer, and the amount of the axillary drainage fluid was measured, and the inflammatory factors related factors IL-2, IL-4, IL-6, TNF- alpha in the drainage fluid were measured. The level of leukocyte count and the level of CRP in the level of inflammation stress in the blood. In the cell experiment part, the effects of MDA-MB-231 cells and MCF-7 cells on the proliferation of MDA-MB-231 cells and MCF-7 cells were measured by MTT method. Results: the local inflammatory symptoms in the 1. treatment group were obviously improved, and the integral was significantly lower than that of the control group. (the D1 score of the experimental group was 8.2. 1 + 1.40, the D1 score of the control group was 9.09 + 2.02, P = 0.186, the D4 score of the experimental group was 3.26 + 1.65, the D4 integral of the control group was 4.55 + 1.88, and P = 0.07; the experimental group was 2.33 + 1.33, and the control group D7 scores were 4.45 + 2.31. The significant statistical difference was found in the postoperative days after the operation, p=0.004), the content of IL-4, IL-6, TNF- alpha in the treatment group was significantly lower than that of the treatment group. In the control group, there were statistical differences in group.IL-4 (the value of D1 in the experimental group was 2.08 + 1.32, the value of D1 in the control group was 3.37 + 1.71, p=0.034, the value of D4 in the experimental group was 1.90 + 1.44, the D4 value of the control group was 4.04 + 2.85, p=0.025, the D7 value of the experimental group was 1.29 + 0.96, the D7 value of the control group was 4.16 + 2.88, P = 0.04), and the IL-6 group (experimental group D1 numerical values 52.66 + values, controls, numerical values) 54 + 5.70, P = 0.002, the experimental group D4 value 48.33 + 4.78, the control group D4 value 53.38 + 6.21, P = 0.001, the experimental group D7 value 47.62 + 8.78, the control group D7 value 54.31 6.42, P = 0.001), TNF- a group (experimental group D1 values 37.98 +, D1 values, D1 values, p=) .75 + 22.51, P = 0.001, the experimental group D7 value 36.17 + 9.26, the control group D7 value 56.58 + 23.80, P = 0.007), the IL-2 content was significantly higher than the control group, 4,7 days after the operation, there were statistical differences (the experimental group D1 value 7.57 + 1.61, the control group D1 value 7.35 + 2.01, P = 0.977; the experimental group D4 values 7.57 + 1.36, the control group D4 numerical values + =; The D7 value of the test group was 7.61 + 1.46, the D7 value of the control group was 6.40 + 0.92 and P = 0.007). The.3. sores in the.3. sores had a significant effect on the decrease of the serum CRP level. The level of CRP in the experimental group was significantly lower than that of the control group (3.62 + 1.43 before the experimental group, 3.66 + 1.34 in the control group, P = 0.929; the experimental group D1 value 13.51 + 7.48, and the control group D1 value) 12.16 + 9.85, p=0.719, the value of D4 in the experimental group was 9.15 + 6.54, the value of D4 in the control group was 10.76 + 6.61, P = 0.616, the D7 value of the experimental group was 4.50 + 2.37, the control group was 9.03 + 4.29, P = 0.007), and the effect of the sores on the serum white blood cell count level was reduced, and the difference of the total count was not seen in the experimental group before the operation of the experimental group, and the control group was before the operation. The value was 4.42 + 0.63, P = 0.310; the value of D1 in the experimental group was 9.49 + 3.65, the value of D1 in the control group was 12.16 + 9.85, and P = 0.880; the D4 value of the experimental group was 5.75 + 1.28, the D4 value of the control group was 6.25 2.04, P = 0.488, the D7 value of the experimental group was 0.310, and the D7 values of the control group, and.4. sores were intervened for the proliferation of the MDA-MB-231 cells. There were statistical differences in.0.5% concentration in the group of 24 hours (D1 value of experimental group was 115.44 + 25.89, D1 value of control group was 127.79 + 14.25, P =0.027, D4 value of experimental group was 112.11 + 26.13, D4 value of control group was 130.40 + 16.63, p=0.001, D7 value of experimental group 108.55 + 23.99, D7 value 131.12 + 13.54, p0.001) in control group; The value of D1 in the experimental group was 115.68 + 20.19, the value of D1 in the control group was 115.44 + 25.89, p=0.001, the value of D4 in the experimental group was 110.45 + 22.57, the D4 value of the control group was 119.48 + 13.54, p0.001, the D7 value of the experimental group was 104.75 + 20.43, the D7 value of the control group was 122.33 + 16.15, p0.001), and the 0.5% concentration was within the D1 value of the experimental group, and the control group D1 numerical values. .81 + 11.23, P = 0.001, the experimental group D4 value 142.03 + 22.15, the control group D4 value 177.39 + 8.19, p=0.001, the experimental group D7 value 120.79 + 42.64, the control group D7 value 172.69 + 15.33, p0.001), the 1% concentration 48 hours group (experimental group D1 values 140.52 + 30.05, D1 values of the control group, P = =; experimental group D4 values + values, experimental group D4 numerical values + traditions, D4 values, experimental group D4 values, P =, The value of D4 in the control group was 169.65 + 2.28, P = 0.034; the value of D7 in the experimental group was 120.94 + 27.16, the D7 value of the control group was 168.89 + 11.53, and p= 0.018) was used to interfere with the proliferation of MCF-7 cells. The statistical difference of.0.5% concentration in the group 1,4,7 days after the operation was 24 hours (D1 value 103.73 + 10.37, D1 value 119.92 + 21.99 in the control group, P = 0.003). The D4 value of the test group was 104.98 + 6.22, the value of D4 in the control group was 117.43 + 17.01, p=0.003, the D7 value of the experimental group was 103.32 + 9.13, the D7 value of the control group was 119.92 + 19.09, p=0.001), and the 1.0%. concentration for 24 hours (the experimental group D1 value 105.39 + 9.96, the control group D1 values 133.61 + 21.99, p0.001), the D4 numerical value of the experimental group was + 103.32. 8, p0.001, the experimental group D7 value 103.32 + 14.94, the control group D7 value 119.92 + 19.09, p0.001), 0.5% concentration 48 hours group (the experimental group D1 value 108.96 + 22.64, the control group D1 value 121.38 + 15.13, P = 0.031; the experimental group D4 value 104.48 + 121.38, p=0.010, D7 value of the experimental group, p=0.010; control group D. 7 values of 124.34 + 14.16, p0.008); 1% concentration 48 hours group (experimental group D1 value 118.41 + 19.40, control group D1 value 172.04 + 40.79, p0.001; experimental group D4 value 114.43 + 20.40, D4 value 169.74 + 29.93 in the control group, p0.001; experimental group D7 value 14.16, p0.001).6. sores to reduce drainage There was no significant difference in the liquid volume, but there was no significant difference between the two groups of drainage fluid volume (D1 value of the experimental group was 76.88 + 35.26, the D1 value of the control group was 84.09 + 40.27, p=0.639, the D4 value of the experimental group was 31.31 + 20.16, the D4 value of the control group was 38.18 + 25.16, p=0.478, the D7 value of the experimental group was 17.20 + 13.78, and the control group D7). The numerical value is 23.46 + 21.99, p=0.401). Conclusion: the external treatment of sores significantly improves the inflammatory symptoms of the surgical wound of breast cancer, regulates the level of inflammatory factors in the serum of the patients after breast cancer and the stimulation of the growth related inflammatory factors in the drainage fluid, improves the microenvironment of the wounds after the operation of breast cancer and restraining the growth of the breast cancer cells, and can promote the repair of the body. Double action with antitumor.

【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R273

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