| Objective:To explore the material basis,mechanism and clinical efficacy of Cayratia Japonica Cream in promoting wound healing after high complex anal fistula operation,and to provide clinical application basis for Cayratia Japonica Cream in treating wound of high complex anal fistula after operation.Methods:(1)The active ingredients and their targets of Cayratia Japonica were searched by TCMSP,and the potential targets of Cayratia Japonica for promoting infected wound healing were obtained by mapping with the targets of infected wound healing queried by Genecards database.The interaction network of target proteins was constructed by String database,the TCM-compounds-targets-disease network was constructed by Cytoscape 3.7.0 software,and the GO function and KEGG pathway enrichment of predicted targets were analyzed by David.(2)Forty patients with high complex anal fistula who were treated in the Department of anorectal surgery,Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine from June 2019 to December 2020 were randomly divided into 20 cases of control group and 20 cases of Cayratia Japonica Cream group.The two groups of patients were compared to each other on day 3 and 9 after operation in terms of the wound area,wound area reduction rate,pain index and granulation growth score.The overall efficacy was evaluated on month 2 after operation.The wound tissue specimens were collected on day 3 and 9 after operation,and the level of Tumor Necrosis Factor-α(TNF-α),Interleukin-6(IL-6),Matrix Metalloproteinase 9(MMP9),Matrix Metalloproteinase 2(MMP2)and Vascular Endothelial Growth Factor A(VEGFA)were measured in wound tissue specimen with Western Blot.Results:(1)Five active components including Luteolin and apigenin in Cayratia Japonica were screened out with TCMSP,and there were 129 targets corresponding to the five active components.523 targets related to infected wound healing were collected from Genecards database.The intersection of the two obtained 53 targets,including TNF-α,IL-6,MMP9,MMP2 and VEGFA,involving HIF-1 signaling pathway,T cell receptor signaling pathway,TNF signaling pathway,NF-κB signaling pathway and so on.(2)A total of 40 patients were included in this study,all of them have finished the study.There was no significant difference in general data of age,gender,disease duration,BMI index,blood glucose between the two groups(P>0.05).On day 3 after operation,there was no significant difference in wound area,pain index and granulation growth score between the two groups(P>0.05).On day 9 after operation,the wound area of Cayratia Japonica Cream group was smaller than that of the control group,the wound area reduction rate of Cayratia Japonica Cream group was higher than that of the control group,the pain index and granulation growth score of the Cayratia Japonica Cream group were lower than those of the control group,the difference was statistically significant(P<0.05).On day 9 after operation,the levels of TNF-α,IL-6,MMP9 and MMP2 in the granulation tissue of patients in Cayratia Japonica Cream group were lower than those in the control group,and the level of VEGFA in the granulation tissue of patients in Cayratia Japonica Cream group was higher than that in the control group(P<0.05).When the two groups were followed up for 2 months,the total effective rate of the two groups was 100%,and the difference was not statistically significant(P>0.05).There were no adverse reactions such as perianal allergy in the two groups.Conclusion:Network pharmacology shows that Cayratia Japonica can play a therapeutic role in infected wound healing through multiple targets and multiple pathways.Combined with clinical observation and laboratory index detection,Cayratia Japonica Cream may promote wound healing after high complex anal fistula operation by reducing the levels of TNF-α,IL-6,MMP9 and MMP2,increasing the level of VEGFA,which provides the basis and prescription for further research of Cayratia Japonica Cream. |
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