Study On The Relationship Between AGEs And Inflammatory Factors And Growth Factors In The Healing Process Of Diabetic Foot Ulcer

Objective:To study the role of the application of TCM external treatment,"Yinhuangsan", in the process of the wound tissue healing when it is used to intervene in the diabetic foot ulcers, and then explore the mechanism and the role of link of the rat and human diabetic ulcers healing.Method:1.Theoretical research:Summarizes the understanding of the etiology and pathogenesis of diabetic foot ulcers by TCM, and the clinical research of the TCM treatment of diabetic foot ulcers; In addition, discusses the modern medicine for the treatment of diabetic foot ulcers.2. Experimental study:Randomly divide the male SD rats into two groups, the control group and model group. The30model rats fed with high fat and sugar a month, and then intraperitoneal injection STZ40mg/kg. The10control group rats and30diabetic rats cut modeling area of skin deep to fascia under sterile conditions. The establishment of diabetic ulcers model rats was randomly divided into model group, western medicine group and TCM group, each10, respectively, corresponding to the drug. After10days of modeling, we drawn materials. Detection of serum TNF-a, IL-1, hs-CRP, AGEs, bFGF, EGF, CEGF, PDGF levels by enzyme-linked immunosorbent assay; Using immunohistochemistry (PCNA staining) to detect the number of fibroblast in the wound granulation tissue; Using immunohistochemistry (CD34staining) to detect the number of new capillaries in granulation tissue; HE staining was using to observe morphological changes.3. Clinical studies:60patients with damp-heat-toxin standard diabetic foot ulcer patients were randomly divided into treatment group and control group. Treatment group using the medicine "Yinhuangsan", while control group using metronidazole and glucose injection, and once daily dressing. Set up0days before treatment, after treatment3days,7days,14days,21days for five detection node, respectively drawn blood, and the serum was separated for the detection of TNF-α,IL-1, hs-CRP, AGEs, bFGF, EGF, CEGF, PDGF content, and syndromes assessed value over the same period. Using SPSS19.0software serological test serological test results and pathology image analysis results were statistically analyzed.Result:1.The experimental research:After the analysis of different experiment, it is credibilitydiabetic rats that high-fat-diet fed rats (80-100g) and intraperitoneal injection of STZ (40mg/kg) for a month.Compared with the model group, in serum of rats, AGEs and TNF-a, IL-1, CRP can be reduced after drug intervention and these proteins can be significantly decreased in traditional chinesemedicinetreatment group (Yin-Huang-San)(P<0.01); bFGF, EGF, VEGF, PDGFcan beimprovedafter drug intervention and these proteins can be significantly increased in traditional chinesemedicinetreatment group (Yin-Huang-San)(P<0.01); newborn capillaries, fibroblastswere increased in granulation tissue of traditional chinesemedicinetreatment group and western medicine treatment group, and traditional chinese medicine treatment group is more pronounced than western medicine treatment group (P<0.05). 2.The clinical research:at the early stage of inflammation, CRP, TNF-a, IL-1were significantly increased in the control group and the treatment group (P<0.05); at the7,14,21days, CRP, TNF-a, IL-1can be reduce in the control group and the treatment group(P<0.05), and the treatment groupis more pronounced thanthe control group(P<0.05); bFGF, EGF, VEGF, PDGF can be improved inthe control group and the treatment group (P<0.05), and the treatment group (Yin-Huang-San) can significantly improve growth factor(P<0.05); after dynamic analysis,we found that AGEs was positively correlated with inflammatory factor and it was negatively correlated with growth factor; transcutaneous oxygen pressure was improved inthe control group and the treatment group (P<0.05), andthe treatment groupis more pronounced than the control group (P<0.05); the treatment groupis more pronounced than the control group in total of symptom scores, main symptom score, secondary symptoms of patients(P<0.05), the total efficiency of the treatment group was up to96.7%, and the total efficiency of thecontrol group (metronidazole and glucose injection) was83.3%.Conclusion:Yin-Huang-Sancan significantly promote the ulcer healing in diabetes mellitus patients and rats, because Yin-Huang-San can reduce inflammatory reaction and it can improve grown factor in rat serum, besides, Yin-Huang-San can reduce AGEsin rat serum, and it can promote new capillaries and fibroblasts proliferation. In addition, AGEs was positively correlated with inflammatory factor and it was negatively correlated with growth factor. It is positive effect in diabetic foot wound healing of inhibit AGEs synthesis and block the action of AGEs. After treat of Yin-Huang-San, oxygen supply is increased in ulcer, nutriturecan be improved in local tissue, destruction caused by hypoxia ischemia is decreased in local tissue. In summary, Yin-Huang-Sanhas better clinical curative effect in treat of Diabetic foot ulcer.