Clinical Study Of Compound Wufengcao Liquid Regulating M1/M2 Macrophage Polarization In Intervening Tuberculous Ulcers

Objective:1.According to the theory of macrophage polarization,the molecular mechanism of compound Wufengcao liquid on tuberculous ulcer is explained.2.To provide an external medicine with accurate clinical effect and clear action mechanism for tuberculous ulcer,which is convenient for promotion and application.Methods:The first part of clinical research:58 patients with tuberculous ulcers were included as the test group(CTB),and 55 healthy volunteers were used as the blank group(CK).The expression levels of macrophage phenotype index iNOS and cytokine TNF-?,M2 macrophage phenotype index Arg-1 and cytokine TGF-? in the two groups of plasma were detected by ELISA and qPCR techniques.The second part of the clinical research:64 patients with tuberculous ulcers were included and randomly divided into a treatment group(compound Wufengcao liquid external use group)and a control group(isoniazid external use group).32 patients in each group were given basic antituberculosis treatment and local dressing change for 28 days.Observe the wound healing rate,healing rate,decay time and speed,TCM syndrome scores,and different expressions of macrophage phenotype index iNOS and cytokine TNF-?,M2 macrophage phenotype index Arg-1 and cytokine TGF-? in the two groups of plasma were detected by ELISA and qPCR techniques.Results:The first part of clinical research:1.There was no statistical difference in the distribution of sex and age between the two groups(P>0.05).2.Comparison of the expression of iNOS,TNF-?,Arg-1,TGF-? protein in the plasma of the two groups by ELISA,The protein expression levels of iNOS and TNF-? in the test group were higher than those in the blank group(P<0.001);The protein expression levels of Arg-1 and TGF-? in the plasma of the test group were lower than those of the blank group(P<0.05).3.QPCR was used to detect the expression of iNOS,TNF-?,Arg-1,and TGF-? mRNA in the two groups of plasma.The expression levels of iNOS,TNF-?mRNA in the plasma of the test group were higher than those of the blank group(P<0.001);The expression levels of Arg-1 and TGF-? mRNA in the plasma of the test group were lower than those of the blank group(P<0.05).The second part of the clinical research:1.There was no statistical difference in the distribution of gender,age,and disease duration between the two groups(P>0.05);There was no statistical difference in the distribution of wound area and sinus depth before treatment in the two groups(P>0.05).2.The total effective rates of the treatment group and the control group after treatment for 28 days were 93.75%and 71.88%.The treatment group was higher than the control group(P<0.05);On the 28th day of treatment,the wound healing rate,healing rate,the TCM syndrome scores were better than those on the 14th day(P<0.05 or P<0.01).The wound healing rate,healing speed,decay time and speed,and TCM syndrome score of the treatment group were better than those of the control group(P<0.05 or P<0.01).3.ELISA and qPCR detected the expression trend of protein and mRNA levels in the four indicators consistent.The expression of iNOS,TNF-?,Arg-1,and TGF-? in the plasma of the two groups before treatment was compared by ELISA,and there was no statistical difference(P>0.05);On the 14th day and 28th day,the expression levels of iNOS and TNF-? in the plasma of the treatment group were lower than before treatment(P<0.05 or P<0.01),and the levels of Arg-1 and TGF-? were higher than before treatment(P<0.05 or P<0.01);Compared with the control group,the treatment group can effectively reduce the expression levels of iNOS and TNF-? in the plasma(P<0.05)and increase the expression levels of Arg-1 and TGF-p(P<0.05).4.QPCR detection of iNOS,TNF-?,Arg-1,and TGF-? mRNA expression in the two groups before treatment showed no statistical difference(P>0.05);On the 14th and 28th days,the levels of iNOS and TNF-? mRNA expression in the two groups were lower than before treatment(P<0.05 or P<0.01 or P<0.001),and the expression levels of Arg-1 and TGF-? mRNA were higher than before treatment(P<0.05 or P<0.01 or P<0.001).The expression of the treatment group was better than that of the control group(P<0.05 or P<0.01 or P<0.001).Conclusion:1.Patients with tuberculous ulcer and healthy people are in the state of coexistence of polarized M1 and M2 macrophages.Compared with healthy people,M1 macrophages in patients with tuberculous ulcers have a very high expression state,while M2 macrophages that can inhibit the formation of granulomas and promote wound repair have lower expression.2.This experiment demonstrates the ability of compound Wufengcao liquid to repair wounds from the perspective of regulating macrophage polarization.Complete the healing of tuberculous ulcers by effectively inhibiting M1 macrophage polarization and promoting M2 macrophage polarization.3.During treatment,the trend of polarization between macrophages in the plasma and tissues of patients with tuberculous ulcers is consistent,providing a laboratory basis for the selection of serum biomarkers for future clinical drug efficacy research.4.On the basis of western medicine against tuberculosis,compound Wufengcao liquid for external treatment of tuberculous ulcer can effectively remove carrion,improve wound healing rate,improve TCM syndrome score and no obvious adverse reactions.Can be included in the treatment of tuberculous ulcers and clinical application.