| Objective: To observe the clinical effect of Zilian ointment on pain,hematochezia,pain duration after defecation,wound healing and anal canal resting pressure in patients with anal fissure,and to study the influence of Zilian ointment on vascular endothelial growth factor(VEGF),macrophage(CD68)and nitric oxide(NO).To explore the clinical mechanism and effect of Zilian ointment in treating anal fissure.Methods: A total of 60 patients with anal fissure in stage Ⅰ,Ⅱ and Ⅲ of blood heat and intestinal dryness were selected and randomly divided into treatment group and control group with 30 cases in each group.The drugs in the treatment group and the control group were Zilian ointment and nitroglycerin ointment for external use,with a total of 2 courses of treatment(1 course of treatment for 2 weeks).That is,the pain,hematochezia,pain duration after defecation and wound healing rate were researced after 1,2,3 and 4 weeks of therapy.The efficient was studied after 1 and 2 courses of therapy severally.Comparing the anal resting pressure before treatment and after 2 courses of treatment,After two courses of treatment,at least 6 cases of anal fissure lesions in each of the two groups were randomly selected to observe the positive expression of VEGF and CD68 by immunohistochemistry,and the concentration of nitric oxide(NO)was calculated by enzyme-linked immunosorbent assay(ELISA).Because the nature of NO is unstable,the concentration of nitric oxide synthase(NOS)is detected to reflect the concentration of NO.Results: In the first course of treatment,after one week of remedy,the wound healing rate of the experimental group was superior to the control group(P < 0.05).After 2 weeks of treatment,the treatment group was superior to the control group in reducing hematochezia and promoting wound healing(P values were less than 0.05).After one course of therapy,the efficient of Zilian ointment and nitroglycerin ointment were 83% and 50% respectively(P <0.05),and the overall curative effect of Zilian ointment was higher than that of nitroglycerin ointment.In the second course of treatment,after 3 weeks of treatment,the treatment group was superior to the control group in relieving the main symptoms caused by anal fissure and promoting wound healing(P values were less than 0.05).After 4 weeks of therapy,the experimental group was advantage over the control group in controlling hematochezia and promoting wound healing(P values were less than 0.05).After two courses of treatment,the total effective rates of Zilian ointment and nitroglycerin ointment were 93% and 90%respectively(P> 0.05),and there was no significant difference between the two groups after two courses of treatment.Compared with the control group,the two groups can reduce the anal resting pressure before and after treatment(P < 0.05).After two courses of treatment,the positive rate of VEGF and CD68 and the concentration of NO(NOS)(all P values are less than 0.05),the treatment group can express VEGF and CD68 more,and the control group can detect higher NO concentration.Conclusion: In the first course of treatment,the total effective rate of Zilian ointment is higher than that of nitroglycerin ointment.After two courses of treatment,there was no significant difference in the total effective rate between the two groups.The results showed that both groups could improve the symptoms of anal pain and hematochezia in patients with anal fissure,and the effective rate of Zilian ointment was significant after one course of treatment.Therefore,Zilian ointment took effect faster and the course of treatment was shorter.Zilian ointment is superior to promoting wound healing,reducing hematochezia,promoting the positive expression of VEGF and CD68,while nitroglycerin ointment is superior to reducing anal resting pressure and increasing NO concentration. |
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