Exploratory Research Of Anal Fistula Biomarkers In People With Chronic Diarrhea And Clinical Study On Perioperative Intervention Of ShiZhengChangYan Prescriptionin Patients With Anal Fistula And Chronic Diarrhea

Objective:1.To explore the biomarkers of anal fistula in people with chronic diarrhea.2.To observe the perioperative clinical effect of Shi Zheng Chang Yan Prescription on patients with anal fistula with chronic diarrhea.Methods:1.In the first part,with serum samples of patients with anal fistula and chronic diarrhea,patients with chronic diarrhea and healthy volunteers,the expression of 40 proteins were simultaneously detected by using antibody array search.Find biomarkers that can be used to predict and diagnose anal fistula in early stage,then validated by ELISA.2.In the second part of the clinical study,64 patients with anal fistula and chronic diarrhea were randomly divided into diarrhea traditional Chinese medicine group(n = 34)and diarrhea control group(n = 34).Another 34 patients with anal fistula and normal defecation were collected as normal control group.The diarrhea traditional Chinese medicine group was treated with Shi Zheng Chang Yan Prescription on the basis of routine treatment.The effect of chronic diarrhea on postoperative recovery of anal fistula and the effect of enteritis prescription on the perioperative effect of patients with anal fistula and chronic diarrhea were evaluated by comparing the number of defecation,stool characteristics,wound healing rate,degree of pain,degree of granulation edema and wound secretion at different time points.Results: 1.Quantification analysis has identified 3 proteins MIP-1α,MIP-1β and TNF-R1 with significant differential expression between anal fistula with chronic diarrhea,chronic diarrhea only and healthy control groups and showed the clear separation between three groups by using the expression of MIP-1α,MIP-1β and TNF-R1(P<0.05).Validation using ELISA with expanded sample population showed the same trend of expression levels of the 3 DEPs,displaying sensitivity of and specificity of respectively.2.In the clinical study,there was no significant difference in sex,age,the course of anal fistula and the course of diarrhea among the three groups(P > 0.05).The wound healing rate and wound healing time in the diarrhea traditional Chinese medicine group were better than those in the diarrhea control group,but there was no significant difference between the diarrhea traditional Chinese medicine group and the normal control group(P < 0.001).The degree of wound granulation edema and wound secretion in the diarrhea traditional Chinese medicine group were better than those in the diarrhea control group(P < 0.001).The defecation frequency and fecal characteristics in the postoperative diarrhea traditional Chinese medicine group were better than those in the diarrhea control group(P < 0.001).After treatment,IL-1β,IL-6 decreased and IL-10 increased in the diarrhea traditional Chinese medicine group.The frequency of defecation and the character of stool were negatively correlated with the wound healing rate(P < 0.01),and positively correlated with the degree of pain,the degree of wound granulation edema and the amount of wound secretion(P < 0.01).Conclusion: 1.These results suggest the possibility of employing serum proteins MIP-1α,MIP-1β and TNF-R1 as potential biomarkers for rapid and convenient diagnosis of anal fistula in chronic diarrhea patients.2.The perioperative treatment of Shi Zheng Chang Yan Prescription for patients with anal fistula and chronic diarrhea can effectively reduce defecation times,improve stool characteristics,reduce postoperative complications such as pain,wound granulation edema,wound secretion,promote wound healing and shorten healing time.The mechanism may be related to down-regulation of IL-1β,IL-6 and and up-regulation of IL-10.3.Chronic diarrhea can aggravate the postoperative complications of anal fistula and prolong the healing time.