组织工程与重建外科杂志

组织工程与重建外科杂志 ›› 2025, Vol. 21 ›› Issue (6): 586-.

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运用16S核糖体RNA高通量测序探讨长皮膏对下肢慢性静脉溃疡微生态的影响

  

  • 出版日期:2025-12-25 发布日期:2025-12-30

 The effect of Zhangpi ointment on the microecology of chronic venous leg ulcers by 16S ribosomal RNA high-throughput sequencing

  • Online:2025-12-25 Published:2025-12-30

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摘要：

目的 运用 16S 核糖体 RNA（16S rRNA）高通量测序，探讨长皮膏治疗下肢慢性静脉溃疡（Chronic venous leg ulcers，CVLU）的临床疗效及其对创面微生态的影响。

方法 按治疗方式将35例CVLU患者分为长皮膏组（18例）和对照组（17例），长皮膏组患者创面给予长皮膏治疗，对照组给予常规换药治疗，疗程4周，观察临床疗效，以及创面生肌及菌群变化情况，同时行优势菌属差异和临床症状相关性分析。结果 治疗28 d后，总有效率长皮膏88.9%（16/18），对照组70.6%（12/17）；长皮膏组创面肉芽组织覆盖率显著高于对照组（P<0.05）。创面菌群16S rRNA高通量测序显示，与治疗前及对照组相比，长皮膏组治疗后Alpha多样性指数明显下降（P<0.05），变形菌门及假单胞菌属丰度明显下降（P<0.05）。LEfSe分析提示，治疗前后菌属水平差异主要包括属于变形菌门的假单胞菌属和短波单胞菌属（P<0.05）。相关性分析发现，假单胞菌属丰度与临床压疮愈合评分表（Pressure ulcer scale forhealing，PUSH）评分呈正相关（r=0.467，P<0.01），而与肉芽组织覆盖率呈负相关（r=-0.545，P<0.01）。

结论 长皮膏治疗CVLU可以改善患者临床症状，促进创面肉芽组织生长，可能是通过调节创面菌群发挥作用，对变形菌门假单胞菌属有明显的抑制作用。

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Abstract:

Objective To investigate the clinical efficacy of Zhangpi ointment in the treatment of chronic venous leg ulcers （CVLU） and its impact on the microecology of the wound surface by using 16S ribosomal RNA （16S rRNA） high-throughput sequencing. Methods A total of 35 patients with CVLU were divided into a Zhangpi ointment group （treatment group，18 cases） and a control group （17 cases） based on the treatment method. The treatment group was treated with Zhangpi ointment， while the control group received conventional treatment. The treatment course was 4 weeks. The clinical efficacy， wound granulation tissue growth， and changes in the microbial flora were observed. Additionally， the differences in dominant bacterial genera and the correlation with clinical symptoms were analyzed. Results At 28 days post-treatment， the total effective rate of the treatment group was 88.9% （16/18）， and that of the control group was 70.6% （12/17）. The coverage of granulation tissue in the treatment group was significantly higher than that in the control group （P<0.05）. High-throughput sequencing of the 16S rRNA of the wound microbiota showed that compared with before treatment and the control group， the Alpha diversity index in the treatment group decreased significantly after treatment （P<0.05）， and the abundance
of the Proteobacteria phylum and Pseudomonas genus decreased significantly （P<0.05）. LEfSe analysis indicated that the  differences in bacterial genera before and after treatment mainly included Pseudomonas and diminuta（P<0.05）. Correlation analysis revealed that the abundance of Pseudomonas was positively correlated with the clinical PUSH score （r=0.467，P< 0.01）， but negatively correlated with the coverage of granulation tissue （r=-0.545，P<0.01）. Conclusion Zhangpi ointment can ameliorate the clinical symptoms of patients with CVLU and promote the growth of granulation tissue on the wound surface. It may exert its effect by regulating the wound surface microbiota and has a significant inhibitory effect on Pseudomonas of the Proteobacteria phylum.

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