Abstract
This study to elucidate how hemorrhoidal analgesic cream (HAC), grounded in the traditional Chinese medicine (TCM) 'elevation and causation' theory, promotes postoperative wound healing after anal fistula surgery in diabetic rats by modulating the Keap1/Nrf2 signaling pathway. We used high-sugar and high-fat chow combined with streptozotocin (STZ) to induce diabetic rats to establish a postoperative wound model of anal fistula. The rats were divided into a blank control group, model group, wound-only group, experimental group (HAC treatment), and positive control group (recombinant human epidermal growth factor gel). HAC's impact on wound healing was evaluated by glycated hemoglobin (HbA1c), serum inflammatory factors (TNF-α, IL-6), oxidative stress markers (SOD, MDA), and Nrf2 pathway proteins and mRNA. The results showed that the wound healing rate was significantly increased in the HAC group (92.85 ± 3.41 %, P < 0.01), the levels of HbA1c were decreased (P < 0.05), the levels of TNF-α, IL-6, and MDA were decreased (P < 0.01), the activity of SOD was increased (P < 0.05), and the Keap1/Nrf2 signaling pathway was activated. The study demonstrated that HAC could reduce oxidative stress and inflammatory responses by regulating the Keap1/Nrf2 signaling pathway, which validates its scientific value in promoting wound healing after diabetes mellitus (DM) fistula surgery.