凉血消银方治疗进行期寻常型银屑病49例

Liangxue Xiaoyin Decoction in Treating 49 Cases with Psoriasis Vulgaris at Active Stage

摘要:

目的: 探讨凉血消银方治疗进行期寻常型银屑病(血热证)近期疗效及对外周血T细胞亚群和炎症因子的调节作用. 方法: 将95例符合条件的患者随机按数字表法分为对照组46例和观察组49例.两组均采用他扎罗汀凝胶外用,对照组口服复方青黛胶囊,4粒/次,3次/d;观察组采用凉血消银方辨证治疗,1剂/d,两组疗程均为8周.于治疗前及治疗后2,4,8周进行银屑病皮损面积和严重程度指数(PASI)和瘙痒程度,采用视觉模拟(VAS)评分;进行治疗前后皮肤病生活质量指数(DLQI)和血热证评分,检测治疗前后外周血T淋巴细胞亚群和血清白介素-6(IL-6)、白介素-17(IL-17)和肿瘤坏死因子-α(TNF-α)水平. 结果: 经Ridit分析,观察组临床疗效优于对照组(P<0.05);在治疗后8周观察组PASI评分低于对照组(P<0.01),在治疗后4,8周观察组瘙痒程度VAS评分低于对照组(P<0.01);治疗后观察组DLQI和血热证评分均低于对照组(P<0.01);治疗后两组CD3⁺,CD4⁺,CD4⁺/CD8⁺均比治疗前升高,观察组上升更为显著(P<0.01),两组CD8⁺水平较治疗前下降,观察组下降更为明显(P<0.01);治疗后观察组血清IL-6,IL-17和TNF-α水平均低于对照组(P<0.01). 结论: 凉血消银方联合他扎罗汀凝胶外用能迅速控制进行期寻常型银屑病(血热证)患者的皮损,促使病情稳定,其机制可能与调节外周血T细胞亚群的失衡状态及下调促炎症介质有关.

Abstract:

Objective: To discuss the short-term curative efficacy of Liangxue Xiaoyin decoction in treating psoriasis vulgaris at active stage (blood heat syndrome) and its adjusting function on T-cell subset in peripheral blood and inflammatory factor. Method: Ninety-five patients were randomly divided into control group (46 cases) and observation group (49 cases) by random number table. Patients in both groups received tazarotene gel by external use, and patients in control group added 4 Fufang Qingdai capsules 3 times daily, patients in observation group added dialectical therapy of Liangxue Xiaoyin decoction 1 dose daily. Patients in two groups received a 8 week period of treatment. Scores of lesion size of skin, psoriasis area and severity index (PASI) and itch degree were graded by visual analogue scale (VAS) before and after 2, 4 and 8-week treatment. Scores of dermatology life quality index (DLQI) and teat in blood system were graded, and levels of T-cell subset in peripheral blood and serous interleukin-6 (IL-6), interleukin-17 (IL-17) and tumor necrosis factor-α(TNF-α) were detected before and after treatment. Result: The clinical effect in observation group was superior to that in control group by Ridit analysis (P<0.05). Score of PASI in observation group was lower than that in control group after 8-week treatment (P<0.01), and VAS score of itch degree in observation group was lower than that in control group after 4 and 8-week treatment (P<0.01). Scores of DLQI and heat in blood system in observation group were lower than those in control group (P<0.01). Levels of CD3⁺,CD4⁺,CD4⁺/CD8⁺ in both groups were increased as compared with those before treatment, while the observation group gained higher results (P<0.01). Level of CD8⁺ in both group was decreased as compared with that before treatment, while the observation group gained lower result (P<0.01). After treatment, levels of serum IL-6, IL-17 and TNF-α in observation group were inferior to those in control group (P<0.01). Result: Using Liangxue Xiaoyin decoction orally combined Tazarotene gel externally could control psoriasis vulgaris during active stage (blood heat syndrome) patients with psoriasis skin lesions and stabilize the disease situation. The mechanism may be related to regulating imbalance of peripheral blood T cell subsets and reducing proinflammatory medium.