消异止痒汤加减治疗儿童期特应性皮炎45例

Effect of Modified Xiaoyi Zhiyang Decoction in Treating 45 Cases with Childhood Atopic Dermatitis

摘要:

目的: 探讨消异止痒汤加减治疗儿童期特应性皮炎(AD)的临床疗效及对外周血白细胞介素-2,4,17(IL-2,IL-4,IL-17)和干扰素(IFN-γ)水平的影响。方法: 将90例AD患者采用随机按数字表法分为对照组和观察组各45例。对照组采用糠酸莫米松乳膏适量外用,2次/d,皮损控制后,1次/d;左西替利嗪口服溶液,1次/d,6岁以上儿童,10 mL/次;4~6岁,5 mL/次。观察组在对照组治疗的基础上采用消异止痒汤进行辨证加减治疗。两组疗程均为3个月。进行治疗前后欧洲AD评分标准(SCORAD)及皮肤病生活质量指数量表(DLQI)评分,检测治疗前后IL-2,IL-4,IL-17和IFN-γ水平。结果: 经Ridit分析,观察组临床疗效优于对照组(P<0.05);治疗后观察组皮肤病变范围(A),皮损严重评分(B)和瘙痒和睡眠程度评分(C)及SCORAD总分均低于对照组(P<0.01);治疗后观察组DLQI评分低于对照组(P<0.01);治疗后观察组IL-4和IL-17水平低于对照组(P<0.01),IL-2和IFN-γ水平高于对照组(P<0.01)。结论: 消异止痒汤能改善儿童期AD患者的主、客观症状、体征,提高生活质量,疗效优于单纯的西医治疗,其作用机制可能与调节Th1/Th2及IL-17等细胞因子有关,值得进一步研究。

Abstract:

Objective: To discuss the curative efficacy of modified Xiaoyi Zhiyang decoction in treating childhood atopic dermatitis (AD) and to investigate its influence on levels of peripheral blood interleukin IL-2, IL-4, IL-17 and interferon-γ. Method: Ninety patients with AD were randomly divided into the control group(45 cases) and the observation group (45 cases) by a random number table. Patients in the control group received mometasone furoate cream twice daily and once daily when the skin lesion was controlled, 10 mL levocetirizine oral liquid for children older than 6 years and 5 mL for children 4 to 5 years old once daily. Based on the treatment of the control group, patients in the observation group added modified Xiaoyi Zhiyang decoction. All patients in the two groups received 3 months of treatment. Before and after treatment, scores of quality of life index scale (DLQI) of SCORAD and skin disease were graded. Levels of IL-2, IL-4, IL-17 and IFN-γ were detected. Result: The curative efficacy in the observation group was superior to that in the control group (P<0.05). After treatment, scores of scope of skin lesions (A), lesion severity (B) and itch and sleeping degree (C) and the total scores of SCORAD in the observation group were lower than those in the control group (P<0.01). Score of DLQI was lower than that in the control group (P<0.01). Levels of IL-4 and IL-17 were lower than those in the control group (P<0.01), while levels of IL-2 and IFN-γ were higher than those in the control group (P<0.01). Conclusion: Xiaoyi Zhiyang decoction could improve the subjective and the objective symptoms, signs, enhance quality of life in AD patients with child's stage. Its curative effect is superior to using Western medicine treatment alone and the mechanism may be related to regulating Th1/Th2 and IL-17 cytokines. The therapy deserves to further study.