自拟疏风解毒方联合卡泊三醇软膏治疗银屑病的疗效及对免疫功能的影响

丁蓉; 黄巧玲; 陈志伟; 潘倩雄

doi:10.16766/j.cnki.issn.1674-4152.003070

自拟疏风解毒方联合卡泊三醇软膏治疗银屑病的疗效及对免疫功能的影响

doi: 10.16766/j.cnki.issn.1674-4152.003070

1.
瑞安市中医医院皮肤科，浙江温州 325200
2.
杭州市第三人民医院皮肤科，浙江杭州 320000
3.
温州市中西医结合医院皮肤科，浙江温州 325000
4.
瑞安市人民医院妇幼分院检验科，浙江温州 325200

基金项目:

浙江省医药卫生科技计划项目 2019KY503

详细信息

通讯作者:
丁蓉，E-mail：linha08462@163.com

中图分类号: R758.63
计量
- 文章访问数: 305
- HTML全文浏览量: 90
- PDF下载量: 5
- 被引次数: 0
出版历程
- 收稿日期: 2023-02-20
- 网络出版日期: 2023-08-28

Efficacy of self-designed Shufeng Jiedu formula combined with calcipotriol on psoriasis and its influence on immune function

1.
Skin Department, Ruian Hospital of Traditional Chinese Medicine, Wenzhou, Zhejiang 325200, China

摘要

摘要: 目的观察自拟疏风解毒方联合卡泊三醇软膏治疗银屑病的效果及对患者免疫功能的影响，为临床治疗银屑病提供参考。方法选取2019年2月—2022年11月瑞安市中医医院诊治的60例银屑病患者，应用随机数字表法分成2组，每组30例。对照组给予局部涂抹卡泊三醇乳膏+窄谱中波紫外线(NB-UVB)照射干预，观察组在对照组基础上，口服自拟疏风解毒方治疗。2组治疗疗程均为8周。通过银屑病皮损面积与严重程度指数(PASI)评分评估临床效果，并对比2组患者治疗前后的中医证候积分、免疫功能(CD3⁺、CD4⁺、CD8⁺、CD4⁺/CD8⁺)水平变化和安全性。结果治疗后，观察组总有效率为96.67%(29/30)，明显高于对照组的73.33%(22/30), χ²=4.706, P=0.030；治疗后，观察组瘙痒剧烈、点状出血、皮疹增多积分均低于对照组(均P＜0.01)；治疗后，观察组PASI评分均低于对照组(均P＜0.01)；治疗后，观察组患者外周血CD3⁺、CD4⁺、CD4⁺/CD8⁺水平均高于对照组[(52.86±6.13)% vs. (45.48±5.57)%，(53.42±5.76)% vs. (48.19±5.24)%，1.90±0.35 vs. 1.62±0.39，t=4.880、3.679、2.927, 均P＜0.01]；而CD8⁺低于对照组[(28.25±5.35)% vs. (31.43±5.07)%，t=2.363, P=0.011]。结论自拟疏风解毒方联合卡泊三醇软膏治疗银屑病疗效显著，可有效降低PASI评分及中医证候积分，其机制可能与调节患者免疫功能有关，且安全性好。
- 银屑病 /
- 疏风解毒方 /
- 卡泊三醇 /
- 免疫功能
Abstract: Objective To observe the efficacy of self-designed Shufeng Jiedu formula combined with calcipotriol on psoriasis and its influence on immune function, and provide theoretical reference for clinical treatment of psoriasis. Methods A total of 60 patients with psoriasis treated in Ruian Hospital of Traditional Chinese Medicine from February 2019 to November 2022 were selected and randomly divided into two groups by random table method, with 30 cases in each group. The control group were treated with calcipotriol ointment combined with NB-UVB, and the observation group were treated with self-designed Shufeng Jiedu formula on the basis of the control group. Both groups had a treatment course of 8 weeks. The clinical efficacy was evaluated by the psoriasis skin lesion area and severity index (PASI), and the changes in traditional Chinese medicine syndrome scores, immune function (CD3⁺, CD4⁺, CD8⁺, CD4⁺/CD8⁺) levels, and safety between two groups of patients before and after treatment were compared. Results After treatment, the total effective rate of the observation group was 96.67% (29/30), which was significantly higher than 73.33% (22/30) of the control group (χ²=4.706, P=0.030); the score of severe itching, punctate bleeding and rash increase in the observation group were lower than those in the control group (all P<0.01); the PASI score index of the observation group were lower than that of the control group (all P<0.01); the levels of peripheral blood CD3⁺, CD4⁺ and CD4⁺/CD8⁺in the observation group were higher than those in the control group [(52.86±6.13)% vs. (45.48±5.57)%, (53.42±5.76)% vs. (48.19±5.24)%, 1.90±0.35 vs. 1.62±0.39, t=4.880, 3.679, 2.927, all P<0.01], however, CD8⁺ was lower than the control group [(28.25±5.35)% vs. (31.43±5.07)%, t=2.363, P=0.011]. Conclusion Self-designed Shufeng Jiedu formula combined with calcipotriol exert certain effect in treating of psoriasis, which can significantly improve the PASI score index and the main syndrome score. Its mechanism may be related to the regulation of immune function, and the safety is good.
- Psoriasis /
- Shufeng Jiedu formula /
- Calcipotriol /
- Immune function

HTML全文

表 1 2组银屑病患者临床疗效比较[例(%)]

Table 1. Comparison of clinical efficacy between the two groups of patients with psoriasis [cases (%)]

组别	例数	治愈	显效	有效	无效	总有效
对照组	30	9(30.00)	8(26.67)	5(16.67)	8(26.67)	22(73.33)
观察组	30	13(43.33)	11(36.67)	5(16.67)	1(3.33)	29(96.67)
注：2组总有效率比较，χ²=4.706，P=0.030。

下载: 导出CSV

表 2 2组银屑病患者中医证候积分比较(x±s，分)

Table 2. Comparison of TCM syndrome scores between the two groups of psoriasis patients (x±s, points)

组别	例数	瘙痒剧烈		点状出血		皮疹增多
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
对照组	30	4.35±0.89	2.31±0.57^a	3.85±0.66	2.01±0.34^a	3.24±0.47	1.82±0.39^a
观察组	30	4.32±0.93	1.72±0.50^a	3.88±0.62	1.44±0.29^a	3.28±0.55	1.45±0.32^a
t值		0.128	4.262	0.181	6.986	0.303	4.017
P值		0.899	＜0.001	0.857	＜0.001	0.763	＜0.001
注：与同组治疗前比较，^aP＜0.05。

下载: 导出CSV

表 3 2组银屑病患者PASI评分比较(x±s，分)

Table 3. Comparison of PASI scores between the two groups of patients with psoriasis (x±s, points)

组别	例数	皮损面积		磷屑		红斑		浸润
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
对照组	30	2.38±0.34	1.63±0.23^a	2.33±0.34	1.44±0.25^a	2.21±0.28	1.35±0.19^a	2.17±0.25	1.49±0.22^a
观察组	30	2.36±0.29	1.27±0.21^a	2.29±0.38	1.17±0.21^a	2.17±0.25	1.09±0.14^a	2.14±0.27	1.27±0.18^a
t值		0.245	6.331	0.430	4.529	0.584	6.034	0.447	4.239
P值		0.807	＜0.001	0.669	＜0.001	0.562	＜0.001	0.656	＜0.001
注：与同组治疗前比较，^aP＜0.05。

下载: 导出CSV

表 4 2组银屑病患者免疫功能指标比较(x±s)

Table 4. Comparison of immune function indexes between the two groups of psoriasis patients (x±s)

组别	例数	CD3⁺(%)		CD4⁺(%)		CD8⁺(%)		CD4⁺/CD8⁺
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
对照组	30	41.29±4.87	45.48±5.57^a	44.47±6.08	48.19±5.24^a	34.81±4.09	31.43±5.07^a	1.38±0.40	1.62±0.39^a
观察组	30	42.45±4.93	52.86±6.13^a	45.31±5.84	53.42±5.76^a	35.22±4.15	28.25±5.35^a	1.44±0.37	1.90±0.35^a
t值		0.917	4.880	0.546	3.679	0.385	2.363	0.603	2.927
P值		0.363	＜0.001	0.587	＜0.001	0.701	0.022	0.549	0.005
注：与同组治疗前比较，^aP＜0.05。

下载: 导出CSV

参考文献(15)

[1]	殷文浩, 金梦祝, 戴晴. 火针配合针刺治疗小腿斑块状银屑病的效果观察[J]. 中华全科医学, 2022, 20(1): 117-120. doi: 10.16766/j.cnki.issn.1674-4152.002291 YIN W H, JIN M Z, DAI Q. Curative effect of fire acupuncture combined with acupuncture in the treatment of lower leg plaque psoriasis[J]. Chinese Journal of General Practice, 2022, 20(1): 117-120. doi: 10.16766/j.cnki.issn.1674-4152.002291
[2]	李红霞, 孙同毅, 王春河. 治疗银屑病的抗体药物研究进展[J]. 华西药学杂志, 2021, 36(3): 325-330. https://www.cnki.com.cn/Article/CJFDTOTAL-HXYO202103020.htm LI H X, SUN T Y, WANG C H. Progress of antibody thereapeutics in the treatment of psoriasis[J]. West China Journal of Pharmaceutical Sciences, 2021, 36(3): 325-330. https://www.cnki.com.cn/Article/CJFDTOTAL-HXYO202103020.htm
[3]	高蓉, 张兰, 李政霄. 生物制剂治疗中重度斑块状银屑病及关节病型银屑病的进展[J]. 中华皮肤科杂志, 2022, 55(1): 72-75. GAO R, ZHANG L, LI Z X. Biological agents in the treatment of moderate to severe plaque psoriasis and psoriatic arthritis[J]. Chinese Journal of Dermatology, 2022, 55(1): 72-75.
[4]	雒映宏, 刘岁元, 房莉, 等. 益气解毒消银汤治疗寻常型银屑病疗效及对免疫机制的影响[J]. 中华中医药学刊, 2021, 39(4): 180-183. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYHS202104046.htm LUO Y h, LIU S y, FANG L, et al. Therapeutic effect of Yiqi Jiedu Xiaoyin Decoction on psoriasis vulgaris and its influence on immune mechanism[J]. Chinese Archives of Traditional Chinese Medicine, 2021, 39(4): 180-183. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYHS202104046.htm
[5]	刘芳, 王敏, 李和平, 等. 青黛膏联合NB-UVB治疗寻常型银屑病(血热型)效果及对血清炎症因子和免疫功能的影响[J]. 中华中医药学刊, 2022, 40(7): 225-228. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYHS202207055.htm LIU F, WANG M, LI H P, et al. Effect of Qingdai Cream combined with NB-UVB on serum inflammatory factors and immune function in patients with psoriasis vulgaris(Blood-Heat Type)[J]. Chinese Archives of Traditional Chinese Medicine, 2022, 40(7): 225-228. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYHS202207055.htm
[6]	赵辨. 中国临床皮肤病学(下册)[M]. 4版. 南京: 江苏科学技术出版社, 2010: 1008-1025. ZHAO B. Chinese Clinical Dermatology (Volume 2)[M]. 4th Ed. Nanjing: Jiangsu Science and Technology Press, 2010: 1008-1025.
[7]	国家中医药管理局医政司. 《中医病证诊断疗效标准》[J]. 湖北中医杂志, 2002(2): 57. https://www.cnki.com.cn/Article/CJFDTOTAL-SYZY202210046.htm Department of Medical Administration, National Administration of Traditional Chinese Medicine. TCM Diagnostic efficacy Criteria[J]. Hubei Journal of TCM, 2002(2): 57. https://www.cnki.com.cn/Article/CJFDTOTAL-SYZY202210046.htm
[8]	王苹, 唐燕. 银屑病PASI评分系统的设计与实现[J]. 中国医药导报, 2017, 14(15): 179-182. https://www.cnki.com.cn/Article/CJFDTOTAL-YYCY201715046.htm WANG P, TANG Y. The design and realization of psoriasis PASI scoring system based on the access database[J]. China Medical Herald, 2017, 14(15): 179-182. https://www.cnki.com.cn/Article/CJFDTOTAL-YYCY201715046.htm
[9]	郑筱萸. 中药新药临床研究指导原则(试行)[S]. 北京: 中国医药科技出版社, 2002, 121-122. ZHENG X Y. Guiding principles for clinical research of new Chinese medicine[S]. Beijing: China Medical Science and Technology Press, 2002, 121-122.
[10]	徐田红, 周梦云, 单筠筠. 中医汗蒸疗法联合卡泊三醇倍他米松软膏治疗寻常型银屑病的临床观察[J]. 中国中西医结合皮肤性病学杂志, 2022, 21(2): 160-162. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXYD202202018.htm XU T H, ZHOU M Y, SHAN J J. Clinical observation of traditional Chinese medicine sweat steam therapy combined with calcipotriol betamethasone ointment in the treatment of psoriasis vulgaris[J]. Chinese Journal of Dermatovenereology of Integrated Traditional and Western Medicine, 2022, 21(2): 160-162. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXYD202202018.htm
[11]	ZHAI W J, MA Z H, WANG W J, et al. Paeoniflorin inhibits Rho kinase activation in joint synovial tissues of rats with collagen-induced rheumatoid arthritis[J]. Biomed Pharmacother, 2018, 106: 255-259.
[12]	李叶静, 谈弋. 紫草素通过TLR4/NF-κB信号通路抑制由脂多糖诱导的巨噬细胞炎症研究[J]. 安徽医药, 2017, 21(8): 1384-1387. https://www.cnki.com.cn/Article/CJFDTOTAL-AHYY201708006.htm LI Y J, TAN Y. Anti-inflammatory effects of Shikonin by TLR4/NF-κB pathway to inhibit LPS-induced macrophage inflammatory[J]. Anhui Medical and Pharmaceutical Journal, 2017, 21(8): 1384-1387. https://www.cnki.com.cn/Article/CJFDTOTAL-AHYY201708006.htm
[13]	KIM H, KIM M, KIM H, et al. Anti-inflammatory activities of Dictamnus dasycarpus Turcz, root bark on allergic contact dermatitis induced by dinitrofluorobenzene in mice[J]. J Ethnopharmacol, 2013, 149(2): 471-477.
[14]	孟繁鹏, 闫学文, 刘栋, 等. 中医药治疗银屑病相关免疫机制研究进展[J]. 中国中西医结合皮肤性病学杂志, 2020, 19(1): 101-103. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXYD202001030.htm MENG F P, YAN X W, LIU D, et al. Progress in research on immune mechanism of Traditional Chinese Medicine in treating psoriasis[J]. Chinese Journal of Dermatovenereology of Integrated Traditional and Western Medicine, 2020, 19(1): 101-103. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXYD202001030.htm
[15]	王鹏, 刘军麟, 符磊, 等. 凉血消风散对寻常型银屑病血热证患者血清炎性因子及免疫功能的影响[J]. 中医杂志, 2021, 62(13): 1144-1149. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZYZ202113011.htm WANG P, LIU J l, FU L, et al. Effect of Liangxue Xiaofeng Powder(凉血消风散) on Serum Inflammatory Factors and Immune Function in Patients with Psoriasis Vulgaris of Blood-heat Syndrome[J]. Journal of Traditional Chinese Medicine, 2021, 62(13): 1144-1149. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZYZ202113011.htm