【作者】 王建国；

【导师】 贺菊乔；

【作者基本信息】 湖南中医药大学 ， 中医外科学， 2012， 博士

【摘要】 目的：观察养血消风饮治疗血虚风燥证慢性湿疹的临床疗效,同时检测慢性湿疹患者与健康志愿者血清中免疫细胞因子的表达,比较分析治疗前后的变化,以期阐述养血消风饮治疗血虚风燥证慢性湿疹的临床疗效及作用机制,为临床治疗慢性湿疹提供一种新的药物和思路。方法：在湖南中医药大学第一附属医院皮肤科门诊及住院病人中招募90名血虚风燥证慢性湿疹患者,随机分为养血消风饮治疗组、中成药对照组及西药对照组。治疗组予养血消风饮口服,每次150m1,每日2次,早晚分服；中成药对照组予口服润燥止痒胶囊；西药对照组予口服盐酸西替利嗪。三组均以羌月乳膏和丁酸氢化可的松软膏交替外涂患处,每日2次。治疗28天为1疗程,共治疗1个疗程。分别在治疗前、治疗第1周、2周、4周后进行症状体征指标观察。在治疗前、治疗第1周、2周、4周后进行生活质量及安全性指标观察,在治疗结束后第1、2、3个月末进行复发情况判定。运用统计方法进行综合疗效评价。同时招募健康志愿者15名作为正常组,健康对照组和治疗组在治疗前后采集静脉血清,运用酶联免疫吸附剂测定法检测IL-2. IL-4、IL-10、IFN-γ、IgE、LTB4水平,并比较分析差异性结果。结果：治疗组与对照组治疗前后EASI积分比较,差异均有统计意义(P<0.05),三组之间治疗前后积分差值比较有统计学意义(P<0.05)。治疗4周后,治疗组总有效率为90.00%,中成药对照组为53.33%,西药对照组为60.00%,治疗组与两对照组总有效率比较差异有统计学意义(P<0.05)。随访3个月,治疗组复发率明显低于两对照组,差异有统计学意义(P<0.05)。治疗组治疗前后生活质量量表评分及维度得分及与健康正常组比较,差异均有统计学意义(P<0.05)。治疗用药安全且无副作用。实验室检测指标结果显示治疗组治疗前较健康对照组IFN-γ、IL-2水平明显减少,而IL-4、IL-10、IgE、LTB4水平明显增加；治疗组治疗后较治疗前IFN-γ水平上升,IL-4、IL-10、LTB4水平下降(P<0.05),而IL-2、IgE差异不明显(P>0.05),提示养血消风饮治疗湿疹的作用机制可能是通过调节Th1/Th2细胞因子平衡状态而实现的,使失衡的Th1/Th2网络趋向于正常。结论：1.养血消风饮治疗血虚风燥证慢性湿疹疗效确切,显著优于润燥止痒胶囊、盐酸西替利嗪对照组,在缓解患者临床症状、改善皮损体征、提高患者生存质量等方面,效果明显,安全且无毒副作用。2.养血消风饮治疗血虚风燥证慢性湿疹患者,能有效调节Th1/Th2细胞因子的平衡状态,减少炎性反应介质释放,从而减轻临床症状,从免疫学角度探讨本方的作用机制,为阐述养血消风饮治疗湿疹的作用机制提供了参考依据,更多还原

【Abstract】 Objective:We comprehensively observed the Yang-xue Xiao-feng Drink orally clinical effects of my tutor’s experience in treating eczema of Blood deficiency and wind-dryness. We studied the severity damage of patient skin, the area, the improvement of the quality of life, etc. and compared the difference on the expression of the immune cytokines in serum and the variance from pre-treatment to post-treatment between eczema patients and healthy volunteers. We discussed the clinical effect and mechanism for treating eczema of blood deficiency and wind dryness from different angles to make an overall explanation of "nourishing blood and dispelling wind, nourishing the skin and relieving itching" of Traditional Chinese Medicine,in order to enrich the theory of traditional Chinese medicine, study on the mechanism effect, research on the document, clinical and experimental study.Method:90inpatients with eczema of blood deficiency and wind dryness were selected from the Department of dermatology in the First Affiliated Hospital of Hunan university of Traditional Chinese Medicine. All the patients were divided into Yang-xue Xiao-feng Drink treatment group, traditional Chinese medicine (TCM) control group and western medicine(WM)control group. At the meanwhile, we recruited15volunteers from healthy people as normal group. The treatment group was administered with Yang-xue Xiao-feng Drink orally; TCM group was administered with Xiaofeng Zhiyang particle; WM control group was administered with cetirizine hydrochloride orally. Three group are all treated externally with QiangYue creams and butyric acid hydrocortisone cream alternatively.One course was lasted for28days,. During the treatment, we observed the clinical symptoms and sign, quality of life, safety at the first,the secong and the fourth week and recurrence rate at the first,the second and the third month by using statistical method for therapeutic effect evaluation. The blood serum of control group and treatment group were collected in pre and post treatment. Then the level of IL-2,IL-4,IL-10,INF-y,IgE,LTB4were examined by commercially ailable enzyme-linked immune sorbent assay (ELISA), and the difference were compared and analyzed.Results:There were no difference in sex, age and disease course between two group (P>0.05) and had comparability. There was statistically significant between the treatment group and control group in pre and post treatment of EASI integral contrast. There were significant difference in pre and post treatment among three groups (P<0.05) by integral contrast of average deviation. After a full treatment of28days, the total effective rate in treatment group was90.00%, TCM control group was53.33%, WM control group was60.00%, there was significant difference in total effective rate between treatment group and two control group. Follow-up3months, the recurrence rate of treatment group was significantly lower than two control groups (P<0.05).The treatment group compared to the health group, there was significant difference in life quality scale score and graded dimension in pre and post treatment. The laboratory marker results showed that the treatment group level of IFN-y,IL-2was reduced significantly, but the level of IL-4, IL-10, IgE, LTB4was significantly increased compared to the normal group. In the treatment group, the level of IFN-ywere increased while the level of IL-4,IL-10, LTB4fell, IL-2, and IgE with insignificant difference after treatment. These suggested that the mechanism of Yang-xue Xiao-feng Drink orally in the treatment of eczema probably regulated on the balance state of Th1/Th2cytokine, and made the imbalanced state of Thl/Th2return to normal.Conclusion:1.It has definite therapeutic effect that Yang-xue Xiao-feng Drink orally on the treatment of blood deficiency and wind dryness eczema, which is superior to control drugs Xiao-feng Zhi-yang particle. There is remarkable effect in lightening the clinical symptoms, repairing the damage skin signs, improving the living quality etc, and medication safety, no side effects, which is worth for further clinical application.2. Yang-xue Xiao-feng Drink orally in treating chronic eczema of blood deficiency and wind dryness can effectively regulate on the balance state of Th1/Th2cytokine, reduce the level of serum IgE, LTB4, decrease the release of inflammatory medium, and mitigate clinical symptom, which will provide reference for the treatment of eczema mechanism with Chinese Herbal Compound.更多还原