【作者】 黄业坚；

【导师】 陈达灿；

【作者基本信息】 广州中医药大学 ， 中西医结合临床， 2010， 博士

【摘要】 背景引起特应性皮炎(AD)的众多因素中,以免疫异常为中心环节的发病机制网络已成为中西医研究热点,导师陈达灿教授创立了清心培土法治疗AD,疗效确切。本研究在既往的临床研究已证实该法有效的基础上,进一步观察其疗效并检测血清总IgE、白介素(IL-5)、白介素(IL-12)和白介素(IL-13)的变化,以探讨清心培土法治疗AD的可能机制,为AD的规范化治疗提供依据。目的1.检测AD患者血清总IgE和IL-5、IL-12和IL-13的表达,以进一步深入认识AD的病机。2.以清心培土法治疗AD,观察治疗前后AD患者SCORAD积分的变化,以评价导师的经验方清心培土方对AD的疗效。3.用ELISA法检测治疗前及治疗3个月后血清总IgE、IL-5、IL-12、IL-13水平,并与正常组进行对照,以探讨清心培土法治疗特应性皮炎可能的机制,为AD的规范化治疗提供依据,有利于中医治疗本病的临床推广和科学性的认证,并为新药开发奠定一定的基础。方法本研究纳入19例符合标准的AD患者为研究对象,于治疗前及治疗后3个月时分别记录SCORAD积分,并在治疗前及治疗后3个月时,采用ELISA法检测血清总IgE和IL-5、IL-12、IL-13的水平,以19例健康志愿者为对照。结果1.临床疗效观察本临床观察共纳入19例符合标准的AD患者,内服中药清心培土方,临床随证加减,以SCORAD指数进行评价,结果显示治疗前的SCORAD评分为46.16±16.94,治疗3个月后为33.53±16.31,较治疗前降低,差异有统计学意义(P<0.05),说明清心培土法治疗AD有良好的疗效。2.血清总IgE的测定AD患者治疗前血清总IgE为1.1±0.84μg／ml,较健康对照组0.25±0.07μg／ml为高,差异有统计学意义(P<0.01)；治疗后AD组血清总IgE为0.63±0.69μg／ml,较治疗前降低,差异有统计学意义(P<0.05)。3.血清IL-5的测定AD患者治疗前血清IL-5为1.12±0.78ng／ml,较健康对照组0.49±0.23 ng／ml为高,差异有统计学意义(P<0.05)；治疗后AD组IL-5为0.81±0.71ng／ml,较治疗前降低,差异有统计学意义(P<0.05)。4.血清IL-12的测定AD患者治疗前血清IL-12为0.82±0.78ng／ml,较健康对照组1.17±1.00 ng／ml为低,差异无统计学意义(P>0.05)；治疗后AD组IL-12为1.00±0.91ng／ml,较治疗前升高,差异无统计学意义(P>0.05)。5.血清IL-13的测定AD患者治疗前血清IL-13为0.12±0.27ng／ml,较健康对照组0.13±0.02 ng／ml为低,差异无统计学意义(P>0.05)；治疗后AD组IL-13为0.12±0.03 ng／ml,较治疗前为低,差异无统计学意义(P>0.05)。结论1.清心培土法治疗AD能显着降低患者的SCORAD指数,说明疗效确切。2.清心培土法治疗AD可显着降低患者血清总IgE和Th2型细胞因子(IL-5)的水平,从而调整Th1／Th2型细胞因子的平衡失调,推测这可能是其作用机理之一。更多还原

【Abstract】 Objectives1. Investigating the mechanism of Atopic Dermatitis (AD) more deeply through measuring IgE、IL-5、IL-12 and IL-13 of the patients with AD.2. Observe changes of the scores of SCORAD index before treatment and 3 months after treatment of the formula, to value therapeutic effect of advisor’s formula of clearing away heart-fire and hilling.3. Measuring IgE, IL-5, IL-12andIL-13of the patients with AD using the ELISA technique before and after the treatment for 3 months respectively. Then compare with 19 healthy controls, in order to investigate the possible mechanism of treatment. It is good for finding its possible mechanism to direct our clinical practice and to make basis of the development of new Traditional Chinese medicine.Method19 patients diagnosed atopic dermatitis are selected to this clinical trial. Scores of SCORAD index are collected before treatment and 3 months after treatment respectively. The level of IgE、IL-5、IL-12 and IL-13 in the serum of both the patients and health controls were detected by ELISA. Results1.19 patients diagnosed atopic dermatitis were admitted to the clinical trial and treated with formula of the clearing away heart-fire and hilling. According to evidence to adjust Chinese herb. SCORAD scale was used to evaluate clinical therapeutic effect. After treatment, scores of SCORAD index decline. So it is demonstrates that the method of clearing away heart-fire and hilling is used to AD patients.2. Before treatment, IgE in serum of the patients was higher than those of the healthy controls (P<0.01), compared with those before treatment. IgE had much change after treatment (P<0.05).3. The value of IL-5 before treatment of AD patients was more than that of healthy people. The statistic significance was also demonstrated (P< 0.05). After treatment of the formula of clearing away heart-fire and hilling, the value of level of IL-5 after treatment was lower than that before treatment with statistical significance (P< 0.05).4. The level of IL-12 of AD patients before treatment was lower than that healthy people. The difference is statistically significant (P> 0.05). After treating with the formula of clearing away heart-fire and hilling, the value of IL-12 arised with statistical significance (P>0.05).5. The values of IL-13 among healthy people, before treatment and after treatment are nearly the same (P>0.05).Conclusions1. After treating with formula of the clearing away heart-fire and hilling, the scores of SCORAD index decline. So it is demonstrates that the formula of clearing away heart-fire and hilling is used to AD patients.2. Treatment with the formula of clearing away heart-fire and hilling, the level of the IgE was decreased (P<0.05), we speculate that it may be one of therapy mechanism of AD.3. After treating with formula of the clearing away heart-fire and hilling,the level of IL-5 declined (P<0.05), the level of IL-12 increased (P>0.05), we speculated that the unbalance of expression of Thl/Th2 cytokines was improved.更多还原