【作者】 付双杏；

【导师】 林少健；

【作者基本信息】 广州中医药大学 ， 中医外科学， 2012， 硕士

【摘要】 目的：观察中药凉血疏肝方的临床疗效,并测定寻常型银屑病患者经凉血疏肝方治疗前后血清神经肽Y水平,以及与正常人血清神经肽Y水平的对比,继而探讨中药凉血疏肝方对寻常型银屑病患者血清神经肽Y的影响,为分析凉血疏肝方的作用机制提供实验依据。方法：本研究采用随机、单盲、对照的临床研究方法,将75例合格入选病例随机分为治疗组和对照组,选取我院体检健康者29例。治疗组予凉血疏肝方,对照组予雷公藤多甙片,疗程一个月。在治疗前后分别对合格入选病例进行银屑病皮损面积和严重性指数(PASI)评分,用酶联免疫法测定两组治疗前后以及正常人血清神经肽Y的浓度。观察治疗后两组的临床疗效、治疗前后银屑病皮损面积和严重性指数(PASI)评分以及血清神经肽Y的变化,检测血液分析、肝肾功能等客观的实验室指标,并记录治疗过程中的不良反应。结果：1.治疗前两组性别、年龄、病程、PASI积分无显著性差异(P>0.05),具有可比性。2.治疗组总有效率为81.1%,对照组总有效率为84.2%,两组相比,经X2检验,无显著性差异(P>0.05)。3.治疗后两组PASI评分均较治疗前显著下降,治疗前后比较,经t检验,差异均有非常显著性意义(P<0.01)；两组治疗后疗效比较,经t检验,无显著性差异(P>0.05)。4.治疗前两组血清神经肽Y水平统计学无显著性差异(P>0.05),但是均显著高于正常人水平(P<0.01),经两种方法治疗后,治疗组血清神经肽Y水平有显著下降(P<0.01),与正常人相比统计学无显著性差异(P>0.05),对照组血清神经肽Y水平无明显下降(P>0.05)。5.安全性观察：两组均未出现明显的不良反应。结论：1.凉血疏肝方治疗银屑病疗效确切,可以起到和雷公藤多甙片相似的治疗效果。2.银屑病患者血清神经肽Y水平高于正常人。3.凉血疏肝方可以降低银屑病患者血清神经肽Y的浓度,而雷公藤多甙片不能。4.凉血疏肝方的作用机制可能是通过疏肝解郁,降低了情绪应激反应导致的神经肽Y的释放,干扰了皮肤局部的炎症及免疫反应而起到治疗作用。5.该方法安全、有效、副作用小,值得临床推广应用。更多还原

【Abstract】 Object iveObservation of clinical curative effect of TCM blood-cooling and soothing the liver and determination in patients with Psoriasis Vulgaris treated by blood-cooling and soothing the liver and serum levels of neuropeptide Y as well as the normal human serum levels of neuropeptide Y, than discussion the traditional Chinese medicine prescription on effect of the serum levels of neuropeptide Y in patients with Psoriasis Vulgaris, and provide experimental basis for the analysis of mechanism of blood-cooling and soothing the liver.MethodsThis study used a randomized, single-blind, placebo-controlled clinical study,75cases subjects were randomly divided into treatment and control groups, and select medical health29cases in our hospital. Treatment group to blood-cooling and soothing the liver, control group given TWP, course of treatment for a month. Respectively on the subjects before and after treatment for skin lesions of psoriasis area and severity index (PASI) score, and enzyme-linked immunoassay for determination of subjects before and after treatment, and neuropeptide Y in normal human serum concentration. Observation of clinical curative effect of two group before and after treatment, skin lesions of psoriasis area and severity index (PASI) score and the serum changes of neuropeptide Y, testing blood analysis, objective laboratory indices of liver and kidney function, and adverse reactions recorded in the treatment process.Result1.Comparing sex, age, course of disease and PASI scores before treatment, there were no significant difference between two groups.2. Treatment group total effective rate of81.1%,control group total effective rate of84.2%, compared to the two groups by X2tests, there were no significant difference (P>0.05).3. After treatment of the two groups marked reduction in PASI score than before treatment, compared before and after the treatment by t test, the differences are very significant implications (P<0.01);Comparison of therapeutic effect after the two groups by t tests, there were no significant difference (P>0.05).4. Two sets of neuropeptide Y concentration compared to normal before the treatment, the difference has a very significant meaning (P<0.01); Compared to the two sets of their neuropeptide Y concentration before and after treatment by t test, treatment of group therapy has a very significant meaning difference (P<0.01), Compared to the normal, there were no significant difference (P>0.05). Control group were no significant difference (P>0.05) compared with before treatment.5. Safety observation: two groups of all did not appear obvious adverse reactions.Conclusion1. Psoriasis treated by TCM blood-cooling and soothing the liver have a definite therapy effect, can play a similar treatment with tripterygium effect.2. The level of neuropeptide Y in serum of patients with psoriasis is higher than normal.3. TCM blood-cooling and soothing the liver can reduces the neuropeptide Y concentration in serum of patients with psoriasis, TWP cannot.4. The mechanism of TCM blood-cooling and soothing the liver may be through the liver qi stagnation, reducing the release of emotional stress reaction caused by neuropeptide Y of, interferes with the skin, local inflammation and immune responses play a therapeutic role.5. The method for safe, effective, small side-effects, and clinical application.更多还原