寻常型银屑病难治性及其相关的临床及实验研究
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摘要
目的：探讨寻常型银屑病的难治性,观察桃红四六汤治疗寻常型银屑病肝肾阴虚血瘀型的临床疗效,以及对模型鼠性激素及阴道上皮上皮细胞及尾部鳞片生长的影响。
方法：对寻常型银屑病的难治性进行文献整理,理论分析,总结银屑病难治的的原因；运用Meta分析方法对比分析出治疗银屑病有效的方法；纳入98例肝肾阴虚血瘀型寻常型银屑病患者,随机分为桃红四六汤治疗组及青黛丸对照组,观察临床疗效、血液流变学改善程度及对血清ELISA法检测VEGF浓度的影响和皮损处免疫组化观察VEGF表达的影响；采用放免检测模型鼠治疗前后E2、FSH、LH的血清水平,HE染色观察桃红四六汤对模型鼠阴道上皮细胞及尾部鳞片生生长的影响。
结果：
1、归纳出寻常型银屑病难治的原因主要有：病因非常复杂且不明确,病理机制不清楚。诊断分型多样,存在多种类型。治疗药物的疗效有待提高,尤其是远期疗效。
2、据Meta分析结果表明,中医或中西医结合治疗银屑病是有效的,其疗效优于迪银片。
3、两组患者经治疗后症状、体征、主症积分均有不同程度的改善。治疗组总有效率为92.31%,对照组总有效率为75.76%,治疗组、对照组间差异有统计学意义(P<0.01),治疗组优于对照组。两组患者经治疗后主症评分均下降,治疗组主症前后差值高于对照组,P<0.05。两组患者经治疗后瘙痒程度均好转,治疗组优于对照组,P<0.05；能明显减低血液粘度,明显降低寻常型银屑病患者血清VEGF浓度和减少皮损处VEGF的表达,表明桃红四六汤在治疗寻常型银屑病疗效优于青黛丸。
4、桃红四六汤能抑制鼠阴道上皮细胞有丝分裂,减少鼠尾部鳞片数；模型鼠血清LH、FSH血浆水平升高,E2水平降低,采用桃红四六汤治疗后,血清E2水平明显升高,FSH、LH水平明显降低。
结论：寻常型银屑病病因非常复杂且不明确,病理机制不清楚,治疗药物的疗效有待提高,尤其是远期疗效。桃红四六汤能有效地治疗寻常型银屑病,与桃红四六汤能改善血液粘度,减少血管内皮细胞表达细胞生长因子,调节血清性激素水平有关。
Objectives:To study the refractoriness of psoriasis vulgaris, and the therapeutic effect of Tao-Hong-Si-Liu decoction in treating Hepatic and Renal Yin Deficiency Syndrome of psoriasis vulgaris,as well as the role of sexual hormone and vagina epithelial cells of model rat.
Methods:To arrange the documents of psoriasis vulgaris and undertake theoretical analysis, to summarize the reason of psoriasis vulgaris. Apply analytical method of Meta utility method to treat psoriasis vulgaris.98 cases of Hepatic and Renal Yin Deficiency Syndrome of psoriasis vulgaris were divided randomly into treatment group (with Tao-Hong-Si-Liu decoction), and control group(with Qingdai pill).Both of the clinical effects,blood rheology, VEGF density, expressed of VEGF in were observed,and the level of E2,LH and FSH in blood plasma were determined in model rat by radioimmunodetection. To observe the vegetations of vagina epithelial cell and scales of rat tail by HE dyeing method with Tao-Hong-Si-Liu decoction.
Results:
Ⅰ. to sum up the incurable reason of psoriasis. Origin of a disease were extraordinary complicate and definite. pathomechanism were indistinct. Diagnose and grouping were manifold.Curative effect of medicine to wait for sublimation. especially for prostecdtive efficacy.
Ⅱ. Psoriasis was treated with Chinese medicine and Chinese medicine and western medicine effectively. The therapeutic effect surpassed indigo naturalis pill and DIYin pill.
Ⅲ.The symptoms,physical signs and Master symptom scores in both groups were improved to a certain extent after intervention. The total effective rate was 92.31% in treatment group, while 75.76% in control group. It was significant different in statistics between two groups (P<0.01). It was better in treatment group than that in control group. Master symptom scores decreased after treating in both groups, and the differences of master symptom scores in treatment group was significant higher in statistics than those in control group, P<0.05.The pruritus was improved in both groups,and it was more significant in treatment group than that in control group, P<0.05.It showed Tao-Hong-Si-Liu decoction was more effective than Qingdai pill in treating psoriasis vulgaris.
Ⅳ. Tao-Hong-Si-Liu decoction can refrain mitotic division of vaginal epithelial cell. to decrease the numbers ofscales of rat tail. The levels of LH and FSH in blood were increase,but E2 was decrease in model rat. The levels of LH and FSH in blood were decrease and E2 was increase with treatment of Tao-Hong-Si-Liu decoction.
Conclusions:It is refractoryto treat psoriasis vulgaris because of its compli catedetiopathogenisis,indefinite pathogenesis, multi-diagnostic-typing,and unsatisfactory pharmacal effects,especially in long-term treatment. Tao-Hong-Si-Liu decoction can cure psoriasis vulgaris efficiently relevant to improve blood apparent viscosity, to decrease vascular endothelial cell to express cell growth factor,and to regulate the level of sexual hormone in blood plasma.
方法：对寻常型银屑病的难治性进行文献整理,理论分析,总结银屑病难治的的原因；运用Meta分析方法对比分析出治疗银屑病有效的方法；纳入98例肝肾阴虚血瘀型寻常型银屑病患者,随机分为桃红四六汤治疗组及青黛丸对照组,观察临床疗效、血液流变学改善程度及对血清ELISA法检测VEGF浓度的影响和皮损处免疫组化观察VEGF表达的影响；采用放免检测模型鼠治疗前后E2、FSH、LH的血清水平,HE染色观察桃红四六汤对模型鼠阴道上皮细胞及尾部鳞片生生长的影响。
结果：
1、归纳出寻常型银屑病难治的原因主要有：病因非常复杂且不明确,病理机制不清楚。诊断分型多样,存在多种类型。治疗药物的疗效有待提高,尤其是远期疗效。
2、据Meta分析结果表明,中医或中西医结合治疗银屑病是有效的,其疗效优于迪银片。
3、两组患者经治疗后症状、体征、主症积分均有不同程度的改善。治疗组总有效率为92.31%,对照组总有效率为75.76%,治疗组、对照组间差异有统计学意义(P<0.01),治疗组优于对照组。两组患者经治疗后主症评分均下降,治疗组主症前后差值高于对照组,P<0.05。两组患者经治疗后瘙痒程度均好转,治疗组优于对照组,P<0.05；能明显减低血液粘度,明显降低寻常型银屑病患者血清VEGF浓度和减少皮损处VEGF的表达,表明桃红四六汤在治疗寻常型银屑病疗效优于青黛丸。
4、桃红四六汤能抑制鼠阴道上皮细胞有丝分裂,减少鼠尾部鳞片数；模型鼠血清LH、FSH血浆水平升高,E2水平降低,采用桃红四六汤治疗后,血清E2水平明显升高,FSH、LH水平明显降低。
结论：寻常型银屑病病因非常复杂且不明确,病理机制不清楚,治疗药物的疗效有待提高,尤其是远期疗效。桃红四六汤能有效地治疗寻常型银屑病,与桃红四六汤能改善血液粘度,减少血管内皮细胞表达细胞生长因子,调节血清性激素水平有关。
Objectives:To study the refractoriness of psoriasis vulgaris, and the therapeutic effect of Tao-Hong-Si-Liu decoction in treating Hepatic and Renal Yin Deficiency Syndrome of psoriasis vulgaris,as well as the role of sexual hormone and vagina epithelial cells of model rat.
Methods:To arrange the documents of psoriasis vulgaris and undertake theoretical analysis, to summarize the reason of psoriasis vulgaris. Apply analytical method of Meta utility method to treat psoriasis vulgaris.98 cases of Hepatic and Renal Yin Deficiency Syndrome of psoriasis vulgaris were divided randomly into treatment group (with Tao-Hong-Si-Liu decoction), and control group(with Qingdai pill).Both of the clinical effects,blood rheology, VEGF density, expressed of VEGF in were observed,and the level of E2,LH and FSH in blood plasma were determined in model rat by radioimmunodetection. To observe the vegetations of vagina epithelial cell and scales of rat tail by HE dyeing method with Tao-Hong-Si-Liu decoction.
Results:
Ⅰ. to sum up the incurable reason of psoriasis. Origin of a disease were extraordinary complicate and definite. pathomechanism were indistinct. Diagnose and grouping were manifold.Curative effect of medicine to wait for sublimation. especially for prostecdtive efficacy.
Ⅱ. Psoriasis was treated with Chinese medicine and Chinese medicine and western medicine effectively. The therapeutic effect surpassed indigo naturalis pill and DIYin pill.
Ⅲ.The symptoms,physical signs and Master symptom scores in both groups were improved to a certain extent after intervention. The total effective rate was 92.31% in treatment group, while 75.76% in control group. It was significant different in statistics between two groups (P<0.01). It was better in treatment group than that in control group. Master symptom scores decreased after treating in both groups, and the differences of master symptom scores in treatment group was significant higher in statistics than those in control group, P<0.05.The pruritus was improved in both groups,and it was more significant in treatment group than that in control group, P<0.05.It showed Tao-Hong-Si-Liu decoction was more effective than Qingdai pill in treating psoriasis vulgaris.
Ⅳ. Tao-Hong-Si-Liu decoction can refrain mitotic division of vaginal epithelial cell. to decrease the numbers ofscales of rat tail. The levels of LH and FSH in blood were increase,but E2 was decrease in model rat. The levels of LH and FSH in blood were decrease and E2 was increase with treatment of Tao-Hong-Si-Liu decoction.
Conclusions:It is refractoryto treat psoriasis vulgaris because of its compli catedetiopathogenisis,indefinite pathogenesis, multi-diagnostic-typing,and unsatisfactory pharmacal effects,especially in long-term treatment. Tao-Hong-Si-Liu decoction can cure psoriasis vulgaris efficiently relevant to improve blood apparent viscosity, to decrease vascular endothelial cell to express cell growth factor,and to regulate the level of sexual hormone in blood plasma.
引文
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[1]王雅娟,董西林,陈琪,等.活血通络汤冶疗寻常型银屑病80例[J].陕西中医,2002,23(9)：796.
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