慢性湿疹的难治性及其相关的临床与实验研究
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摘要
目的:研究慢性湿疹的难治性,滋阴活血方治疗肝肾阴虚型慢性湿疹的临床疗效,以及对CCL17、CCL18、CCL22、CCL24、CCL26在IgE相关性慢性湿疹中的意义。
方法:对慢性湿疹的难治性进行文献整理,理论分析;纳入100例肝肾阴虚型慢性湿疹患者,随机分为滋阴活血方治疗组、及乌蛇止痒丸对照组,观察临床疗效。采用ELISA和RTPCR法检测CCL17、CCL18、CCL22、CCL24、CCL26的血浆水平与皮损中的表达。
结果:
1、两组患者经治疗后症状、体征、EASI积分均有不同程度的改善。治疗组总有效率为93.5%,对照组总有效率为76.3%,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EASI评分均下降,治疗组EASI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。表明滋阴活血方在治疗IgE相关性慢性湿疹疗效优于乌蛇止痒丸。
2、IgE相关性慢性湿疹中CCL17、CCL18、CCL22、CCL26血浆水平升高,而CCL24没有。按疾病严重度分级,轻中重三组比较有显著性差异,而CCL24没有。IgE相关性慢性湿疹CCL17、CCL18、CCL22、CCL26血浆水平、EASI、血清总IgE的对数值两两比较,均有显著相关性,而它们与CCL24没有显著相关性。
3、免疫组化检测显示IgE相关性慢性湿疹皮损中表达CCL17、CCL18。RTPCR检测显示CCL17、CCL18、CCL22、CCL26mRNA比正常者明显增强。
4、采用滋阴活血方治疗IgE相关性慢性湿疹后,血浆CCL17、CCL18、CCL22、CCL26水平、血清总IgE下降,与疾病改善、皮损好转一致,而CCL24没有此现象
结论:慢性湿疹难治的原因主要有: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。CCL17、CCL18、CCL22、CCL26的血浆水平清楚的反映了IgE相关性慢性湿疹的疾病活动性,同时强烈提示CCL17、CCL18、CCL22、CCL26有IgE相关性慢性湿疹的发病机制中有重要作用。
Objective:To study the refractoriness of chronic eczema,therapeutic effect of hepatic and renal yin deficiency type chronic eczema with Ziyinhuoxue Wate and the role of CCL17,CCL18,CCL22,CCL24,CCL26 in IgE-relative eczema.
Methods:100 cases of patients with chronic eczema of hepatic and renal yin deficiency type were randomly divided into treatment group(with Ziyinhuoxue Wate),control group(with Wushezhiyang pill),observed clinic efficacy, detected CCL17,CCL18,CCL22,CCL24,CCL26 in blood and skin biopsy by ELISA and RT-PCR analysis.
Results:
Ⅰ.Two groups were all improved to a certain extent in symptom,physical sign and EASI scores after intervention.Total effective rate was 93.5%in treatment group,76.3%in control group.It was significant different in statistics between two groups(P＜0.01).It was better in treatment group than control group.EASI scores were decreasing after treating in two groups,and EASI difference before and after treating was bigger in treatment group than control group,P＜0.05. eczema patients and significantly correlated with the disease severity,EASI scores and IgE level,but CCL24 no.
Ⅲ.CCL17 and CCL18 were clearly detected in skin tissues by Immunohistochemical staining from all chronic eczema patients,but not in those from normal donors.CCL17,CCL18,CCL22,CCL26 were detected in skin tissues by RT-PCR from all chronic eczema patients,but not in those from normal donors.
Ⅳ.Plasma CCL17,CCL18,CCL22,CCL26,IgE levels were decreased in IgE-relative chronic eczema patients with Ziyinhuoxue Wate and in line with the disease and lesion improving,but CCL24 no.
Conclusions:It was refractory for Chronic Eczema because of complicated and indefinite etiopathogenisis,indefinite pathogenesis,multitude diagosis grouping, and unsatisfactory therapeutic effect especially long-term therapeutic effect.It was good for hepatic and renal yin deficiency type chronic eczema with with Ziyinhuoxue Wate.CCL17,CCL18,CCL22,CCL26 were significantly correlated with the disease reactiveness and involved in the pathogenesis of IgE-relative chronic eczema.
方法:对慢性湿疹的难治性进行文献整理,理论分析;纳入100例肝肾阴虚型慢性湿疹患者,随机分为滋阴活血方治疗组、及乌蛇止痒丸对照组,观察临床疗效。采用ELISA和RTPCR法检测CCL17、CCL18、CCL22、CCL24、CCL26的血浆水平与皮损中的表达。
结果:
1、两组患者经治疗后症状、体征、EASI积分均有不同程度的改善。治疗组总有效率为93.5%,对照组总有效率为76.3%,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EASI评分均下降,治疗组EASI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。表明滋阴活血方在治疗IgE相关性慢性湿疹疗效优于乌蛇止痒丸。
2、IgE相关性慢性湿疹中CCL17、CCL18、CCL22、CCL26血浆水平升高,而CCL24没有。按疾病严重度分级,轻中重三组比较有显著性差异,而CCL24没有。IgE相关性慢性湿疹CCL17、CCL18、CCL22、CCL26血浆水平、EASI、血清总IgE的对数值两两比较,均有显著相关性,而它们与CCL24没有显著相关性。
3、免疫组化检测显示IgE相关性慢性湿疹皮损中表达CCL17、CCL18。RTPCR检测显示CCL17、CCL18、CCL22、CCL26mRNA比正常者明显增强。
4、采用滋阴活血方治疗IgE相关性慢性湿疹后,血浆CCL17、CCL18、CCL22、CCL26水平、血清总IgE下降,与疾病改善、皮损好转一致,而CCL24没有此现象
结论:慢性湿疹难治的原因主要有: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。CCL17、CCL18、CCL22、CCL26的血浆水平清楚的反映了IgE相关性慢性湿疹的疾病活动性,同时强烈提示CCL17、CCL18、CCL22、CCL26有IgE相关性慢性湿疹的发病机制中有重要作用。
Objective:To study the refractoriness of chronic eczema,therapeutic effect of hepatic and renal yin deficiency type chronic eczema with Ziyinhuoxue Wate and the role of CCL17,CCL18,CCL22,CCL24,CCL26 in IgE-relative eczema.
Methods:100 cases of patients with chronic eczema of hepatic and renal yin deficiency type were randomly divided into treatment group(with Ziyinhuoxue Wate),control group(with Wushezhiyang pill),observed clinic efficacy, detected CCL17,CCL18,CCL22,CCL24,CCL26 in blood and skin biopsy by ELISA and RT-PCR analysis.
Results:
Ⅰ.Two groups were all improved to a certain extent in symptom,physical sign and EASI scores after intervention.Total effective rate was 93.5%in treatment group,76.3%in control group.It was significant different in statistics between two groups(P＜0.01).It was better in treatment group than control group.EASI scores were decreasing after treating in two groups,and EASI difference before and after treating was bigger in treatment group than control group,P＜0.05. eczema patients and significantly correlated with the disease severity,EASI scores and IgE level,but CCL24 no.
Ⅲ.CCL17 and CCL18 were clearly detected in skin tissues by Immunohistochemical staining from all chronic eczema patients,but not in those from normal donors.CCL17,CCL18,CCL22,CCL26 were detected in skin tissues by RT-PCR from all chronic eczema patients,but not in those from normal donors.
Ⅳ.Plasma CCL17,CCL18,CCL22,CCL26,IgE levels were decreased in IgE-relative chronic eczema patients with Ziyinhuoxue Wate and in line with the disease and lesion improving,but CCL24 no.
Conclusions:It was refractory for Chronic Eczema because of complicated and indefinite etiopathogenisis,indefinite pathogenesis,multitude diagosis grouping, and unsatisfactory therapeutic effect especially long-term therapeutic effect.It was good for hepatic and renal yin deficiency type chronic eczema with with Ziyinhuoxue Wate.CCL17,CCL18,CCL22,CCL26 were significantly correlated with the disease reactiveness and involved in the pathogenesis of IgE-relative chronic eczema.
引文
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