摘要
目的观察中药联合窄谱中波紫外线(NB-UVB)治疗银屑病的临床疗效和对血小板活化因子(PAF)及血小板活化因子-乙酰水解酶(PAF-AH)的影响,并探讨PAF及PAF-AH与患者皮损面积及严重程度(PASI)的相关性。方法 60例寻常性银屑病患者按门诊顺序编号,采用随机表法分为中药组和联合组各30例。中药组予辨证加减中药口服,联合组采用中药口服及NB-UVB照射治疗;并设立健康对照组30例。治疗前、治疗2周、4周和治疗结束时(8周)对银屑病患者进行PASI评分,采用ELISA法检测银屑病患者治疗前后和正常对照者血清中PAF及PAF-AH水平。结果联合组有效率83.33%,中药组有效率60.00%,两组比较差异有统计学意义(P<0.05)。中药组PAF,PAF-AH在治疗前后差异无统计学意义(P>0.05);联合组PAF治疗后其水平下降,差异有统计学意义(P<0.05),PAF-AH在治疗前后差异无统计学意义(P>0.05)。中药组、联合组治疗前后PAF,PAF-AH与PASI的相关性分析,差异均无统计学意义(P>0.05)。结论中药联合NB-UVB治疗寻常性银屑病疗效确切,其有效率、疗效指数、PASI积分及PAF下降方面较单纯应用中药明显,疗效指数较单纯中药组高。
Objective To observe the therapeutic effect of Traditional Chinese Medicine( TCM) combined with narrowband ultraviolet B light( NB-UVB) on the treatment of psoriasis vulgaris and effect on platelet-activating factor( PAF) and PAF-acetylhydrolase( PAF-AH),and to explore the relevance between PAF,PAF-AH and psoriasis area and severity index( PASI). Methods Sixty patients with psoriasis were equally divided into two groups at random. The TCM group was treated with Traditional Chinese Medicine,the combined group was treated with Chinese herbal medicine combined with NB-UVB,and 30 healthy people were selected as control group. PASI scores were evaluated before treatment,2 weeks,4 weeks and at the end of treatment( 8 weeks). The serum levels of PAF,PAF-AH were determined in patients with psoriasis vulgaris before and after treatment and in 30 healthy volunteers of control group by Enzyme-Linked Immunosorbnent Assay( ELISA) method. Results The effective rate was 83. 33% in the combined group and was 60. 00% in TCM group. There was statistical difference between two groups( P < 0. 05). In the TCM group,the difference of PAF and PAFAH levels before and after treatment were not meaningful( P > 0. 05). In the combined group,the levels of PAF were significantly decreased after treatment( P < 0. 05),and the difference of PAF-AH levels before and after treatment were not meaningful( P > 0. 05). The level of PAF,PAF-AH had no significant correlation with PASI score in both groups( P < 0. 05). Conclusion The therapeutic effects of TCM combined with NBUVB on patients with psoriasis vulgaris were obvious. The combined group had more remarkable results in total efficiency,therapeutic indexes,PASI and PAF decreasing than using TCM only.
引文
[1]Izaki S,Yamamoto T,Goto Y,et al.Platelet activating factor and arachidonic acid metabolites in proriatic inflammation[J].Br J Dermatol,1996,134(6):1060-1064.
[2]朱红倩,姚新生.银屑病患者血浆PAF、PAF-AH的变化及意义[J].临床检验杂志,2004,22(3):217-218.
[3]林大东,毕新岭,缪明永,等.银屑病患者血浆血小板活化因子乙酰水解酶活性变化及其临床意义[J].中国皮肤性病学杂志,2004,18(7):387-388.
[4]夏天保,毕新岭,顾军,等.银屑病患者血小板活化因子乙酰水解酶基因突变的研究[J].中华皮肤科杂志,2005,38(11):677-679.
[5]夏天保,顾军,毕新岭,等.血小板活化因子乙酰水解酶基因Ile198Thr突变与银屑病的相关研究[J].中国麻风皮肤病杂志,2006,22(1):17-19.
[6]林大东,毕新岭,朱克军,等.血小板活化因子乙酰水解酶基因Val279Phe突变与银屑病的相关性研究[J].中华皮肤科杂志,2005,38(3):151-153.
[7]邹颖,顾军.血浆型PAF乙酰水解酶与炎性疾病相关性研究进展[J].中国皮肤性病学杂志,2007,21(9):570-571.
[8]王旋,张慧灵,顾振纶,等.银杏内酯药理作用的研究进展[J].中草药,2005,36(11):1741-1743.
[9]秦小卫,郑茂荣,牟贤龙,等.银杏叶对银屑病患者中性粒细胞趋化反应的影响[J].临床皮肤科杂志,1998,27(3):154-155.
[10]刘宝军,张海涛,郑茂荣,等.血小板活化因子刺激后中性粒细胞对角阮细胞增殖的影响[J].中华皮肤科杂志,1994,27(4):215-217.
[11]羌建峰,曹双林.银杏石榴煎对寻常性银屑病患者血小板活化因子及其受体表达水平的影响[J].中华皮肤科杂志,2007,40(10):640-642.
[12]Wolverton JE,Al-Hassani M,Yao Y,et al.Epidermal platelet-activating factor receptor activation and ultraviolet B radiation result in synergistic tumor necrosis factor-alpha production[J].Photochem Photobiol,2010,86(1):231-235.
[13]Travers JB,Berry D,Yao Y,et al.Ultraviolet B radiation of human skin generates platelet-activating factor receptor agonists[J].Photochem Photobiol,2010,86(4):949-954.
