雷公藤多苷与复方甘草酸苷配合抗组胺药治疗特应性皮炎疗效对比
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摘要
目的:观察雷公藤多苷与甘草酸制剂分别联合抗组胺药治疗特应性皮炎(Atopic dermatitis,AD)的疗效。方法:将80例特应性皮炎(AD)患者,按随机数字表法分为雷公藤组及甘草酸苷组。其中甘草酸苷组给予甘草酸制剂+枸地氯雷他定+依巴斯汀治疗;雷公藤组除给予雷公藤多苷代替甘草酸制剂外,其余治疗同甘草酸苷组,治疗期间每2周观察患者治疗前后临床症状积分(SCORAD评分及VAS评分)、白细胞介素-4(IL-4)、干扰素-γ(INF-γ)、血常规、嗜酸性粒细胞计数变化及不良反应发生情况,计算相关指标下降百分比,共观察8周。结果:在2周后观察到雷公藤组及甘草酸苷组患者病情均有缓解,雷公藤组症状有效改善率为40%,明显高于甘草酸苷组的22.5%;追踪病情至8周,雷公藤组症状有效改善率为94.7%,明显高于甘草酸苷组的73.6%,差异均有统计学意义(P<0.05)。每2周检测相关指标并进行分析,各个时间点雷公藤组各相关指标下降(上升)百分比较甘草酸苷组下降(上升)速度更快,且在2周左右各指标下降(上升)最快,之后各百分比下降(上升)速度减慢。两组药物疗效均与药物在体内积累有直接关系。两组不良反应发生率比较:雷公藤多苷白细胞降低发生率较甘草酸苷组增多,多发生在治疗2～4周,停止用药后给予升白片对症治疗,可恢复正常。甘草酸制剂引起面部水肿2例,停药后可恢复正常。结论:雷公藤多苷配合抗组胺药较甘草酸制剂配合抗组胺药治疗AD具有治疗起效快,疗效更持久特点。
Objective To observe the effect of tripterygium glycosides and compound glycyrrhizin combined with antihistamines in treatment of atopic dermatitis. Methods 80 patients with AD were divided into two groups according to random number table method: Tripterygium wilfordii group and glycyrrhizin group, Glycyrrhizin group was given glycyrrhizic acid preparation + desloratadine citrate + ebastine treatment scheme, Tripterygium wilfordii group was given Tripterygium wilfordii polyglycosides instead of glycyrrhizin preparation, the rest of the treatment was the same, observed for 8 weeks.The clinical symptom scores(SCORAD score and VAS score), IL-4, INF-γ, blood routine, eosinophil count change and adverse reaction were observed every 2 weeks before and after treatment, and the decrease percentage was also calculated(pre treatment index treatment index)/pre treatment index. Results After 2 weeks, the condition of Tripterygium wilfordii group and glycyrrhizin group were relieved. The effective improvement rate of Tripterygium wilfordii group was 40%, which was significantly higher than that of glycyrrhizin group(22.5%).After 8 weeks, the effective improvement rate of the Tripterygium wilfordii group was 94.7%, which was still significantly higher than that of the glycyrrhizin group(P<0.05).By analyzing the related indicators detected every two weeks, it was found that the percentage of related indicators in Tripterygium wilfordii group decreased(increased) faster than that in glycyrrhizin group at each time point, and the index decreased(increased) fastest in about 2 weeks, then the percentage decreased(increased) slowed down.The efficacy of both groups was directly related to the accumulation of drugs in vivo.The incidence of adverse reaction: the incidence of leucocytosis of Tripterygium wilfordii was increased more than that in the experimental group, which occurred more in the 2-4 week treatment. Two cases of facial edema were caused by glycyrrhizin preparation. Conclusion Tripterygium wilfordii polyglycoside combined with antihistamine is more effective than glycyrrhizic acid combined with antihistamine in the treatment of AD.
Objective To observe the effect of tripterygium glycosides and compound glycyrrhizin combined with antihistamines in treatment of atopic dermatitis. Methods 80 patients with AD were divided into two groups according to random number table method: Tripterygium wilfordii group and glycyrrhizin group, Glycyrrhizin group was given glycyrrhizic acid preparation + desloratadine citrate + ebastine treatment scheme, Tripterygium wilfordii group was given Tripterygium wilfordii polyglycosides instead of glycyrrhizin preparation, the rest of the treatment was the same, observed for 8 weeks.The clinical symptom scores(SCORAD score and VAS score), IL-4, INF-γ, blood routine, eosinophil count change and adverse reaction were observed every 2 weeks before and after treatment, and the decrease percentage was also calculated(pre treatment index treatment index)/pre treatment index. Results After 2 weeks, the condition of Tripterygium wilfordii group and glycyrrhizin group were relieved. The effective improvement rate of Tripterygium wilfordii group was 40%, which was significantly higher than that of glycyrrhizin group(22.5%).After 8 weeks, the effective improvement rate of the Tripterygium wilfordii group was 94.7%, which was still significantly higher than that of the glycyrrhizin group(P<0.05).By analyzing the related indicators detected every two weeks, it was found that the percentage of related indicators in Tripterygium wilfordii group decreased(increased) faster than that in glycyrrhizin group at each time point, and the index decreased(increased) fastest in about 2 weeks, then the percentage decreased(increased) slowed down.The efficacy of both groups was directly related to the accumulation of drugs in vivo.The incidence of adverse reaction: the incidence of leucocytosis of Tripterygium wilfordii was increased more than that in the experimental group, which occurred more in the 2-4 week treatment. Two cases of facial edema were caused by glycyrrhizin preparation. Conclusion Tripterygium wilfordii polyglycoside combined with antihistamine is more effective than glycyrrhizic acid combined with antihistamine in the treatment of AD.
引文
[1]张建中.特应性皮炎的诊断标准发展及评价[J].中华皮肤科杂志,2017,50(1):67-69.
[2]Koh MJ,Giam YC,Liew HM,et al.Comparison of the simple patientcentric atopic dermatitis scoring system PEST with SCORAD in young children using a ceramide dominant therapeutic moisturizer[J].Dermatol Ther(Heidelb),2017,7(3):383-393.
[3]Ograczyk-Piotrowska A,Gerlicz-Kowalczuk Z,Pietrzak A,et al.Stress,itch and quality of life in chronic urticaria females[J].Postepy Dermatol Alergol,2018,35(2):156-160.
[4]黄真,毛庆秋.雷公藤多苷的临床应用、不良反应及预防[J].药品评价,2005,2(2):125-127.
[5]刘素晓,闫凤娜,王幼平.雷公藤多苷的抗炎作用与临床应用进展[J].中医临床研究,2017,9(32):131-133.
[6]陈新谦,金有豫,汤光.新编药物学[M].北京:人民卫生出版社,2011:703.
[7]金忱,倪泉兴,张群华,等.雷公藤多苷对急性坏死性胰腺炎免疫调节作用的实验研究Ⅲ[J].中华普通外科杂志,2000,11(5):5-7.
[8]钦丹萍,周毅骏,张绍珠,等.雷公藤多苷抗巨噬细胞炎症及对TLR4/NF-κB调控炎症作用的研究[J].中国中药杂志,2015,40(16):3256-3261.
[9]Spehlmann M,Eckmann L.Nuclear factor-kappa B in intestinal protection and destruction[J].Curr Opin Gastroenterol,2009,25(2):92-99.
[10]Akao T1,Akao T,Hattori M,et al.Hydrolysis of glycyrrhizin to 18 betaglycyrrhetyl monoglucuronide by lysosomal beta-D-glucuronidase of animal livers[J].Biochem Pharmacol,1991,41(6-7):1025-1029.
[11]Hosseinzadeh H,Nassiri-Asl M.Pharmacological effects of glycyrrhiza spp.and its bioactive constituents:update and review[J].Phytother Res,2015,29(12):1868-1886.
[12]王颖,韩秀萍.甘草酸苷作用机制的研究进展[J].实用药物与临床,2018,21(1):109-112.
[13]张云颖,任小平,陈玉芬.复方甘草酸苷在皮肤科的应用进展[J].中国药物滥用防治杂志,2015,21(4):246-248.
[14]Qu Y,Zong L,Xu M,et al.Effects of 18α-glycyrrhizin on TGF-β1/Smad signaling pathway in rats with carbon tetrachloride-induced liver fibrosis[J].Int J Clin Exp Pathol,2015,8(2):1292-1301.
[15]Kao TC,Wu CH,Yen GC.Glycyrrhizic acid and 18β-glycyrrhetinic acid recover glucocorticoid resistance via PI3K-induced AP1,CREand NFAT activation[J].Phytomedicine,2013,20(3-4):295-302.
[16]Li JY,Cao HY,Liu P,et al.Glycyrrhizic acid in the treatmentof liver diseases:literature review[J].Biomed Res Int,2014,2014:872139.
[17]Liang B,Guo XL,Jin J,et al.Glycyrrhizic acid inhibits apoptosis and fibrosis in carbon-tetrachloride-induced rat liver injury[J].World J Gastroenterol,2015,21(17):5271-5280.
[18]Yamamura S,Arai K,Toyabe S,et al.Simultaneous activation of granulocytes and extrathymic T cells in number and function by excessive administration of nonsteroidal anti-inflammatory drugs[J].Abo T Cell Immunol,1996,173(2):303-311.
[19]Han S,Sun L,He F,et al.Anti-allergic activity of glycyrrhizic acid on IgE-mediated allergic reaction by regulation of allergy-related immune cells[J].Sci Rep,2017,7(1):7222.
[20]Jin H,He R,Oyoshi M,et al.Animal models of atopic dermatitis[J].JInvest Dermatol,2009,129(1):31-40.
[21]Mosmann TR,Cherwinski H,Bond MW,et al.Two types of murine helper T cell clone.Ⅰ.Definition according to profiles of lymphokine activities and secreted proteins[J].J Immunol,1986,136(7):2348-2357.
[22]栾贻银,赵伟,吕磊.依巴斯汀联合雷公藤多甙治疗慢性特发性荨麻疹疗效观察[J].中国麻风皮肤病杂志,2008,24(12):1003.
[23]钱苗,张少渊.雷公藤多苷联合抗组胺药治疗慢性荨麻疹临床疗效及生活质量的观察[J].中国中西医结合皮肤性病学杂志,2011,10(6):359-362.
[24]邹金波,路涛,杜晓琳,等.复方甘草酸苷联合地氯雷他定治疗泛发性湿疹疗效观察[J].吉林医学,2015,22(1),4117-4118.
[2]Koh MJ,Giam YC,Liew HM,et al.Comparison of the simple patientcentric atopic dermatitis scoring system PEST with SCORAD in young children using a ceramide dominant therapeutic moisturizer[J].Dermatol Ther(Heidelb),2017,7(3):383-393.
[3]Ograczyk-Piotrowska A,Gerlicz-Kowalczuk Z,Pietrzak A,et al.Stress,itch and quality of life in chronic urticaria females[J].Postepy Dermatol Alergol,2018,35(2):156-160.
[4]黄真,毛庆秋.雷公藤多苷的临床应用、不良反应及预防[J].药品评价,2005,2(2):125-127.
[5]刘素晓,闫凤娜,王幼平.雷公藤多苷的抗炎作用与临床应用进展[J].中医临床研究,2017,9(32):131-133.
[6]陈新谦,金有豫,汤光.新编药物学[M].北京:人民卫生出版社,2011:703.
[7]金忱,倪泉兴,张群华,等.雷公藤多苷对急性坏死性胰腺炎免疫调节作用的实验研究Ⅲ[J].中华普通外科杂志,2000,11(5):5-7.
[8]钦丹萍,周毅骏,张绍珠,等.雷公藤多苷抗巨噬细胞炎症及对TLR4/NF-κB调控炎症作用的研究[J].中国中药杂志,2015,40(16):3256-3261.
[9]Spehlmann M,Eckmann L.Nuclear factor-kappa B in intestinal protection and destruction[J].Curr Opin Gastroenterol,2009,25(2):92-99.
[10]Akao T1,Akao T,Hattori M,et al.Hydrolysis of glycyrrhizin to 18 betaglycyrrhetyl monoglucuronide by lysosomal beta-D-glucuronidase of animal livers[J].Biochem Pharmacol,1991,41(6-7):1025-1029.
[11]Hosseinzadeh H,Nassiri-Asl M.Pharmacological effects of glycyrrhiza spp.and its bioactive constituents:update and review[J].Phytother Res,2015,29(12):1868-1886.
[12]王颖,韩秀萍.甘草酸苷作用机制的研究进展[J].实用药物与临床,2018,21(1):109-112.
[13]张云颖,任小平,陈玉芬.复方甘草酸苷在皮肤科的应用进展[J].中国药物滥用防治杂志,2015,21(4):246-248.
[14]Qu Y,Zong L,Xu M,et al.Effects of 18α-glycyrrhizin on TGF-β1/Smad signaling pathway in rats with carbon tetrachloride-induced liver fibrosis[J].Int J Clin Exp Pathol,2015,8(2):1292-1301.
[15]Kao TC,Wu CH,Yen GC.Glycyrrhizic acid and 18β-glycyrrhetinic acid recover glucocorticoid resistance via PI3K-induced AP1,CREand NFAT activation[J].Phytomedicine,2013,20(3-4):295-302.
[16]Li JY,Cao HY,Liu P,et al.Glycyrrhizic acid in the treatmentof liver diseases:literature review[J].Biomed Res Int,2014,2014:872139.
[17]Liang B,Guo XL,Jin J,et al.Glycyrrhizic acid inhibits apoptosis and fibrosis in carbon-tetrachloride-induced rat liver injury[J].World J Gastroenterol,2015,21(17):5271-5280.
[18]Yamamura S,Arai K,Toyabe S,et al.Simultaneous activation of granulocytes and extrathymic T cells in number and function by excessive administration of nonsteroidal anti-inflammatory drugs[J].Abo T Cell Immunol,1996,173(2):303-311.
[19]Han S,Sun L,He F,et al.Anti-allergic activity of glycyrrhizic acid on IgE-mediated allergic reaction by regulation of allergy-related immune cells[J].Sci Rep,2017,7(1):7222.
[20]Jin H,He R,Oyoshi M,et al.Animal models of atopic dermatitis[J].JInvest Dermatol,2009,129(1):31-40.
[21]Mosmann TR,Cherwinski H,Bond MW,et al.Two types of murine helper T cell clone.Ⅰ.Definition according to profiles of lymphokine activities and secreted proteins[J].J Immunol,1986,136(7):2348-2357.
[22]栾贻银,赵伟,吕磊.依巴斯汀联合雷公藤多甙治疗慢性特发性荨麻疹疗效观察[J].中国麻风皮肤病杂志,2008,24(12):1003.
[23]钱苗,张少渊.雷公藤多苷联合抗组胺药治疗慢性荨麻疹临床疗效及生活质量的观察[J].中国中西医结合皮肤性病学杂志,2011,10(6):359-362.
[24]邹金波,路涛,杜晓琳,等.复方甘草酸苷联合地氯雷他定治疗泛发性湿疹疗效观察[J].吉林医学,2015,22(1),4117-4118.