婴幼儿湿疹的中药治疗研究
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摘要
目的 婴幼儿湿疹是皮肤科常见病和多发病，它是由多种因素引起的一种具有明显渗出倾向的皮肤炎症反应，临床以皮肤红斑、丘疹、水疱、糜烂、渗出伴剧烈瘙痒为特征，常反复发作，严重影响婴幼儿的身体健康和正常发育。早期的研究认为食物和吸入性抗原是发病的主要诱因。近年来的研究显示，微生物感染性因素，尤其是金黄色葡萄球菌可诱发和加重本病。目前，临床多用皮质类固醇激素和其复方制剂治疗婴幼儿湿疹，由于其顺应性差、副作用多，故治疗效果欠佳。基于上述理由，我们选用具有收敛、去湿、抗炎、抗过敏和抑菌作用的中药黄柏、地榆、紫草配成黄柏紫草地榆霜治疗婴幼儿湿疹，旨在寻找有效的治疗婴幼儿湿疹的新途径。
方法 采用琼脂稀释法，对黄柏、地榆和紫草进行定量抑菌实验，寻找三者具有较佳抑菌效果的配伍比例，并以此比例制作水包油型外用药。然后进行黄柏紫草地榆霜的稳定性实验和皮肤刺激性实验。设5％、10％的黄柏紫草地榆霜为治疗组，派瑞松霜和空白基质为对照组，将120例湿疹患儿随机分为A、B、C、D四组，A组外用5％黄柏紫草地榆霜，B组外用10％的黄柏紫草地榆霜、C组外用派瑞松霜、D组外用空白基质，进行随机、对照临床观察。
结果 黄柏、地榆、紫草对金黄色葡萄球菌和表皮葡萄球菌均有抑菌效果，而且三种药物以一定比例混合后同样有很好的抑菌效果，当三者以1：1：2的比例配伍时抑菌效果优于单用黄柏、紫草或地榆。实验室研究证实，所配制黄柏紫草地榆霜稳定性好，对皮肤无刺激性。临床观察表明，5％、10％黄柏紫草地榆霜组的疗效及对金黄色葡萄球菌和表皮葡萄球菌的清除率均优于空白基质组，有显著性差异(P＜0.05～0.01)。10％黄柏紫草地榆霜组的治愈率优于5％的黄柏紫草地榆霜组，有显著性差异(P＜0.05)。10％黄柏紫草地榆霜组与派瑞松霜组比较，在疗效、对金黄色葡萄球菌的清除率、耐受性、不良反应发生率等方面，经统计学分析，均无显著性差异(P＞0.05)。
结论黄柏、紫草、地榆所配制黄柏紫草地榆霜具有很好的收敛、去湿、抗过敏和抑菌效果，耐受性好、副作用少，是治疗婴幼儿湿疹的理想方法。
Objective Infantile eczema is a common dermatosis which may be caused by many different factors. It is a kind of skin inflammatory response which is clinically characterized by erythema, papule, blister, erosion, effusion and severe pruritus. Because of its liability to recurrence, infantile eczema can do harm to the healthy of infants and even affect their growth and development. Food and inhaling antigens were considered as the main causes of infantile eczema by many early researchers, however, recent studies have shown that microorganism, especially staphylococcus aureous, may cause or exacerbate this disease. Corticosteroid and its compound, which are currently used topically to treat infantile eczema, are not satisfactory because of their remarkable side-effects and poor long-term effects.In order to find a new way to treat infantile eczema, we choose Certex phellodendri, Radix Arnebiae seu lithospermi and Radix sanguisorbae. These drugs have many effects, such as astring,dispelling dampness, anti-infla
mmatory, antianaphylaxis and antibiosis.
Methods By agar diluent method, the activity of antibiosis of Certex phellodendri, Radix Sanguisorbae and Radix Arnebiae seu Lithospermi were detected quantitatively to find proper matching proportion in which the compound has better powerful suppressing effect on bacteria. Then, a kind of oil-in-water emulsion was made according to the proportion. Before clinical application, the cream had undergone stability test and skin-irritative test. The traditional Chinese medicine creams, 5% and 10%, were used to treat the patients of treatment groups, pevenson and space stroma were applied to the control groups. One hundred and twenty cases of infantile eczema were randomly divided into four groups A, B, C and D. The patients in group A were treated with 5% traditional Chinese medicine cream, group B with 10% traditional Chinese medicine cream, group C with pevenson and group D with stroma only. Clinical study was undertaken in randomized and parallel-group methods.
Results Staphylococcus aureous and staphylococcus epiderm all could be suppressed by Certex phellodendri, Radix Arnebiae seu lithospermi or/and Radix sanguisorbae. When they were mixed in the proportion of 1:1:2, they showed better antiseplic effect than Certex phellodendri, Radix Sanguisorbae or Radix Arnebiae seu lithospermi alone. We also demonstrated that traditional Chinese medicine cream had good stability and no irritation on skins.
Clinical observation showed that the curavite effects and clearance rate of bacteria of traditional Chinese medicine cream, 5% and 10%, were both significantly better than that of stroma(P<0.05~0.01). The cure rate of 10% traditional Chinese medicine cream was significantly higher than that of 5% traditional Chinese medicine cream(P<0.05). In curavite effect, clearance rate of staphylococcus aureous, tolerance and side-effect, there were no significant differences between 10% traditional Chinese medicine cream group and pevenson group (P>0.05).
Conclusions Traditional Chinese medicine cream containing certex phellodendri, Radix sanguisorbae and Radix Arnebiae seu lithospermi has multiple potencies of astringe, dispelling dampness, anti-inflammatory, antianaphylaxis and antibiosis. Because of its good effect, tolerance and little side-effect, it is an ideal drug for infantile eczema.
方法 采用琼脂稀释法，对黄柏、地榆和紫草进行定量抑菌实验，寻找三者具有较佳抑菌效果的配伍比例，并以此比例制作水包油型外用药。然后进行黄柏紫草地榆霜的稳定性实验和皮肤刺激性实验。设5％、10％的黄柏紫草地榆霜为治疗组，派瑞松霜和空白基质为对照组，将120例湿疹患儿随机分为A、B、C、D四组，A组外用5％黄柏紫草地榆霜，B组外用10％的黄柏紫草地榆霜、C组外用派瑞松霜、D组外用空白基质，进行随机、对照临床观察。
结果 黄柏、地榆、紫草对金黄色葡萄球菌和表皮葡萄球菌均有抑菌效果，而且三种药物以一定比例混合后同样有很好的抑菌效果，当三者以1：1：2的比例配伍时抑菌效果优于单用黄柏、紫草或地榆。实验室研究证实，所配制黄柏紫草地榆霜稳定性好，对皮肤无刺激性。临床观察表明，5％、10％黄柏紫草地榆霜组的疗效及对金黄色葡萄球菌和表皮葡萄球菌的清除率均优于空白基质组，有显著性差异(P＜0.05～0.01)。10％黄柏紫草地榆霜组的治愈率优于5％的黄柏紫草地榆霜组，有显著性差异(P＜0.05)。10％黄柏紫草地榆霜组与派瑞松霜组比较，在疗效、对金黄色葡萄球菌的清除率、耐受性、不良反应发生率等方面，经统计学分析，均无显著性差异(P＞0.05)。
结论黄柏、紫草、地榆所配制黄柏紫草地榆霜具有很好的收敛、去湿、抗过敏和抑菌效果，耐受性好、副作用少，是治疗婴幼儿湿疹的理想方法。
Objective Infantile eczema is a common dermatosis which may be caused by many different factors. It is a kind of skin inflammatory response which is clinically characterized by erythema, papule, blister, erosion, effusion and severe pruritus. Because of its liability to recurrence, infantile eczema can do harm to the healthy of infants and even affect their growth and development. Food and inhaling antigens were considered as the main causes of infantile eczema by many early researchers, however, recent studies have shown that microorganism, especially staphylococcus aureous, may cause or exacerbate this disease. Corticosteroid and its compound, which are currently used topically to treat infantile eczema, are not satisfactory because of their remarkable side-effects and poor long-term effects.In order to find a new way to treat infantile eczema, we choose Certex phellodendri, Radix Arnebiae seu lithospermi and Radix sanguisorbae. These drugs have many effects, such as astring,dispelling dampness, anti-infla
mmatory, antianaphylaxis and antibiosis.
Methods By agar diluent method, the activity of antibiosis of Certex phellodendri, Radix Sanguisorbae and Radix Arnebiae seu Lithospermi were detected quantitatively to find proper matching proportion in which the compound has better powerful suppressing effect on bacteria. Then, a kind of oil-in-water emulsion was made according to the proportion. Before clinical application, the cream had undergone stability test and skin-irritative test. The traditional Chinese medicine creams, 5% and 10%, were used to treat the patients of treatment groups, pevenson and space stroma were applied to the control groups. One hundred and twenty cases of infantile eczema were randomly divided into four groups A, B, C and D. The patients in group A were treated with 5% traditional Chinese medicine cream, group B with 10% traditional Chinese medicine cream, group C with pevenson and group D with stroma only. Clinical study was undertaken in randomized and parallel-group methods.
Results Staphylococcus aureous and staphylococcus epiderm all could be suppressed by Certex phellodendri, Radix Arnebiae seu lithospermi or/and Radix sanguisorbae. When they were mixed in the proportion of 1:1:2, they showed better antiseplic effect than Certex phellodendri, Radix Sanguisorbae or Radix Arnebiae seu lithospermi alone. We also demonstrated that traditional Chinese medicine cream had good stability and no irritation on skins.
Clinical observation showed that the curavite effects and clearance rate of bacteria of traditional Chinese medicine cream, 5% and 10%, were both significantly better than that of stroma(P<0.05~0.01). The cure rate of 10% traditional Chinese medicine cream was significantly higher than that of 5% traditional Chinese medicine cream(P<0.05). In curavite effect, clearance rate of staphylococcus aureous, tolerance and side-effect, there were no significant differences between 10% traditional Chinese medicine cream group and pevenson group (P>0.05).
Conclusions Traditional Chinese medicine cream containing certex phellodendri, Radix sanguisorbae and Radix Arnebiae seu lithospermi has multiple potencies of astringe, dispelling dampness, anti-inflammatory, antianaphylaxis and antibiosis. Because of its good effect, tolerance and little side-effect, it is an ideal drug for infantile eczema.
引文
1 赵辨．临床皮肤病学．第3版．南京：江苏科学技术出版社，2001．606
2 McFadden JP, Noble WC, Camp RD. potential of staphylococci isolated from atopic eczematous skin[J]. Br J Dermatol, 1993, 128(6):631～632
3 Leung DYM, Harbeck R, Nina P, et al. Presence of IgE antibodies to staphylococcal exotoxin on the skin of patients with atpoic dermatitis:Evidence for a new group of allergens[J]. J Clin Invest, 1993, 92(3):1374～1380
4 Stalder J, Fleury M, Sourisse M, et al. Local steroid therapy and bacterial skin flora in atopic dermatitis[J]. Br J Dermatol, 1994, 131(3):536～540
5 Harris DWS, Hunter JAA. The use and abuse of 0.05 percent clobetasol propionate in dermatology. Dermatol Clin, 1988,6(5):643
6 徐仲吕．89种中药对志贺氏菌痢之体外抗生实验研究．中华医学杂志，1947，33(3)：71
7 徐振．植物药剂对主要病菌药效比较研究．农报，1947，1(1)：17～25
8 郑武飞．普通中国草药在试管内对致病性和非致病性真菌的抗真菌力．中华医学杂志，1952，38(4)：315～318
9 王岳．70种药用植物抗菌效能的试验．植物学报，1954，3(2)：121
10 高菊红．紫草的资源，化学，药理和临床研究概况．中草药，1986，17(6)：28
11 叶应妩，王毓三．全国临床检验操作规程．第2版．南京：东南大学出版社，1997．556
12 陈奇．中药药理研究方法学．北京：人民卫生出版社，1991．259～262
13 李仲兴，王秀华，赵建宏，等．用新方法进行黄柏对224株葡萄球菌的体外抗菌活性研究．中医药信息，2000,(5)：33～35
14 药典编辑委员会．中国药典．一部．第7版．北京：化学工业出版社，2000．37～38
15 赵辨．临床皮肤病学．第3版．南京：江苏科学技术出版社，2001．604～605
16 张国华，麻致中，康白．人体正常皮肤、鼻粘膜需氧微生物群的定量分析[J]．中国微生态学杂志，1990，2(1)：35～38
17 Leung DY, Hank P, Strickland I, et al. The role of superantigensin humandisease: therapeutic implications for the treatment of skin diseases[J]. Br J Dermatol, 1998, 139(Suppl 53):17～29
18 Lever R, Hadley k, Downey D, et al. Staphylococcal colonization in atopic dermatitis and the effect of topical mupirocin therapy[J]. Br J Dermatol, 1988,
119(21：189～198
19 南云生．炮制对黄柏部分药理作用的影响．中药材，1995，18(2)：81
20 叶聚荣，林大杰．地榆抗炎作用的药理研究．福建医学杂志，1985，7(6)：34
21 王浴生主编．中药药理与应用．北京：人民卫生出版社，1993．543
22 张树臣．黄柏的抗菌作用．哈尔滨中医，1965，8(6)：32
23 谢道刚．黄柏类及三颗针药用植物中抗真菌物质的制备及抑菌作用．中草药，1981，12(12)：23
24 王海俊，王学民，乐嘉豫．10年来我国外用中药致不良反应发病分析．中国中药杂志，1999，24(12)：755～757
25 刘国杰．药剂学．第2版．北京：北京人民出版社，1985．854
2 McFadden JP, Noble WC, Camp RD. potential of staphylococci isolated from atopic eczematous skin[J]. Br J Dermatol, 1993, 128(6):631～632
3 Leung DYM, Harbeck R, Nina P, et al. Presence of IgE antibodies to staphylococcal exotoxin on the skin of patients with atpoic dermatitis:Evidence for a new group of allergens[J]. J Clin Invest, 1993, 92(3):1374～1380
4 Stalder J, Fleury M, Sourisse M, et al. Local steroid therapy and bacterial skin flora in atopic dermatitis[J]. Br J Dermatol, 1994, 131(3):536～540
5 Harris DWS, Hunter JAA. The use and abuse of 0.05 percent clobetasol propionate in dermatology. Dermatol Clin, 1988,6(5):643
6 徐仲吕．89种中药对志贺氏菌痢之体外抗生实验研究．中华医学杂志，1947，33(3)：71
7 徐振．植物药剂对主要病菌药效比较研究．农报，1947，1(1)：17～25
8 郑武飞．普通中国草药在试管内对致病性和非致病性真菌的抗真菌力．中华医学杂志，1952，38(4)：315～318
9 王岳．70种药用植物抗菌效能的试验．植物学报，1954，3(2)：121
10 高菊红．紫草的资源，化学，药理和临床研究概况．中草药，1986，17(6)：28
11 叶应妩，王毓三．全国临床检验操作规程．第2版．南京：东南大学出版社，1997．556
12 陈奇．中药药理研究方法学．北京：人民卫生出版社，1991．259～262
13 李仲兴，王秀华，赵建宏，等．用新方法进行黄柏对224株葡萄球菌的体外抗菌活性研究．中医药信息，2000,(5)：33～35
14 药典编辑委员会．中国药典．一部．第7版．北京：化学工业出版社，2000．37～38
15 赵辨．临床皮肤病学．第3版．南京：江苏科学技术出版社，2001．604～605
16 张国华，麻致中，康白．人体正常皮肤、鼻粘膜需氧微生物群的定量分析[J]．中国微生态学杂志，1990，2(1)：35～38
17 Leung DY, Hank P, Strickland I, et al. The role of superantigensin humandisease: therapeutic implications for the treatment of skin diseases[J]. Br J Dermatol, 1998, 139(Suppl 53):17～29
18 Lever R, Hadley k, Downey D, et al. Staphylococcal colonization in atopic dermatitis and the effect of topical mupirocin therapy[J]. Br J Dermatol, 1988,
119(21：189～198
19 南云生．炮制对黄柏部分药理作用的影响．中药材，1995，18(2)：81
20 叶聚荣，林大杰．地榆抗炎作用的药理研究．福建医学杂志，1985，7(6)：34
21 王浴生主编．中药药理与应用．北京：人民卫生出版社，1993．543
22 张树臣．黄柏的抗菌作用．哈尔滨中医，1965，8(6)：32
23 谢道刚．黄柏类及三颗针药用植物中抗真菌物质的制备及抑菌作用．中草药，1981，12(12)：23
24 王海俊，王学民，乐嘉豫．10年来我国外用中药致不良反应发病分析．中国中药杂志，1999，24(12)：755～757
25 刘国杰．药剂学．第2版．北京：北京人民出版社，1985．854