清热益气方治疗复发性生殖器疱疹的疗效观察及对人β防御素-2表达的影响
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摘要
目的:探讨清热益气方防治复发性生殖器疱疹(Recurrent genitalherpes,RGH)的临床意义和作用机理;探讨RGH患者包皮和宫颈上皮人β防御素-2(humanβdefensin 2,hBD-2)的表达情况及清热益气方对其影响。
方法:临床89例RGH患者完全随机分为泛昔洛韦组29例,清热益气方组30例和清热益气方加泛昔洛韦组30例,分别观察治疗前后临床症状积分、临床有效率、3个月和6个月内复发率,检测患者治疗前后外周血T淋巴细胞亚群的变化,并与20例健康者进行比较。实验部分13例男性患者、14例女性患者各分别随机分为清热益气方组和泛昔洛韦组,于治疗前后检测hBD-2的表达情况,并各与5例健康者进行比较。
结果:1.三组治疗后临床症状积分均明显改善,三组近期临床有效率无显著性差异,3个月和6个月内复发情况比较,清热益气方加泛昔洛韦组明显优于其它两组。2.清热益气方组和清热益气方加泛昔洛韦组均能提高患者外周血CD_3~+、CD_4~+T淋巴细胞百分比和CD_4~+/CD_8~+比值,但泛昔洛韦组治疗前后无明显变化。3.正常人和RGH患者包皮和宫颈上皮中均可检测到hBD-2表达,但RGH患者表达比正常人明显增多,治疗后检测hBD-2表达情况,清热益气方组表达高于泛昔洛韦组。
结论:清热益气方适用于RGH治疗,可以改善患者的免疫功能,与泛昔洛韦合用防止GH复发有协同作用,并可保持患者局部hBD-2的较高浓度表达。
Objective:To investigate the clinical significance and mechanism of Qi-Tonifying Heat-Clearing Decoction in preventing and curing the Recurrent genital herpes(RGH). To investigate the expressive situation of prepuce and neck of uterus humanβ-Defension-2(hBD-2) and influence of Qi-Tonifying Heat-Clearing Decoction.
Method:The 89 patients were randomly divided into 3 groups completely. 29 were treated with Famciclovir. 30 were with Qi-Tonifying Heat-Clearing Decoction. 30 were with Qi-Tonifying Heat-Clearing Decoction combined Famciclovir. Observed the integral of clinical symptoms, clinical efficient rate, and the recurring rate respectively before and after the treatment, also checked the change of T-Lymphocyte subsets, and compared with 20 normal person. In the part of experiment, 13 male patients and 14 female patients were randomly devided into the group treated with Qi-Tonifying Heat-Clearing Decoction, the group with Famciclovir. The expressive situation of hBD-2 were observed before and after the treatment comparing with 5 normal person respectively.
Results:
1. The integral of clinical symptoms were improved obviously after theatment for three groups. There was no significant difference in clinical rate for another three groups. The group treated with Qi-Tonifying Heat-Clearing Decoction combined Famciclovir showed a lower recurring rate than other two groups.
2. The group treated with Qi-Tonifying Heat-Clearing Decoction and Qi-Tonifying Heat-Clearing Decoction combined Famciclovir can improve the percentage of CD_3~+,CD_4~+ T-Lymphocyte and the rate of CD_4~+ and CD_8~+ in periphery blood for patients.
3. hBD-2 can be found in prepuce and neck of uterus for normal person and the patients with RGH, but the patients with RGH got more. The group treated with Qi-Tonifying Heat-Clearing Decoction showed higher efficient rate than Famciclovir by checking the situation of expression after treatment.
Conclusion: Qi-Tonifying Heat-Clearing Decoction is effective for patient with RGH. It can improve the function of immunity, also prevent the recurring of RGH combining with Famciclovir, and keep a higher density of hBD-2 in local parts of body.
方法:临床89例RGH患者完全随机分为泛昔洛韦组29例,清热益气方组30例和清热益气方加泛昔洛韦组30例,分别观察治疗前后临床症状积分、临床有效率、3个月和6个月内复发率,检测患者治疗前后外周血T淋巴细胞亚群的变化,并与20例健康者进行比较。实验部分13例男性患者、14例女性患者各分别随机分为清热益气方组和泛昔洛韦组,于治疗前后检测hBD-2的表达情况,并各与5例健康者进行比较。
结果:1.三组治疗后临床症状积分均明显改善,三组近期临床有效率无显著性差异,3个月和6个月内复发情况比较,清热益气方加泛昔洛韦组明显优于其它两组。2.清热益气方组和清热益气方加泛昔洛韦组均能提高患者外周血CD_3~+、CD_4~+T淋巴细胞百分比和CD_4~+/CD_8~+比值,但泛昔洛韦组治疗前后无明显变化。3.正常人和RGH患者包皮和宫颈上皮中均可检测到hBD-2表达,但RGH患者表达比正常人明显增多,治疗后检测hBD-2表达情况,清热益气方组表达高于泛昔洛韦组。
结论:清热益气方适用于RGH治疗,可以改善患者的免疫功能,与泛昔洛韦合用防止GH复发有协同作用,并可保持患者局部hBD-2的较高浓度表达。
Objective:To investigate the clinical significance and mechanism of Qi-Tonifying Heat-Clearing Decoction in preventing and curing the Recurrent genital herpes(RGH). To investigate the expressive situation of prepuce and neck of uterus humanβ-Defension-2(hBD-2) and influence of Qi-Tonifying Heat-Clearing Decoction.
Method:The 89 patients were randomly divided into 3 groups completely. 29 were treated with Famciclovir. 30 were with Qi-Tonifying Heat-Clearing Decoction. 30 were with Qi-Tonifying Heat-Clearing Decoction combined Famciclovir. Observed the integral of clinical symptoms, clinical efficient rate, and the recurring rate respectively before and after the treatment, also checked the change of T-Lymphocyte subsets, and compared with 20 normal person. In the part of experiment, 13 male patients and 14 female patients were randomly devided into the group treated with Qi-Tonifying Heat-Clearing Decoction, the group with Famciclovir. The expressive situation of hBD-2 were observed before and after the treatment comparing with 5 normal person respectively.
Results:
1. The integral of clinical symptoms were improved obviously after theatment for three groups. There was no significant difference in clinical rate for another three groups. The group treated with Qi-Tonifying Heat-Clearing Decoction combined Famciclovir showed a lower recurring rate than other two groups.
2. The group treated with Qi-Tonifying Heat-Clearing Decoction and Qi-Tonifying Heat-Clearing Decoction combined Famciclovir can improve the percentage of CD_3~+,CD_4~+ T-Lymphocyte and the rate of CD_4~+ and CD_8~+ in periphery blood for patients.
3. hBD-2 can be found in prepuce and neck of uterus for normal person and the patients with RGH, but the patients with RGH got more. The group treated with Qi-Tonifying Heat-Clearing Decoction showed higher efficient rate than Famciclovir by checking the situation of expression after treatment.
Conclusion: Qi-Tonifying Heat-Clearing Decoction is effective for patient with RGH. It can improve the function of immunity, also prevent the recurring of RGH combining with Famciclovir, and keep a higher density of hBD-2 in local parts of body.
引文
[1]赖伟红,韩国柱.泛昔洛韦与阿昔洛韦治疗生殖器疱疹的临床对比观察.中国麻风皮肤病杂志,2003,19(2):106-107.
[2]欧阳恒,杨志波.新编中医皮肤病学.北京:人民军医出版杜,2000,603-605.
[3]谭新华,陆德铭.主编.中医外科学.北京:人民卫生出版社,1999:986.
[4]张杰.中草药抗单纯疱疹病毒作用的研究进展.中医药信息.1995:(1):31-34.
[5]骆和生,罗鼎辉.免疫中药学:中药免疫药理与临床[M]北京:北京医科大学、中国协和医科大学联合出版社,1999,42.
[6]张学军等主编,现代皮肤病学基础.北京:人民卫生出版社,2001:1342
[7]Berstein DI,Stanberry LR.Herpes simplex virus vaccines.Vaccine.1999,17:1681-1689.
[8]Cunningham AL,Mikloska Z.The Holy Grail:immune control human herpes simplex virus infection and disease.Herpes 2001:(Suppl)1:6-10.
[9]季卉,李富荣.复发性生殖器疱疹患者外周血Th 1/Th2淋巴细胞类型.中华皮肤科杂志,2002,35(3)212-213.
[10]Harandi AM,Svennerholm B,Holmgren J,etal.Interleukin-12(IL-12)and IL-18 are important in innate defense against genital herpes simplex virus type 2 interferon-mediated Cunn protective immunity.J Virol 2001;75:6705-6709.
[11]Pietra G,Semino C,Cagnoni F,et al Natural killer cells lyse autologous herpes simplex virus infected targets using cytolytic mechansms distributed clonotypically.J Med virol 2000:62:354- 363.
[12]张敏,张谊之等.复发性生殖器疱疹患者血清IL-2及其受体、IL-6、Sicam-1和sVCAM-1水平的研究.四川大学学报(医学版)2003:34(1):84-85.
[13]刘家军,陈伟,董娟等.生殖器疱疹患者干扰素治疗前后血清IL-2及sIL-2R水平变化.中国皮肤性病学杂志,2000,14(1):33-34.
[14]AliRS,Falconer A,Ikram M,et al.Expression of the peptide antibiotics human beta defensin-1 and human beta defensin-2 in normal human skin.JInvest Dermatol,2001,117(1):106-111
[15]冯艳,潘小玲.女性生殖道人Beta—防御素基因的表达.中国病理生理杂志2003,19(11):1564.
[16]Harder J,Bartels J,Christophers E et al.Isolation and characterization of human beta-defensin-3,a novel human inducible peptide antibiotic.Jbiol Chem.2001 Feb23;276(8):5707-13.
[17]Singh PK,Jia HP,Wiles K etal.Production of betadefensins by human airway epithelia.Proc Natl Acad Sci U S A.1998 Dec 8;95(25):14961-6.
[18]Chertov O,Michiel DF,Xu 1,el al.Identification of defensin-1,defensin-2,and CAP37 azurocidin as T-cell chemoat tractant proteins released from interleukin-2-stimulate mertrophils.J Biol Chem.1996.271:2935-2940.
[19]Huang GT,Zhang HB,Kim D.A Model for Antimicrobial Gene Therapy:Demonstralion of Human beta.Defensin 2 Antimicrobial Activilies In Vivo HumGene Ther.2002,13(17):2017-2025.
[20]Van WS,Mannesse.SP,Djkman JH,et al.Effect of neutrophil serine proteinases and defensins on lung epithelial cells medulation of cytotoxlcity and IL-8 production.J Leukoc Biol.1997.62:217-226.
[2]欧阳恒,杨志波.新编中医皮肤病学.北京:人民军医出版杜,2000,603-605.
[3]谭新华,陆德铭.主编.中医外科学.北京:人民卫生出版社,1999:986.
[4]张杰.中草药抗单纯疱疹病毒作用的研究进展.中医药信息.1995:(1):31-34.
[5]骆和生,罗鼎辉.免疫中药学:中药免疫药理与临床[M]北京:北京医科大学、中国协和医科大学联合出版社,1999,42.
[6]张学军等主编,现代皮肤病学基础.北京:人民卫生出版社,2001:1342
[7]Berstein DI,Stanberry LR.Herpes simplex virus vaccines.Vaccine.1999,17:1681-1689.
[8]Cunningham AL,Mikloska Z.The Holy Grail:immune control human herpes simplex virus infection and disease.Herpes 2001:(Suppl)1:6-10.
[9]季卉,李富荣.复发性生殖器疱疹患者外周血Th 1/Th2淋巴细胞类型.中华皮肤科杂志,2002,35(3)212-213.
[10]Harandi AM,Svennerholm B,Holmgren J,etal.Interleukin-12(IL-12)and IL-18 are important in innate defense against genital herpes simplex virus type 2 interferon-mediated Cunn protective immunity.J Virol 2001;75:6705-6709.
[11]Pietra G,Semino C,Cagnoni F,et al Natural killer cells lyse autologous herpes simplex virus infected targets using cytolytic mechansms distributed clonotypically.J Med virol 2000:62:354- 363.
[12]张敏,张谊之等.复发性生殖器疱疹患者血清IL-2及其受体、IL-6、Sicam-1和sVCAM-1水平的研究.四川大学学报(医学版)2003:34(1):84-85.
[13]刘家军,陈伟,董娟等.生殖器疱疹患者干扰素治疗前后血清IL-2及sIL-2R水平变化.中国皮肤性病学杂志,2000,14(1):33-34.
[14]AliRS,Falconer A,Ikram M,et al.Expression of the peptide antibiotics human beta defensin-1 and human beta defensin-2 in normal human skin.JInvest Dermatol,2001,117(1):106-111
[15]冯艳,潘小玲.女性生殖道人Beta—防御素基因的表达.中国病理生理杂志2003,19(11):1564.
[16]Harder J,Bartels J,Christophers E et al.Isolation and characterization of human beta-defensin-3,a novel human inducible peptide antibiotic.Jbiol Chem.2001 Feb23;276(8):5707-13.
[17]Singh PK,Jia HP,Wiles K etal.Production of betadefensins by human airway epithelia.Proc Natl Acad Sci U S A.1998 Dec 8;95(25):14961-6.
[18]Chertov O,Michiel DF,Xu 1,el al.Identification of defensin-1,defensin-2,and CAP37 azurocidin as T-cell chemoat tractant proteins released from interleukin-2-stimulate mertrophils.J Biol Chem.1996.271:2935-2940.
[19]Huang GT,Zhang HB,Kim D.A Model for Antimicrobial Gene Therapy:Demonstralion of Human beta.Defensin 2 Antimicrobial Activilies In Vivo HumGene Ther.2002,13(17):2017-2025.
[20]Van WS,Mannesse.SP,Djkman JH,et al.Effect of neutrophil serine proteinases and defensins on lung epithelial cells medulation of cytotoxlcity and IL-8 production.J Leukoc Biol.1997.62:217-226.