基于毒瘀序贯疗法研究银屑病病症指数及Th1/Th2平衡的动态交互效应

Study on Dynamic Interaction Effect of Psoriasis Symptom Index and Th1/Th2 Balance Based on Sequential Therapy of Toxin and Blood Stasis

目的基于杨素清教授辨治银屑病的毒瘀序贯疗法,观察该疗法对于进行期的寻常性银屑病患者病症疗效及相关Th1/Th2平衡因子影响的多时间点"组-时"交互效应。方法随机入组进行期寻常性银屑病患者81例,治疗组40例患者采用毒瘀序贯疗法进行治疗,前4周口服中药"解毒方",后4周口服中药"化瘀方",对照组41例患者口服复方甘草酸苷片,选择治疗第0天、治疗4周后、治疗8周后的3个时间点,分别对患者的银屑病疾病指数(PASI)和瘙痒症状指数进行观测,采用ELISA法对患者Th1型细胞分泌因子IL-2、IFN-γ、TNF-α和Th2型细胞分泌因子IL-4、IL-10进行检测,多时间点分析各指标的时间效应、组间效应、交互效应,并进行临床疗效评价。同时,根据前后4周的各指标变化量表示相应的时间段差值,观察前4周"解毒方"和后4周"化瘀方"对于各指标的干预作用。结果通过3个时间点的交互效应比较,治疗组患者的PASI指数、瘙痒指数及Th1/Th2平衡因子表达水平均显著优于对照组(P<0.01),治疗组在4周末及8周末的疗效均优于对照组(P<0.05或P<0.01);通过时间段差值变化量结果比较,治疗组在前后4周内的PASI变化值无差异(P>0.05),皮损逐渐趋于缓解;治疗组前4周的瘙痒缓解程度大于后4周(P<0.05);与对照组比较,Th1型分泌因子(IL-2、IFN-γ、TNF-α)在前4周采用"解毒方"治疗的下降水平明显,Th2型分泌因子(IL-4、IL-10)在后4周采用"化瘀方"的上升水平明显,其趋势与交互效应轮廓图显示一致。结论毒瘀序贯疗法可以有效改善银屑病患者的病症状态,其机制可能与银屑病所处不同时期所表现出的优势免疫细胞不同相关,"解毒方"干预Th1型细胞因子,"化瘀方"调控Th2型细胞因子可能是其发挥作用的关键。

Objective To observe the“Group-Time”interaction effect of multiple time points for clinical efficacy and Th1/Th2 balance factors of progressive psoriasis vulgaris based on sequential therapy of toxin and blood stasis which was put forward by Professor YANG Suqing.Methods Totally 81 patients with psoriasis vulgaris were randomly divided into two groups.Forty patients in the treatment group were treated with sequential therapy of toxin and blood stasis.In the first 4 weeks,“Relieving Toxin Prescription”was taken orally,and“Resolving Blood Stasis Prescription”was taken orally in the next 4 weeks.Forty-one patients in the control group were treated with Compound Glycyrrhizin Tablets,three time points were selected which were day 0,4 and 8 weeks after treatment.The psoriasis index(PASI)and pruritus symptom index were observed,and IL-2,IFN-γ,TNF-α secreted by Th1 cells and IL-4,IL-10 secreted by Th2 cells were detected by ELISA.The time effect,inter-group effect and interaction effect of each index were analyzed at multiple time points,and the clinical efficacy was evaluated.Meanwhile,the changes of each index before and after 4 weeks were taken as the time difference accordingly,the intervention effects of“Relieving Toxin Prescription”in the first 4 weeks and“Resolving Blood Stasis Prescription”in the second 4 weeks were observed.Results By comparing the interaction effects at three time points,PASI index,pruritus index and Th1/Th2 balance factors expression in the treatment group were significantly better than those in the control group(P<0.01).The curative effect of the treatment group was better than that of the control group at the end of 4 and 8 weeks(P<0.05 or P<0.01).By comparing the time difference variation,in the treatment group,there was no difference in PASI changes before and after 4 weeks(P>0.05).The lesions tended to be relieved gradually.The remission degree of pruritus in the first 4 weeks of treatment group was greater than that in the second 4 weeks(P<0.05).Compared with those of the control group,the levels of Th1 secretory factors(IL-2,IFN-γ,TNF-α)were decreased significantly in the first 4 weeks after treatment with“Relieving Toxin Prescription”,while the levels of Th2 secretory factors(IL-4,IL-10)were increased significantly in the second 4 weeks after treatment with“Resolving Blood Stasis Prescription”,and the trend was consistent with the interactive effect profiles.Conclusion The sequential therapy of toxin and blood stasis can effectively improve the condition of patients with psoriasis.The mechanism may be related to the different dominant immune cells in different stages of psoriasis,and“Relieving Toxin Prescription”intervenes Th1 type cytokines,and“Resolving Blood Stasis Prescription”regulating Th2 type cytokines may be the key to its function.