血分论治对寻常型银屑病患者免疫功能的影响

Effect of blood-stage treatment on cytokine IFN-？,IL -4,IL-10 and IL-17 of patients with psoriasis vulgaris in the periods

目的：通过观察清热凉血方和活血化瘀方对寻常型银屑病患者外周血γ-干扰素（IFN-γ）、白细胞介素4（IL-4）、白细胞介素10（IL-10）及白细胞介素17（IL-17）等细胞因子的影响，探讨银屑病血分论治的作用机理。方法收集2010年10月至2012年10月上海中医药大学附属曙光医院皮肤科寻常型银屑病血热证、血瘀证患者各20例，采用银屑病面积与严重性指数（PASI）判定临床疗效，并通过酶联免疫吸附试验法（ELISA）检测患者治疗前后血清中IFN-γ、IL-4、IL-10、IL-17水平变化。结果两组治疗后PASI积分均同组治疗前明显下降（t 血热证组＝6.685，P＜0.01；t 血瘀证组＝4.959，P＜0.01）。治疗前血热证与血瘀证间细胞因子存在差异。治疗后，两组患者血清细胞因子水平均得到不同程度改善，其中血热证组患者IFN-γ、IL-17水平明显下降（t值分别为3.024、2.543，P＜0.01或0.05），血瘀证组患者IL-17水平下降，IL-4水平升高，与治疗前比较差异有统计学意义（t值分别为2.417、2.547，P均＜0.05）。结论血分论治可通过调节IFN-γ、IL-4、IL-10及IL-17等细胞因子水平达到治疗银屑病的目的。

Objective To explore the mechanism of blood-stage treatment in patients with psoriasis vulgaris through studying the level change of IFN-γ, IL-4, IL-10 and IL-17 in patients with blood-stage treatment during activity and quiescence period separately. Methods 20 patients with psoriasis vulgaris in active stage（blood heat syndrome）and 20 patients with psoriasis vulgaris in resting stage（blood stasis syndrome） were recruitedto observe the treatment effects by the PASI score,and to observe thechange of IFN-γ, IL-4, IL-10, IL-17 before and after treatment in the serum by ELISA. Results The PASI scores of two groups were both significantly decreased after treatment （blood heat syndrome group t=6.685, P〈0.01;blood stasis syndrome group t=4.959, P〈0.01）. The levels of cytokines were significantly different between patients in the periods of activity and quiescence. Onvarying degrees, the levels of cytokines of two groups were improved after treatment. The levels of cytokines IFN-γ, IL-17 in blood heat group significantly decreased（t=3.024, P〈0.01;t=2.543, P〈0.05）. The levels of cytokines IL-17 drop but the levels of cytokines IL-4 raised in blood stasis group,that were significantly differentwith the levels before treatment（t=2.417, P〈0.05; t=2.547, P〈0.05）. Conclusion The levels of INF-γ, IL-4, IL-10 and IL-17 could be effectively modulated with blood-stage treatment in treating psoriasis vulgaris.