联合臭氧水治疗特应性皮炎患者的疗效及白细胞介素4、神经生长因子检测

Combined ozone hydrotherapy for atopic dermatitis：evaluation of efficacy and detection of interleukin-4 and nerve growth factor levels in peripheral blood from patients before and after treatment

目的：观察联合臭氧水治疗特应性皮炎（AD）患者的临床疗效和安全性。方法收集6~65岁中重度AD患者，分为试验组和对照组，每组30例。两组患者均口服左西替利嗪胶囊（5 mg每日1次），外涂他克莫司软膏，每日2次，同时外涂保湿润肤霜。试验组加用臭氧水疗，每周3~5次。共观察2周。观察两组患者治疗前后特应性皮炎严重度评分（SCORAD）评分、视觉模拟尺（VAS）瘙痒评分、皮肤病生活质量指数（DLQI）/儿童皮肤病生活质量指数（CDLQI）变化情况，ELISA法检测患者治疗前后外周血白细胞介素4、神经生长因子表达水平。结果试验组患者治疗前SCORAD评分、VAS评分、DLQI/CDLQI评分分别为42.13±16.03、7.14±2.12、14.92±5.94，治疗2周后分别为27.3±11.01、2.23±1.31、9.69±4.17；对照组治疗前SCORAD评分、VAS评分、DLQI/CDLQI评分分别为43.36±17.78、6.45±1.29、15.15±5.40，治疗2周后分别为39.65±16.67、3.32±0.87、12.84±5.37。两组3种评分治疗前后比较，差异均有统计学意义（均P〈0.05），且治疗2周后两组之间3种评分差异亦有统计学意义（均P〈0.05）。两组患者治疗后外周血白细胞介素4和神经生长因子水平均下降，与治疗前相比，差异有统计学意义（均P〈0.05），其中试验组白细胞介素4下降幅度大于对照组（t=8.57，P〈0.05），神经生长因子下降幅度两组间差异无统计学意义（t=9.51，P〉0.05）。结论联合臭氧水能安全、有效地改善AD患者病情，可能与降低患者外周血白细胞介素4水平有关。

Objective To evaluate the clinical efficacy and safety of combined ozone hydrotherapy for the treatment of atopic dermatitis（AD）. Methods A total of 60 patients with moderate or severe AD aged from 6 to 65 years were enrolled, and randomly and equally divided into a test group and a control group. Both the two groups were treated with oral levocetirizine capsules 5 mg once a day, topical tacrolimus ointment twice a day, and topical moisturizers. The test group was additionally treated with ozone hydrotherapy 3- 5 times every week. The treatment lasted 2 weeks. The severity scoring of atopic dermatitis （SCORAD） score, visual analog scale （VAS） score, dermatology life quality index （DLQI） or children′s dermatology life quality index （CDLQI） score were assessed before and after the treatment, and compared between the two groups. Enzyme-linked immunosorbent assay（ELISA） was performed to measure the levels of interleukin-4（IL-4）and nerve growth factor（NGF）in peripheral blood from the patients before and after the treatment. Results After 2-week treatment, the SCORAD scores, VAS scores and DLQI/CDLQI scores significantly decreased from 42.13 ± 16.03, 7.14 ± 2.12 and 14.92 ± 5.94 before the treatment to 27.3 ± 11.01, 2.23 ± 1.31 and 9.69 ± 4.17 respectively in the test group（all P〈0.05）, and from 43.36 ± 17.78, 6.45 ± 1.29 and 15.15 ± 5.40 to 39.65 ± 16.67, 3.32 ± 0.87 and 12.84 ± 5.37 respectively in the control group（all P〈0.05）. In addition, all the three scores were significantly lower in the test group than in the control group after 2-week treatment（all P〈0.05）. A significant decline was also observed in the levels of IL-4 and NGF in peripheral blood in the two groups at the end of the treatment compared with those at baseline（all P〈0.05）, and the magnitude of decline in IL-4 levels was significantly higher in the test group than in the control group（t=8.57, P〈0.05）, while that in NGF levels was insignificantly different between the two groups（t=9.51, P〉0.05）. Conclusion Combined ozone hydrotherapy can effectively and safely improve the condition of patients with AD, likely by decreasing the levels of IL-4 in peripheral blood.