三黄搽剂对慢性湿疹的临床效果及其对血清免疫因子水平的影响

Clinical Efficacy of Sanhuang Liniment and Its Alleviation in Serum Cytokines for Treatment of Patients with Chronic Eczema

目的观察院内自制三黄搽剂改善慢性湿疹皮肤屏障功能、免疫功能的临床效果,探讨其对血清IL-4、ECP、TNF-2α、sIL-2R水平的影响。方法选择2017年1月~2018年4月本院皮肤科门诊收治的86例慢性湿疹患者为研究对象,采用随机数字表法分为对照组(n=43例)和观察组(n=43例)。对照组患者给予盐酸西替利嗪片口服;观察组患者则在对照组基础上加用院内自制三黄搽剂涂擦患处,两组均连续治疗4周。对比两组的临床疗效,评价患者治疗前后的瘙痒程度,检测患者皮肤屏障功能指标皮肤油脂(SC)、角质层含水量(WCSC)、经皮肤水份丢失值(transepidermal waterloss,TEWL)的变化情况,以及免疫功能相关Th 1、Th 2细胞变化,监测治疗前后外周血白细胞介素-4(Interleukin-4,IL-4)、嗜酸细胞阳离子蛋白(acidophilic cationic protein,ECP)、肿瘤坏死因子-2α(tumor necrosis factor-2α,TNF-2α)、可溶性白细胞介素2受体(soluble interleukin-2 receptor,sIL-2R)水平。结果与对照组有效率74.42%相比,观察组有效率高达90.70%(P<0.05)。观察组患者治疗后的瘙痒改善优于对照组,患者的瘙痒频率、瘙痒程度、瘙痒部位评分明显低于对照组(P<0.0 5);皮肤屏障功能指标SC、WCSC明显高于对照组,TEWL则明显低于对照组(P<0.0 5);免疫功能指标Th 1、Th2明显低于对照组,Th1/Th2则明显高于对照组(P<0.05);血清IL-4、ECP、TNF-2α、sIL-2R水平明显低于对照组(P<0.05)。结论院内自制三黄搽剂能明显改善慢性湿疹皮肤屏障功能、免疫功能,其机制可能是通过调控血清IL-4、ECP、TNF-2α、sIL-2R水平实现的,值得临床推广。

Objective To observe the clinical effect of Sanhuang liniment made in hospital on the treatment of chronic eczema and its influence on serum levels of IL-4,ECP,TNF-2αand sIL-2R.Methods A total of 86 outpatients of dermatology with chronic eczema were divided into controls of the group(n=43)and the observation(n=43).Patients of the control were orally given cetirizine hydrochloride tablets as routine treatment whereas those of the observation received cetirizine hydrochloride combined with Sanhuang liniment(a Traditional Chinese Medicine)for four weeks.Clinical manifestations such as skin itching,grease,corneous layer water content,trans-epidermal water loss as well as immune indicators were evaluated.Serum IL-4,ECP,TNF-2αand sIL-2R were measured by ELISA before and after the treatments.Results A high efficacy of 90.70%was observed when the treatment was combined with Sanhuang liniment(P<0.05).Skin pruritus and severity and itching scores were significantly ameliorated and the skin barrier function indexes were remarkably increased in the observation group(P<0.05).Additionally,the serum cytokine levels of IL-4,ECP,TNF-2αand sIL-2R were inhibited in the group of combination with the liniment(P<0.05).Conclusion The hospital-made Sanhuang liniment has a potential in enhancement effect on chronic eczema in underlying routine therapy,and the possible mechanism might be involved in improvement of skin barrier function.