复方青黛丸联合MTX治疗银屑病疗效及机制研究

Therapeutic effect and mechanism of compound Qingdai capsule combined with MTX in the treatment of psoriasis

目的研究中成药复方青黛丸联合甲氨喋呤(MTX)对银屑病患者辅助性T细胞(Th)1、Th2细胞免疫平衡调节机制,评价联合用药的疗效。方法选取50例银屑病皮损面积和严重程度评分(PASI)>10的斑块型银屑病患者,随机分为2个组,每组25例患者。一组服用MTX,每周1次;另一组服用复方青黛丸联合每周1次的MTX治疗,为期8周。收集患者治疗前(基线)和治疗8周后血样,分离外周血单个核细胞(PBMC),应用实时聚合酶链反应(PCR)分析Th1转录因子T-bet,细胞因子白细胞介素(IL)-12和干扰素-γ(IFN-γ),以及Th2转录因子GATA-3和细胞因子IL-4的表达。临床表现通过PASI评分进行评估。结果治疗至第8周时,复方青黛丸联合MTX治疗组有12例患者达到PASI-75(定义为PASI评分降低75%或更多),单用MTX组有8例患者达到PASI-75,2个组临床表现差异有统计学意义(P<0.05)。复方青黛丸联合MTX治疗组Th1相关细胞因子下调,Th2相关细胞因子上调(P<0.05)。进一步以PASI-75为阈值,复方青黛丸联合MTX治疗组达到PASI-75者的IFN-γ表达比单用MTX组患者下降更为明显(P<0.05);复方青黛丸联合MTX治疗组达到PASI-75的患者GATA-3和IL-4水平明显高于单用MTX组患者(P<0.05)。结论复方清黛丸联合MTX治疗对银屑病有更好的疗效,其原因可能是联合治疗对Th1、Th2细胞具有更强的免疫调控作用。

Objective To study the regulation of Chinese herbal medicine compound Qingdai capsule combined with methotrexate(MTX) on the immune balance of helper T cell(Th)1 and Th2 in patients with psoriasis,and to evaluate the efficacy of combined therapy. Methods A total of 50 patients with plaque psoriasis with a psoriasis area and severity index(PASI)>10 were enrolled. The study lasted for 8 weeks,of which 25 patients received weekly MTX treatment,and the other 25 patients received daily oral compound Qingdai capsule combined with weekly MTX treatment. Blood samples were collected before treatment(baseline) and after 8 weeks of treatment. Peripheral blood mononuclear cell(PBMC) was isolated,and real-time polymerase chain reaction(PCR) was used to analyze Th1 transcription factor T-bet,cytokine interleukin(IL)-12 and interferon-gamma(IFN-γ). In addition,the Th2 transcription factor GATA-3 and cytokine IL-4 were also determined. Clinical performance was assessed by PASI. Results At the 8 th week of treatment,12 patients in compound Qingdai capsule combined with MTX group achieved PASI-75(defined as at least 75% reduction in PASI),and 8 patients in single MTX group achieved PASI-75. There was statistical significance in clinical manifestation between the 2 groups(P<0.05). The Th1-related cytokines were down-regulated,and the Th2-related cytokines were up-regulated in compound Qingdai capsule combined with MTX group(P<0.05). Furthermore,with PASI-75 as the threshold,in compound Qingdai capsule combined with MTX group,the IFN-γ expression of PASI-75 was lower than that in single MTX group(P<0.05). Compound Qingdai capsule combined with MTX group reached PASI-75,and GATA-3 and IL-4 levels were higher than those in single MTX group(P<0.05). Conclusions Compound Qingdai capsule combined with MTX has better therapeutic effect on psoriasis. The reason may be that combination treatment has strong immune regulatory effect on Th1 and Th2.