清热利湿方联合5-氨基酮戊酸光动力疗法治疗中、重度痤疮的疗效观察及对患者血清基质金属蛋白酶-1、基质金属蛋白酶-9、白细胞介素-1β和肿瘤坏死因子-α的影响

Therapeutic effect of heat-clearing and dampness-eliminating method combined with 5-aminolevulinic acid photodynamic therapy on moderate and severe acne and its influence on MMP-1,MMP-9,IL-1βand TNF-α

目的探讨清热利湿方联合5-氨基酮戊酸光动力疗法对中、重度痤疮患者疗效及对基质金属蛋白酶-1(MMP-1)、基质金属蛋白酶-9(MMP-9)、白细胞介素-1β(IL-1β)和肿瘤坏死因子-α(TNF-α)的影响。方法选择宁波市中医院2017年3月至2019年3月收治的中重度痤疮患者106例,应用随机数字表法分为观察组(n=53)与对照组(n=53)。对照组患者采用5-氨基酮戊酸光动力疗法治疗,观察组在对照组基础上联合清热利湿方治疗。两组疗程均为6周。比较两组治疗疗效,治疗前后皮肤损害情况、皮肤病生活质量指数(DLQI)评分、MMP-1、MMP-9、IL-1β和TNF-α水平变化,及不良反应发生情况。结果观察组治疗总有效率(94.34%)高于对照组(73.58%)(χ^2=8.477,P<0.05);观察组治疗后粉刺[(19.32±2.37)分]、炎性丘疹[(25.42±4.17)分]和脓疱[(14.32±3.29)分]评分均低于对照组[(28.74±3.46)分、(32.87±3.78)分和(23.78±4.76)分](t=16.352、9.637、11.902,均P<0.05);观察组治疗后DLQI量表评分(0.65±0.13)分、(0.63±0.15)分、(1.23±0.16)分、(1.18±0.19)分、(1.39±0.23)分和(1.45±0.28)分,均低于对照组的(1.20±0.17)分、(1.14±0.18)分、(1.92±0.23)分、(1.79±0.13)分、(1.81±0.27)分和(1.87±0.21)分(t=18.710、15.846、17.929、19.290、8.621、8.736,均P<0.05);观察组治疗后血清MMP-1(34.25±7.48)μg/L、MMP-9(108.98±14.25)μg/L、IL-1β(137.98±10.23)μg/L和TNF-α(103.24±10.18)μg/L,均低于对照组的(59.37±4.56)μg/L、(164.32±18.48)μg/L、(156.37±13.10)μg/L和(137.91±8.29)μg/L(t=20.875、17.264、8.055、19.226,均P<0.05)。两组患者均未发生严重不良反应。结论清热利湿方联合5-氨基酮戊酸光动力疗法对中、重度痤疮患者疗效明显,可降低患者血清MMP-1、MMP-9、IL-1β和TNF-α水平。

Objective To investigate the effect of heat-clearing and dampness-eliminating therapy combined with 5-aminolevulinic acid photodynamic therapy on moderate and severe acne and its influence on matrix metalloproteinase-1(MMP-1),matrix metalloproteinase-9(MMP-9),interleukin-1β(IL-1β)and tumor necrosis factor-α(TNF-α).Methods From March 2017 to March 2019,106 patients with moderate to severe acne admitted to the Traditional Chinese Medicine Hospital of Ningbo were divided into observation group(n=53)and control group(n=53)according to the random digital table method.The control group was treated with 5-aminolevulinic acid photodynamic therapy,while the observation group was treated with heat-clearing and dampness-eliminating therapy on the basis of the control group.Both two groups were treated for 6 weeks.The therapeutic effects,skin lesions,dermatological quality of life index(DLQI),MMP-1,MMP-9,IL-1βand TNF-αlevels,and adverse reactions were compared between the two groups before and after treatment.Results The total effective rate of the observation group(94.34%)was higher than that of the control group(73.58%)(χ^2=8.477,P<0.05).The scores of acne[(19.32±2.37)points],inflammatory papules[(25.42±4.17)points]and pustules[(14.32±3.29)points]in the observation group after treatment were lower than those in the control group[(28.74±3.46)points,(32.87±3.78)points,(23.78±4.76)points](t=16.352,9.637,11.902,all P<0.05).After treatment,the scores of DLQI scale in the observation group[(0.65±0.13)points,(0.63±0.15)points,(1.23±0.16)points,(1.18±0.19)points,(1.39±0.23)points,(1.45±0.28)points]were lower than those in the control group[,(1.20±0.17)points,(1.14±0.18)points,(1.92±0.23)points,(1.79±0.13)points,(1.81±0.27)points,(1.87±0.21)points](t=18.710,15.846,17.929,19.290,8.621,8.736,all P<0.05).After treatment,the serum levels of MMP-1[(34.25±7.48)μg/L],MMP-9[(108.98±14.25)μg/L],IL-1β[(137.98±10.23)μg/L]and TNF-α[(103.24±10.18)μg/L]in the observation group were lower than those in the control group[(59.37±4.56)μg/L,(164.32±18.48)μg/L,(156.37±13.10)μg/L and(137.91±8.29)μg/L](t=20.875,17.264,8.055,19.226,all P<0.05).There were no serious adverse reactions in both two groups.Conclusion The method of heat-clearing and dampness-eliminating combined with 5-aminolevulinic acid photodynamic therapy is effective in treating moderate and severe acne,and can reduce the serum levels of MMP-1,MMP-9,IL-1βand TNF-α.