调胃承气汤加减内服与苦参汤外洗联合治疗斑块型银屑病胃肠湿热证的临床研究

Clinical Observation on Treating Plaque Psoriasis(Syndrome of Dampness-Heat in Stomach and Intestine)by Oral Administration of Modified Tiaowei Chengqi Decoction and Washing with Kushen Decoction

目的 观察调胃承气汤加减内服与苦参汤外洗联合治疗斑块型银屑病胃肠湿热证的临床疗效。方法 选取2019年6月—2021年6月期间河南省商丘市中医院就诊的斑块型银屑病胃肠湿热证患者90例,按照入院先后顺序进行编号,采用随机数字表法进行分组,编号为单数的45例设为对照组,编号为双数的45例设为治疗组。对照组采用卡泊三醇乳膏、维A酸乳膏外擦,治疗组采用调胃承气汤加减内服与苦参汤外洗。治疗3个疗程后,观察比较两组患者的临床疗效,中医证候评分、银屑病面积与严重程度指数(Psoriasis Area and Severity Index, PASI)评分、生活质量指数(Dermatology Life Quality Index, DLQI)评分,观察比较治疗前后血清炎性因子[白细胞介素-2(Interleukin-2,IL-2)、白细胞介素-4(Interleukin-2,IL-4)及白细胞介素-10(Interleukin-10,IL-10)]水平。结果 治疗后治疗组总有效率93.33%(42/45)明显高于对照组77.78%(35/45),差异有统计学意义(P<0.05)。治疗后两组患者红斑、鳞屑、乏力困倦及瘙痒积分均较治疗前降低,差异有统计学意义(P<0.05);且治疗组红斑、鳞屑、乏力困倦及瘙痒积分均低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者PASI评分及DLQI评分均较治疗前降低,差异有统计学意义(P<0.05);且治疗组患者PASI评分及DLQI评分明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者血清IL-2、IL-4及IL-10水平均较治疗前降低,差异有统计学意义(P<0.05);且治疗组患者血清IL-2、IL-4及IL-10水平均明显低于对照组,差异有统计学意义(P<0.05)。结论 调胃承气汤加减内服与苦参汤外洗联用能提高斑块型银屑病胃肠湿热证的治疗有效率,改善中医证候症状,促进皮损消退,改善生活质量,减轻炎症反应。

Objective To observe the clinical efficacy of oral administration of Tiaowei Chengqi Decoction and washing with Kushen Decoction in the treatment of plaque psoriasis with the syndrome of dampness-heat in stomach and intestine.Methods A total of 90 plaque psoriasis patients with the syndrome of dampness-heat in stomach and intestine treated in Shangqiu Hospital of Traditional Chinese Medicine from June 2019 to June 2021 were selected and numbered ac-cording to the order of admission.The random number table method was used for grouping of the patients.The 45 patients in odd number were assigned to the control group,and the 45 patients in even number to the observation group.The control group was treated with calcipotriol cream and tretinoin cream,and the observation group was treated by oral administration of Tiaowei Chengqi Decoction and washing with Kushen Decoction.After three courses of treatment,the clinical efficiency was compared between the two groups.The TCM symptom scores,psoriasis area and severity index(PASI)score,dermatolo-gy life quality index(DLQI)score,and the serum levels of inflammatory cytokines[interleukin-2(IL-2),IL-4,and IL-10]were recorded before and after treatment.Results The total effective rate of the observation group was 93.33%(42/45),which was higher than that(77.78%,35/45)of the control group(P<0.05).The scores of erythema,scales,fa-tigue,pruritus,PASI,and DLQI in both groups declined after treatment compared with those before treatment(P<0.05),and the scores in the observation group were lower than those in the control group(P<0.05).The serum levels of IL-2,IL-4,and IL-10 in both groups after treatment declined compared with those before treatment(P<0.05),and the levels in the observation group were lower than those in the control group(P<0.05).Conclusion Oral administration of Tiao-wei Chengqi Decoction combined with washing with Kushen Decoction can increase the effective rate,alleviate the TCM symptoms,promote the regression of skin lesions,improve the quality of life,and reduce inflammation in the treatment of plaque psoriasis with the syndrome of dampness-heat in stomach and intestine.