中医综合诊疗方案对脾虚湿盛型银屑病患者皮损组织FLG、K17蛋白表达及皮肤屏障功能的影响

Effects of FLG and K17 protein expression and skin barrier function by comprehensive Chinese medicine treatment program on skin lesion tissues of psoriasis patients with spleen-deficiency and dampness-rich type

目的:探讨中医综合诊疗方案对脾虚湿盛型银屑病患者皮损组织丝聚蛋白(FLG)、角蛋白17(K17)蛋白表达及皮肤屏障功能的影响。方法:设立以口服甲氨蝶呤片,外用卡泊三醇乳膏,NB-UVB光疗为主的对照组和口服健脾解毒汤,外用中药药浴、普连乳膏和走罐疗法为主的治疗组,两组全部接受4周治疗。对两组治疗前后靶皮损组织FLG、K17蛋白的表达与皮肤屏障功能[经皮水分散失(TEWL)、角质层含水量]、银屑病面积与严重程度指数(PASI)评分比较,以观察其临床疗效及对皮肤屏障功能的影响。结果:两组患者治疗后,PASI评分较治疗前显著降低(P<0.01),皮损组织内FLG蛋白几乎均表达于角质层,分布均匀,表达量较治疗前显著增多(P<0.01),K17蛋白表达极弱甚至不表达。两组治疗后角质层含水量较治疗前显著增加(P<0.01),同时TEWL丢失显著减少(P<0.01)。治疗组疗效显著优于对照组(P<0.05)。结论:中医综合诊疗方案治疗脾虚湿盛型银屑病,可以减轻皮损症状,影响皮损组织FLG、K17蛋白的表达,改善皮肤屏障功能,提高临床治疗效果。

Objective:To investigate the effects of comprehensive Chinese medicine treatment program on filaggrin(FLG)and keratin 17(K17)protein expression and skin barrier function in skin lesion tissues of psoriasis patients with spleen-deficiency and dampness-rich type.Methods:A control group based on oral Methotrexate Tablets,Topical Carbotriol Cream and NB-UVB phototherapy was established and a treatment group based on oral Jianpi Jiedu Decoction,topical Chinese medicine bath,Pulian Cream and cupping therapy was established,and both groups were treated for 4 weeks.The expression of FLG and K17 protein and skin barrier function of target skin lesion tissue[trans epidermal water loss(TWEL),stratum corneum hydration]and psoriasis area and severity index(PASI)score were compared.It mainly analyzed the clinical manifestation of the comprehensive scheme and the specific effect on the skin barrier.Results:After treatment,the PASI values of the two groups decreased comprehensively than before treatment(P<0.01),FLG protein was almost always expressed in the stratum corneum in the lesion tissue,uniformly distributed and strongly expressed than before treatment(P<0.01),and K17 protein was extremely weakly expressed or even not expressed. After treatment, the water content of stratum corneum in two groups increased comprehensively than before treatment (P<0.01), and the TEWL fell down (P<0.01). The clinical efficacy of treatment group was better than control group (P<0.05). Conclusion: The comprehensive Chinese medicine treatment program for psoriasis with spleen-deficiency and dampness-rich type can reduce the symptoms of skin lesions, affect the expression of FLG and K17 proteins in skin lesion tissues, improve the skin barrier function, and enhance the clinical treatment effect.