四藤合剂联合中药浴治疗寻常型银屑病血热证的临床研究

Combination of Siteng Mixture and Traditional Chinese Medicine Bath in Treating Psoriasis Vulgaris with Blood Heat Syndrome

目的观察四藤合剂、自制清热消银药浴方单用和联合治疗血热证寻常型银屑病(PsV)的临床疗效及相关炎性因子的变化。方法收集2021年1月—2023年6月就诊于本院,符合纳入标准的血热证PsV患者120例,随机分为药浴组、中药组和联合组,每组40例,共治疗4周。于第0周和第4周记录患者银屑病面积和严重程度指数(PASI)评分和采用酶联免疫吸附测定(ELISA)法检测血清白细胞介素-17(IL-17)、IL-22、肿瘤坏死因子-α(TNF-α)和血管内皮生长因子(VEGF)血清浓度变化。结果治疗4周时,药浴组(38例)治疗总有效率为31.58%,中药组(36例)为41.67%,联合组(38例)为68.42%,联合组治疗总有效率显著高于其他2组(P<0.01);3组患者治疗后PASI评分与治疗前比较均显著降低(均P<0.01);联合组PASI评分(6.16±2.25)下降程度显著大于药浴组的(3.13±1.61)和中药组的(5.47±2.26,P<0.01)。治疗后,3组患者血清中IL-17、IL-22、TNF-α和VEGF浓度均显著低于治疗前(P<0.01);联合组血清浓度水平降低更为显著[IL-17(40.74±12.70)、IL-22(35.17±2.93)、TNF-α(22.22±1.72)和VEGF(266.00±11.45)],显著低于药浴组[IL-17(57.02±12.57)、IL-22(54.55±0.56)、TNF-α(28.05±2.56)和VEGF(287.60±11.33)]以及中药组[IL-17(57.61±15.04)、IL-22(54.45±0.63)、TNF-α(27.43±2.15)和VEGF(285.10±10.33,P<0.01)]。3组都有因安全性退出的患者,其中:药浴组2例,中药组4例,联合组2例。结论四藤合剂与自制清热消银药浴方治疗血热证PsV都有一定疗效,二者联用能显著提高治疗有效率,并且针对血热证PsV患者的炎性因子,也较单用有显著抑制作用。四藤合剂联合自制清热消银药浴方治疗血热证PsV值得临床使用和推广。

Objective In order to observe the clinical efficacy and changes in related inflammatory factors of the treatment of psoriasis vulgaris(PsV)with blood heat syndrome using Siteng mixture and self-made Qingre Xiaoyin medicinal bath formula alone and in combination.Methods Totally 120 patients with blood heat syndrome PsV who met the inclusion criteria were enrolled in our hospital and randomly divided into medicine bath group,traditional Chinese medicine(TCM)group,and combination group,with 40 patients in each group.The treatment lasted for four weeks.Psoriasis area and severity index(PASI)scores were recorded and the changes of serum interleukin-17(IL-17),IL-22,tumor necrosis factor-α(TNF-α)and vascular endothelial growth factor(VEGF)were detected by enzyme linked immunosorbent assay(ELISA)at week 0 and 4,respectively.Results After four weeks of treatment,the effective rate of the medicine bath group(38 cases)was 31.58%,the TCM group(36 cases)was 41.67%,and the combined group(38 cases)was 68.42%.After treatment,the PASI score of the three groups decreased significantly than before treatment(P<0.01).The decreasing in PASI score in the combination group(6.16±2.25)was significantly greater than that in the medicine bath group(3.13±1.61)and the TCM group(5.47±2.26,P<0.01).After treatment,the serum concentrations of IL-17,IL-22,TNF-αand VEGF in the three groups were significantly lower than those before treatment(P<0.01).The serum concentrations of VEGF were significantly lower than those before treatment(P<0.01).In combination group,serum concentration levels of IL-17(40.74±12.70),IL-22(35.17±2.93),TNF-α(22.22±1.72)and VEGF(266.00±11.45)were significantly lower than those of IL-17(57.02±12.57),IL-22(54.55±0.56),and TNF-α(28.05±2.56)and VEGF(287.60±11.33)in the medicated bath group,also lower than those of IL-17(57.61±15.04),IL-22(54.45±0.63),and TNF-α(27.43±2.15)and VEGF(285.10±10.33)in the traditional Chinese medicine group(P<0.01).All three groups had patients who withdrew due to safety reasons,including two cases in the medicine bath group,four cases in the TCM group,and two cases in the combination group.Conclusion Both Siteng mixture and self-made Qingre Xiaoyin medicinal bath formula have certain therapeutic effects on PsV with blood heat syndrome.The combination of the two can significantly improve the treatment effectiveness.Moreover,the combination of the two has significant inhibitory effects on inflammatory factors in patients with PsV of blood heat syndrome compared to single use.The combination of self-made Qingre Xiaoyin medicinal bath formula and Siteng mixture in the treatment of PsVwith blood heat syndrome is worthy of clinical use and promotion.