退红舒缓中药面膜联合丹栀逍遥散治疗玫瑰痤疮患者的疗效及对其皮肤屏障功能、BDNF、TrKB表达的影响

Curative Effect of Redness-relieving and Soothing TCM Face Mask Combined with Danzhi Xiaoyao Powder on Rosacea and Its Influences on Skin Barrier Function,Serum BDNF,and TrKB

目的探讨退红舒缓中药面膜联合丹栀逍遥散治疗肝郁脾虚型玫瑰痤疮患者的疗效及对其皮肤屏障功能、脑源性神经营养因子(Brain-derived neurotrophic factor,BDNF)、脑源性神经营养因子受体(Tropomyosin receptor kinase b,TrKB)表达的影响。方法选取2021年5月—2023年5月期间在湖南省中西医结合医院诊治的90例肝郁脾虚型玫瑰痤疮患者,采用随机数字表法分为对照组、中药组和联合治疗组,每组各30例。对照组患者外用退红舒缓中药面膜治疗,中药组患者口服丹栀逍遥散治疗,联合治疗组采用退红舒缓中药面膜联合丹栀逍遥散治疗,3组均持续治疗4周。观察比较3组患者临床疗效、不良反应情况,治疗前后中医证候积分、心理状态评分[汉密尔顿抑郁量表(Hamilton depression rating scale,HAMD)、汉密尔顿焦虑量表(Hamilton anxiety rating scale,HAMA)]、BDNF、TrKB蛋白和mRNA相对表达水平、炎症因子水平[白介素-4(Interleukin-4,IL-4)、白介素-17(Interleukin-17,IL-17)和白介素-37(Interleukin-37,IL-37)]。结果治疗后3组患者中医证候积分较治疗前降低,差异有统计学意义(P<0.05);且联合治疗组患者中医证候积分低于对照组和中药组,差异有统计学意义(P<0.05)。治疗后3组患者皮肤泛红、颜色评分和经表皮失水率较治疗前降低,角质层水平含量较治疗前升高,差异有统计学意义(P<0.05);且联合治疗组患者皮肤泛红、颜色评分和经表皮失水率低于对照组和中药组,角质层水平含量高于对照组和中药组,差异有统计学意义(P<0.05)。治疗后3组患者心理状态评分均较治疗前降低,差异有统计学意义(P<0.05);且联合治疗组患者心理状态评分低于对照组和中药组,差异有统计学意义(P<0.05)。治疗后3组患者BDNF、TrKB和BDNF mRNA、TrkB mRNA均较治疗前降低,差异有统计学意义(P<0.05),且联合治疗组患者BDNF、TrKB和BDNF mRNA、TrkB mRNA低于对照组和中药组,差异有统计学意义(P<0.05)。治疗后3组患者IL-4、IL-17和IL-37水平均较治疗前降低,差异有统计学意义(P<0.05);且联合治疗组患者IL-4、IL-17和IL-37水平低于对照组和中药组,差异有统计学意义(P<0.05)。治疗后联合治疗组临床愈显率为90.00%(27/30),较对照组63.33%(20/30)和中药组66.67%(19/30)明显升高,差异有统计学意义(P<0.05)。治疗期间,3组患者均未发生明显不良反应。结论退红舒缓中药面膜联合丹栀逍遥散治疗可以改善肝郁脾虚型玫瑰痤疮患者临床症状,提高皮肤屏障功能和心理水平,其机制可能与降低BDNF、TrkB表达有关。

Objective To explore the curative effect of redness-relieving and soothing traditional Chinese medicine(TCM)face mask combined with Danzhi Xiaoyao Powder on rosacea of the liver depression and spleen deficiency type and its influences on skin barrier function,serum brain-derived neurotrophic factor(BDNF),and tropomyosin receptor kinase B(TrKB).Methods A total of 90 patients with rosacea of the liver depression and spleen deficiency type who were treated in Hunan Provincial Hospital of Integrated Traditional Chinese and Western Medicine between May 2021 and May 2023 were enrolled as the research subjects.According to the random number table method,they were divided into a control group(redness-relieving and soothing TCM face masks),a TCM group(oral Danzhi Xiaoyao Powder),and a combined treatment group(redness-relieving and soothing TCM face masks+Danzhi Xiaoyao Powder),30 cases in each group.All patients were treated for 4 weeks.The clinical curative effects and adverse reactions in the three groups were compared.In addition,comparison was also performed on TCM syndrome scores,psychological state[Hamilton Depression Rating Scale(HAMD)and Hamilton Anxiety Rating Scale(HAMA)],relative expression levels of BDNF and TrKB proteins and mRNA,and levels of inflammatory factors[interleukin-4(IL-4),interleukin-17(IL-17),and interleukin-37(IL-37)]of the three groups before and after treatment.Results After treatment,TCM syndrome scores were decreased in the three groups,and the differences were statistically significant(P<0.05).The TCM syndrome scores in the combined treatment group were lower than those in the control group and the TCM group,and the differences were statistically significant(P<0.05).After treatment,the scores of skin redness and color and the transepidermal water loss rate were decreased,and water content of stratum corneum was increased in the three groups,with differences being statistically significant(P<0.05).Additionally,the scores of skin redness and color and the transepidermal water loss rate in the combined treatment group were lower than those in the control group and the TCM group,and water content of stratum corneum in the combined treatment group was higher than that in the other two groups,with differences being statistically significant(P<0.05).After treatment,scores of psychological state were decreased in the three groups with statistically significant differences(P<0.05),and those were lower in the combined treatment group than in the control group and the TCM group,showing statistically significant differences(P<0.05).After treatment,the levels of BDNF,TrKB,BDNF mRNA,and TrkB mRNA were decreased in the three groups with statistically significant differences(P<0.05),and their levels were lower in the combined treatment group than in the control group and the TCM group with statistically significant differences(P<0.05).The levels of IL-4,IL-17,and IL-37 were decreased after treatment in the three groups,exhibiting statistically significant differences(P<0.05).Their levels in the combined treatment group were lower than those in the control group and the TCM group,and the differences were statistically significant(P<0.05).After treatment,the clinical cure rate was 90.00%(27/30)in the combined treatment group,significantly higher than 63.33%(20/30)and 66.67%(19/30)in the control group and the TCM group,respectively,and the differences were statistically significant(P<0.05).During the treatment,no obvious adverse reactions were observed in the patients of the three groups.Conclusion The redness-relieving and soothing TCM face mask combined with Danzhi Xiaoyao Powder can improve clinical symptoms,skin barrier function,and psychological state of patients with rosacea of the liver depression and spleen deficiency type,and the mechanism may be related to reducing BDNF and TrkB expression.