清疹方对慢性荨麻疹细胞免疫功能的调节作用

目的:观察瑶医清疹方对慢性荨麻疹(浆朋比)的临床疗效及对细胞免疫功能的影响作用。方法:按随机数字表法,将132例患者分为对照组和观察组各66例。对照组脱落、失访和剔除共6例,最后完成60例;观察组最后完成62例。两组均口服依巴斯汀片,10~20 mg/次,1次/d。对照组口服皮敏消胶囊,4粒/次,3次/d;观察组内服清疹方,1剂/d。两组疗程均为治疗8周。于治疗前、治疗后2,4,8周分别进行7 d荨麻疹活动度评分(USA7)和皮损情况评分(TSS);进行治疗前后慢性荨麻疹生活质量量表(CU-Q2oL)和风湿热内蕴证评分;对USA7<7分者进行3个月随访,记录复发情况;检测治疗前后补体3,4(C3,C4),CD4^(+)和CD8^(+)细胞,计算Th17,Treg细胞在CD4^(+)细胞中的比例,并计算CD4^(+)/CD8^(+)和Th17/Treg;检测治疗前后外周血白细胞介素-10(IL-10),IL-17,IL-23和IL-35水平;进行安全性评价。结果:在治疗后2,4和8周,观察组USA7评分和TSS评分均低于同期对照组(P<0.01);观察组CU-Q2oL和风湿热内蕴证评分均低于对照组(P<0.01);观察组C3,C4和IL-35水平均高于对照组(P<0.01);观察组CD4^(+),Treg细胞和CD4^(+)/CD8^(+)均高于对照组(P<0.01),观察组IL-10,IL-17,IL-23,CD8^(+),Th17细胞和Th17/Treg均低于对照组(P<0.01);观察组复发率为25.58%(11/43)低于对照组的复发率为48.48%(16/33)(χ^(2)=4.276,P<0.05);观察组临床疗效优于对照组(Z=2.021,P<0.05)。结论:采用清疹方治疗慢性荨麻疹,可控制病情程度,提高生活质量,有着较好的临床疗效,并可减少复发,还能升高C3,C4水平,调节细胞免疫功能,减轻免疫炎症应答,值得临床进一步的研究与使用。

缪正来治疗难治性皮肤病验案2则

难治性皮肤病临床治疗极为棘手,共同特点是皮损严重,反复发作,缠绵难愈。缪正来主任医师,《江苏中医药》编辑部原编审,年逾八旬,行医60余载,中医理论基础扎实,临床经验丰富,善治皮肤病之重症,现择验案2则如下,以飨同道。

Comparison and Evaluation of Several Dermatophagoides Pteronyssinus Allergen Extracts for Skin Prick Test

Objective To evaluate the significance of several Dermatophagoides pteronyssinus allergen extracts for skin prick test(SPT) in patients allergic to Dermatophagoides pteronyssinus.Methods Two hundred and nineteen patients enrolled in Peking Union Medical College Hospital underwent SPT and serum specific IgE assay to detect the Dermatophagoides pteronyssinus allergen.Three kinds of house dust mite allergen extracts were used for SPT,including the Dermatophagoides pteronyssinus extract prepared by our laboratory(group A),standardized Dermatophagoides pteronyssinus extract(group B),and mixed extracts of Dermatophagoides pteronyssinus and Dermatophagoides farinae(group C).Human serum specific IgE result was regarded as the reference standard for diagnosis of Dermatophagoides pteronyssinus allergy.The receiver operating characteristic(ROC) curve was used to evaluate the diagnostic performance of SPT with the extracts of three groups.Results SPT results showed that the median wheal diameter of group A,group B,and group C was 0.43,0.35,and 0.28 cm,respectively,with significant difference among three groups(P<0.05).The difference was significant between group A and B(P<0.01) as well as group A and C(P<0.01),but not between group B and C(P>0.05).There was no local urticaria or systemic allergic reactions following the procedure of SPT.Local reaction was observed in 5 patients and delayed reaction was in 2 patients of group A.As for group B and C,local reaction occurred in 3 cases and delayed reaction in 2 cases in each group.The area under ROC curve of SPT with extract in group A,group B,and group C was 0.765,0.801,and 0.782,respectively.Based on the detection results of serum specific IgE,the sensitivity of SPT in diagnosis of Dermato-phagoides pteronyssinus allergy with extract of group A,group B,and group C was 92.4%,87.0%,and 81.5%,and the specificity was 60.6%,73.2%,and 74.8%,respectively.Conclusion The Dermatophagoides pteronyssinus extract for SPT prepared by our laboratory offers good sensitivity and specificity comparable to commercially available allergen extracts,and it may be an appropriate candidate for clinical screening and diagnosis of Dermatophagoides pteronyssinus allergy.