傅青主火丹神方加味联合西医治疗肝经郁热型老年胸段中重度带状疱疹的作用机制  

Effect of Fuqingzhu Huodan Shenfang in Treatment of Herpes Zoster with Liver Meridian

作　　者：韩晓东[1] 黄炜[1] 常亚军[1] 张海霞 温馨[1] HAN Xiao-dong;HUANG Wei;CHANG Ya-jun;ZHANG Hai-xia;WEN Xin(Tangshan Worker＇s Hospital, Tangshan 063000, China;School of Traditional Chinese Medicine, North China University of Science and Technology, Tangshan 063009, China)

机构地区：[1]唐山市工人医院,河北唐山063000 [2]华北理工大学中医学院,河北唐山063009

出　　处：《中国实验方剂学杂志》2018年第1期163-168,共6页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：河北省中医药管理局科研计划项目(20160504)

摘　　要：目的：探讨傅青主火丹神方加味联合液氮冷冻疗法及阿昔洛韦片治疗老年胸段中重度带状疱疹肝经郁热型的疗效及其作用机制。方法：选择2013年1月至2014年12月于唐山市工人医院就诊的老年胸段中重度带状疱疹患者,随机数字分为治疗组和对照组,各90例。对照组患者给予阿昔洛韦片和甲钴胺分散片口服,同时,给予液氮冷冻疗法。观察组患者在上述治疗基础上给予傅青主火丹神方加味治疗。比较两组患者的临床疗效及后遗神经痛发生情况。采用酶联免疫吸附法检测并比较Th1细胞分泌因子白细胞介素（IL）-2,干扰素（IFN）-γ水平,Th2细胞分泌因子IL-4,IL-10水平。采用流式细胞仪检测T淋巴细胞亚群水平。实时荧光实时定量PCR法检测p38丝裂原活化蛋白激酶（MAPK）,细胞外调节蛋白激酶（ERK）1/2,氨基末端激酶（JNK）基因的表达。比较两组患者治疗期间出现的不良反应。结果：治疗组临床有效率高于对照组（P〈0.05）。治疗组止疱时间、结痂时间及脱痂时间均短于对照组（P〈0.05）。治疗6个月后,治疗组后遗神经痛的发生率为41.1%;对照组为48.9%。两组患者后遗神经痛发生率比较无统计学差异。治疗组发生后遗神经痛患者的疼痛视觉模拟评分（VAS）显著低于对照组（P〈0.01）。治疗后治疗组患者CD3^＋,CD4^＋和CD4^＋/CD8^＋水平高于治疗前,CD8^＋水平低于治疗前（P〈0.05）。治疗组患者治疗后IL-2,IFN-γ水平高于治疗前,IL-4,IL-10水平低于治疗前（P〈0.05）。治疗后两组患者p38MAPK,JNK mRNA表达较治疗前降低（P〈0.05）。且治疗组治疗后p38 MAPK,JNK mRNA表达低于对照组（P〈0.05）。结论：傅青主火丹神方治疗老年胸段中重度带状疱疹有较好的临床疗效,可显著减轻后期发生后遗神经痛的疼痛程度,其机制可能与调节Th1/Th2细胞的失衡状态,提高机体免疫功能,增强机体抗病毒�Objective： To investigate the efficacy and mechanism of Fuqingzhu Huodan Shenfang in the treatment of moderate to severe herpes zoster（ liver meridian）. Method： A total of 180 patients with severe herpes zoster treated in our hospital were randomly divided into the treatment group（ 90 cases） and the control group（ 90 cases） by the random number table. Another 90 healthy cases were also selected as the normal control group.Patients in control group were given oral acyclovir tablets,methylcobalamin dispersions,and liquid nitrogen cryotherapy. In addition to the above therapy,patients in observation group were also given modified Fuqingzhu Huodan Shenfang. A course of treatment was 14 days. The efficacy and the incidence of postherpetic neuralgia were compared between two groups. Th1 factor [interleukin（ IL）-2 and interferon（ IFN）-γ],and Th2 factor（ IL-4 and IL-10） expressions were observed by enzyme-linked immunosorbent assay. T lymphocyte subsets were measured by Flow cytometry. p38 mitogen-activated protein kinases（ MAPK）, extracellular-signal regulated protein kinase（ ERK） 1/2 and c-Jun NH2-terminalprotein kinase（ JNK） gene expressions were detected by Realtime PCR. Adverse reactions were compared. Result： The clinical efficiency of treatment group was significantly higher than control group（ P〈0. 05）. After 6 months of treatment,the incidence of postherpetic neuralgiathe in the treatment group was 41. 1%,while that of the control group was 48. 9%. There was no significant difference in the incidence of postherpetic neuralgia between two groups. VAS score in the PHN patients of treatment group was significantly lower than control group（ P〈0. 05）. After treatment, CD3^＋,CD4^＋,CD4^＋/CD8^＋levels in treatment group were higher than before treatment,while CD8^＋level was lower than before treatment（ P〈0. 05）.After treatment,IL-2 and IFN-γ levels in treatment group were higher than before treatment,while IL-4 and IL-10 levels were lower than before

关 键 词：傅青主火丹神方 带状疱疹 免疫 P38丝裂原活化蛋白激酶 TH1/TH2细胞 

分 类 号：R287[医药卫生—中药学]