柴胡解毒汤治疗尖锐湿疣的疗效观察和机制探讨  

Investigation of curative effect and mechanism of Chaihu Jiedu Decoction on condyloma acuminatum

作　　者：卜璋于 吴黎明 俞小虹 刘珏 邓琳 BU Zhangyu;WU Liming;YU Xiaohong;LIU Jue;DENG Lin(Department of Dermatology,Affiliated Hangzhou Frist People's Hospital,Zhejiang University,the Fourth Clinical Medical School of Zhejiang University of Traditional Chinese Medicine,Hangzhou 310006,Zhejiang,China)

机构地区：[1]浙江大学医学院附属杭州市第一人民医院皮肤科浙江中医药大学第四临床医学院

出　　处：《中国临床药理学与治疗学》2019年第6期681-686,共6页Chinese Journal of Clinical Pharmacology and Therapeutics

基　　金：浙江省中医药科技计划项目(2014ZA081)

摘　　要：目的:观察柴胡解毒汤治疗尖锐湿疣(CA)的临床疗效和探讨其部分起效机制。方法:将2015年6月至2017年9月浙江大学医学院附属杭州市第一人民医院皮肤科门诊就诊的120例CA病例(年龄16~65岁)随机分为A组、B组和C组,每组40例。A组采用柴胡解毒汤治疗(n=40),100mL口服,2次/日,连续治疗30d为1个疗程;B组采用α-2b重组人干扰素治疗(n=39,其中1位病例用药2周后因不良反应退出研究),300万IU肌肉注射,隔天1次,注射15次为1个疗程;C组不采用任何全身系统治疗方案(n=40)。比较3组病例临床疗效,统计复发率和复发次数,以及药物不良反应情况。检测A组病例口服柴胡解毒汤治疗前后外周静脉血中T淋巴细胞亚群及NK细胞百分率,血清中细胞因子IL-2、IL-4、IL-10、IL-12、IFN-γ的蛋白表达水平。结果:除B组1位退出研究病例,随访12周复发率和复发次数,总病例中复发率为51.26%(61/119),平均复发次数为1.6次。其中A组病例和B组病例的复发率和复发次数均低于C组病例(P<0.01);A组病例和B组病例之间的复发率和复发次数无统计学差异(P>0.05)。与口服柴胡解毒汤治疗前相比,治疗一个月后的CA病例外周血CD4^+T淋巴细胞百分率升高,CD4^+/CD8^+比值升高,NK细胞百分率升高(P均<0.01);而CD3^+T淋巴细胞百分率和CD8^+T淋巴细胞百分率的差异均无统计学意义。与口服柴胡解毒汤治疗前相比,治疗后的CA病例外周血清IL-2、IL-12、IFN-γ增多(P<0.01),IL-10下降(P<0.05),而IL-4含量的差异无统计学意义(P>0.05)。结论:柴胡解毒汤治疗CA的临床疗效确切,与肌注α-2b重组人干扰素相当,其起效机制可能是通过促进CD4^+T淋巴细胞数量和功能改善细胞免疫功能,并通过促进CD4^+T细胞分泌的细胞因子IL-2、IFN-γ增加而实现NK细胞数量增多和功能活化。AIM : To observe the clinical efficacy of the Chaihu Jiedu Decoction in the treatment of condyloma acuminatum (CA), and to explore the possible effective mechanism. METHODS : A total of 120 patients with CA (age range from 16 to 65) who were admitted and treated in our hospital from June 2015 to September 2017 were selected. All patients were randomly divided into three groups: group A received Chaihu Jiedu Decoction( n =40), group B received α-2b recombinant human interferon( n =39, one of the patients withdrew from the study due to adverse reactions after 2 weeks of medication)and group C received no systemic therapy( n =40). The clinical efficacy, recurrence rate, recurrence frequency and adverse drug adverse reaction of the three groups were compared. Peripheral blood T lymphocyte subsets and NK cells before and after the treatment of CA patients in group A were detected by flow cytometry, and IL-2, IL-4, IL-10, IL-12, IFN-γ in peripheral venous blood serum were detected by ELISA. RESULTS :Except for the one withdrawal case from group B, after 12 weeks follow-up, the rate and the average times of recurrence in all of the CA cases were 51.26%(61/119)and 1.6 , respectively. The rate and the average times of recurrence in group A and B were lower than those of group C( P < 0.01 ), but the differences between group A and B were not statistically significant( P > 0.05 ). At the end of one month treatment with Chaihu Jiedu Decoction, the CD4 ^+T cell percentage, the CD4 ^+/CD8 ^+ cell ratio, and the NK cell percentage were all increased( P < 0.01 )in peripheral blood of CA patients, but the differences of CD3 ^+T cell percentage and CD3 ^+T cell percentage were not statistically significant. Also, at the end of treatment with Chaihu Jiedu Decoction, the peripheral blood serum IL-2 of CA patients increased( P < 0.01 ), the IL-12( P < 0.01 ), IFN-γ( P < 0.01 )and IL-10 decreased( P < 0.05 ), while the difference of IL-4 content was not statistically significant( P > 0.05 ). CONCLUSION :The Chaihu Jiedu Decoction h

关 键 词：柴胡解毒汤 尖锐湿疣 T淋巴细胞亚群 自然杀伤细胞 细胞因子 

分 类 号：R285[医药卫生—中药学] R752.53[医药卫生—中医学]