加味逍遥散治疗特应性皮炎的临床疗效及实验研究  

Efficacy of Jiawei Xiaoyao San in the Treatment of Atopic Dermatitis and Experimental Study

作　　者：王志敏 秦成 杨显娜 王芳 孔祥一 赵永东 杨雪松 叶建州 Wang Zhimin;Qin Cheng;Yang Xianna;Wang Fang;Kong Xiangyi;Zhao Yongdong;Yang Xuesong;Ye Jianzhou(First School of Clinic Medicine,Yunnan University of Traditional Chinese Medicine,Kunming 650500,Yunnan,China;Baoshan College of Traditional Chinese Medicine,Baoshan 678099,Yunnan,China;The First Affiliated Hospital of Yunnan Traditional Chinese Medicine University,Kunming 650021,Yunnan,China)

机构地区：[1]云南中医药大学第一临床医学院,云南昆明650500 [2]保山中医药高等专科学校,云南保山678099 [3]云南中医药大学第一附属医院,云南昆明650021

出　　处：《中国中西医结合皮肤性病学杂志》2024年第5期397-403,共7页Chinese Journal of Dermatovenereology of Integrated Traditional and Western Medicine

基　　金：国家自然科学基金项目(编号:82260940);云南省中医(皮肤病)临床医学中心;云南省教育厅项目(编号:2022Y370)。

摘　　要：目的探讨加味逍遥散对特应性皮炎(AD)患者的临床疗效及对2,4-二硝基氯苯(DNCB)诱导的AD模型的疗效及其潜在作用机制。方法采用随机对照临床试验设计,将64例云南省中医医院皮肤科AD患者,按照1∶1比例随机分为2组,观察组和对照组各32例。观察组予加味逍遥散,对照组予西替利嗪片,疗程均为4周。记录治疗前后AD疗效评分(SCORAD)、血清免疫球蛋白E(IgE)、白细胞介素-17(IL-17)、神经肽P物质(SP)、神经生长因子(NGF)和5-羟色胺(5-HT)。通过DNCB诱导复制AD小鼠模型,分别设立空白组、模型组、西替利嗪组和加味逍遥散低、中、高剂量(14.30、28.60和57.20g/kg)组。除空白组外,其余各组给予相应药物干预,观察皮损变化、耳廓皮损厚度和搔抓次数(30min);HE染色观察皮损组织病理形态学改变,酶联免疫吸附测定(ELISA)法检测血清IgE、IL-17、SP、NGF、5-HT以及皮损5-HT水平。结果2组患者治疗后,全分析集(FAS)分析显示,观察组总有效率为84.38%(27/32),对照组总有效率为75%(24/32),观察组总有效率高于对照组(P<0.01);且对患者病情严重程度、睡眠质量、焦虑抑郁评分均优于西替利嗪组,有效降低AD患者IgE、IL-17、SP、NGF和5-HT水平。经动物试验,与空白组比较,模型组皮损出现水肿、红斑、结痂,皮损组织结构完整性差,可见淋巴细胞、中性粒细胞浸润,皮损厚度增加,给药后,小鼠组织炎性细胞浸润较少,血清中IgE、IL-17、SP、NGF和5-HT均明显下降(P<0.05)。结论加味逍遥散治疗AD的效果显著,能够降低患者及AD小鼠血清IgE、IL-17、SP、NGF和5-HT水平,从而抑制炎性反应程度,有效地缓解AD患者临床症状、缓解瘙痒症状,降低SCORAD评分,提高其生活质量,值得临床推广使用。Objective In order to explore the clinical effects of Jiawei Xiaoyao San on patients with atopic dermatitis(AD)and on 2,4-dinitrochlorobenzene(DNCB)-induced AD mice model and its potential mechanisms.Methods A randomized controlled clinical trial design was applied,64 patients with AD in the dermatology clinic of Yunnan traditional Chinese medicine hospital were randomly divided into observation group(n=32)and control group(n=32).The observation group was treated with Jiawei Xiaoyao San and the control group was treated with cetirizine tablets for four weeks.The scoring atopic dermatitis index(SCORAD)score,the level of serum immunoglobulin E(IgE),interleukin-17(IL-17),substance P(SP),nerve growth factor(NGF),5-Hydroxytryptamine(5-HT)were recorded before and after treatment.The AD mice model was induced by DNCB,were divided into blank group,model group,cetirizine group and Jiawei Xiaoyao San with different dosages(14.30,28.60,57.20 g/kg)groups.Except for the blank group,other groups were treated with corresponding drugs.The changes of skin lesions,the thickness of auricle lesions and the frequency of scratching(30 mins)were observed after treatment.The pathomorphological changes of skin lesions were observed via hematoxylin-eosin(HE)staining,and the levels of IgE,IL-17,SP,NGF,5-HT in serum and 5-HT in lesional skin were detected by enzyme-linked immunosorbent assay(ELISA).Results Full analysis set(FAS)analysis revealed a total effective rate of 84.38%(27/32)in the observation group,which was significantly higher than the control group's rate of 75%(24/32)(P<0.01).The observation group showed improved severity of condition,sleep quality,anxiety,and depression scores compared to the control group.Jiawei Xiaoyao San effectively reduced levels of IgE,IL-17,SP,NGF and 5-HT in AD patients.In the animal experiments,the model group exhibited edema,erythema,scab formation in skin lesions,compromised tissue structure,lymphocyte and neutrophil infiltration,and increased skin lesion thickness compared to the control group.Pos

关 键 词：特应性皮炎 加味逍遥散 瘙痒 神经肽P物质 神经生长因子 

分 类 号：R758.23[医药卫生—皮肤病学与性病学]