芩柏软膏治疗进行期银屑病血热证的临床观察和实验研究

作者	单位
徐佳	首都医科大学附属北京中医医院皮肤科
张苍	北京中医药大学附属东直门医院皮肤科
瞿幸	首都医科大学附属北京中医医院皮肤科
王萍	首都医科大学附属北京中医医院皮肤科

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中文摘要:

目的观察芩柏软膏对进行期银屑病血热证的治疗作用和安全性及细化芩柏软膏在安全及疗效方面是否更优于芩柏软膏;观察此二药对雌激素期小鼠阴道上皮细胞有丝分裂及小鼠尾部鳞片表皮角化的影响。方法临床观察:采用随机方法,将93例患者分为芩柏软膏组、细化芩柏软膏组及对照组(白凡士林组),3组均口服凉血活血汤,并分别采用芩柏软膏、细化芩柏软膏及白凡士林外涂患处治疗8周,记录改良银屑病面积严重程度指数(改良PASI)积分、皮损面积、红斑、浸润、鳞屑、瘙痒的改善情况及症状改善时间,并观察药膏的安全性。动物实验:(1)将小鼠随机分为模型组、芩柏软膏组、细化芩柏软膏组及对照组,每组7只,外用上述药3天后,比较各组小鼠阴道上皮细胞有丝分裂指数。(2)将小鼠随机分为芩柏软膏组、细化芩柏软膏组及对照组,每组7只,用药28天后,比较各组小鼠尾部有颗粒层形成的鳞片数的均数。结果临床综合疗效分析:芩柏软膏组、细化芩柏软膏组、对照组愈显率分别为63.3%(25/30)、66.7%(20/30)、36.7%(11/30),两中药组优于对照组(P<0.05)。3组治疗后皮损改良PASI积分较治疗前均明显降低(P<0.01);两中药组优于对照组(P<0.05)。3组均能显著改善进行期银屑病血热证皮损的红斑、鳞屑、浸润、瘙痒症状;在改善鳞屑、浸润、瘙痒方面两中药组明显优于对照组(P<0.05)。在改善红斑、浸润、瘙痒的时间上,尤其在瘙痒改善时间方面,细化芩柏软膏更优于传统芩柏软膏(P<0.05)。动物实验(1)中,两中药组阴道上皮细胞有丝分裂指数均低于对照组及模型组(P<0.05),动物实验(2)中,两中药组小鼠尾部颗粒层形成的鳞片数值均高于对照组(P<0.01)。结论芩柏软膏、细化芩柏软膏能够有效改善进行期银屑病血热证的皮损症状,其疗效优于白凡士林,而细化芩柏软膏在改善局部皮损症状的时间方面更优于芩柏软膏。动物实验证明两中药均可显著抑制小鼠阴道上皮有丝分裂,可显著促成小鼠尾部鳞片表皮的颗粒层的形成。

英文摘要:

Objective To investigate and compare the efficacy and safety of two kinds of Qinbai ointment prepared conventionally and finely(C-QBO and F-QBO)in treating psoriasis in the active stage of blood-heat syndrome type,and to observe their influences on vaginal epithelial cell mitosis,also on keratinization of caudal flakes in mice.Methods Clinical observation:Adopting randomized,single-blinded,controlled design,93 patients administered orally with Liangxue Huoxue Decoction were randomized into three groups treated externally with C-QBO,F-QBO and white vaseline respectively,applied twice a day for 8 weeks.The safety was checked and the changes of modified psoriasis area severity index(PASI),as well as the conditions of skin lesions(size,erythema,infiltration,squama,and itching)and symptom improving time were compared.Experimental study 1:Mice were randomized into the model group,the C-QBO group,the F-QBO group and the blank group,7 in each group.Their vaginal epithelial cell mitosis indices were compared after 3 days of treatment with corresponding remedies.Experimental study 2:Mice were randomized into the C-QBO group,the F-QBO group and the blank group,7 in each group.After the mice had been treated with corresponding remedies for 28 days,the granular layer formation in their caudal scales was compared.Results Clinical observation:The markedly effective rate was 63.3%(25/30)in the C-QBO group,66.7%(20/30)in the F-QBO group,and 36.7%(11/30)in the control group.No statistical difference was showen between the two QBO treated groups(P>0.05),but that in both of them was significantly different from that in the control group(P<0.05).PASI scores lowered after treatment in all the three groups(P<0.01),but the improvement in the two QBO groups was better than that in the control group(P<0.05);the conditions of skin lesion were improved in all groups,but the improvements were more significant in the two QBO groups in terms of squama,infiltration and itching(P<0.05),in aspects of improving time on erythema,infiltration and itching,especially the itching,F-QBO was superior to the C-QBO.Experimental study 1:The mitosis index in both QBO groups was lower than that in the blank group and the model group(P<0.01).Experimental study 2:Number of scales with granular layer formation was higher in the two QBO groups than in the blank group(P<0.01).Conclusion C-QBO and F-QBO can effectively relieve the skin lesion of psoriasis patients in the active stage of blood-heat type,and they could also promote the formation of epithelial granular layer in the caudal scales of mice.

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