中药“喘可治”治疗特应性皮炎的实验与临床研究

发布时间：2018-05-09 14:35

本文选题：喘可治 + 温阳补肾　；参考：《广州中医药大学》2016年博士论文

【摘要】：目的：1.研究温阳补肾法及中药“喘可治”与特应性皮炎相关性,初步为温阳补肾法及中药“喘可治”治疗特应性皮炎提供理论依据。2.研究2,4-二硝基氟苯(DNFB)外源性诱导方法建立特应性皮炎样小鼠模型可靠性,初步探索特应性皮炎样小鼠模型的生理病理学特点。3.研究中药“喘可治”干预DNFB诱导的特应性皮炎样小鼠模型炎症形成过程,初步探索中药“喘可治”对特应性皮炎的疗效及作用机制。4.研究特应性皮炎中医证型分布并阐明成人特应性皮炎患者肾阳不足证型的特点,评价既往临床使用中药“喘可治”治疗的成人期特应性皮炎的疗效,初步为中药“喘可治”治疗特应性皮炎提供一定的临床依据。5.评价中药“喘可治”对成人期特应性皮炎的临床疗效,为中药“喘可治”治疗特应性皮炎提供确切证据。方法：1.文献研究方面,对Pubmed数据库、Cochrane图书馆、Embase循证医学数据库、sinoMED数据库,CNKI数据库、维普数据库(VIP)、万方数据库(WANFANG)进行检索,筛选中成药治疗特应性皮炎、中药“喘可治”治疗变态反应性疾病、温阳补肾与特应性皮炎的文献进行系统分析；对当代皮肤病中医临床家针对温阳补肾法治疗变态反应性皮肤病及免疫性皮肤病论述进行整理。2.实验研究：1)通过2,4-二硝基氟苯(DNFB)经皮肤致敏诱导C57BL/6小鼠建立特应性皮炎样小鼠模型,并检测临床表现、皮肤病理、血清IgE、IL-4、IFN-γ、皮损microRNA-155。2)对2,4-二硝基氟苯诱导特应性皮炎样小鼠随机分为空白组、模型组、喘可治大剂量组、喘可治小剂量组,中药“喘可治”干预后对小鼠临床表现、皮肤镜下表现、背部及耳部皮肤普通病理、背部及耳部甲苯胺蓝染色病理、血清IgE、IFN-γ、IL-4水平、皮损IFN-γ、IL-4 mRNA表达进行分析。3.临床研究：1)采用回顾性研究对314例特应性皮炎患者的一般情况、病情分期、临床特点、症候分型等进行评价。2)采用回顾性研究对28例使用中药“喘可治”治疗的特应性皮炎患者的治疗前后SCORAD评分、研究者整体评价(IGA)评分进行评价。3)采用前瞻性、随机、对照的治疗方案,对成人期患者随机分为喘可治治疗组(基础治疗+喘可治)和对照组(基础治疗),观察期为4周及随访期4周,在治疗前、第2周、第4周、第8周对患者的SCORAD评分、分层分析(皮损严重程度、皮损面积、瘙痒程度、失眠程度)、研究者整体评价(IGA)、畏寒程度、复发风险、血清IgE、症候特点进行评价。结果：1.文献研究发现存在中药“喘可治”及温阳补肾法治疗特应性皮炎相关研究,中药“喘可治”具有抗炎、免疫调节等方面的药理作用。2.通过使用2,4-二硝基氟苯(DNFB)外源性诱导的方法成功建立C57BL/6特应性皮炎样小鼠模型,临床表现为红斑、干燥、脱屑、痂皮等表现；病理符合海绵水肿性皮炎改变；血清IgE、IL-4升高,皮损中microRNA-155升高。3.通过中药“喘可治”干预的特应性皮炎样小鼠模型临床症状及皮肤镜下表现明显改善；耳部肿胀程度明显减轻；病理提示背部及耳部皮肤增厚减轻,真皮炎症细胞数目明显减少；甲苯胺蓝染色提示背部及耳部皮肤真皮肥大细胞数目明显减少；血清IgE、IL-4表达下降；皮肤中IL-4 mRNA表达明显下降。4.临床回顾性研究发现,特应性皮炎患者,尤其是成人期特应性皮炎患者中医证型中存在兼夹肾阳不足证型或以肾阳不足为主证的证型；使用中药“喘可治”治疗特应性皮炎后,患者SCORAD评分、IGA评分下降,差异具有统计学意义(P0.05)。5.随机对照研究发现,中药“喘可治”治疗组患者较对照组相比,在SCORAD评分、分层分析(皮损面积、皮损严重程度、瘙痒程度、失眠程度)、IGA评分、复发风险有明显改善,差异有统计学意义(P0.05),畏寒程度、生活质量、血清IgE轻度下降趋势,差异无统计学意义(P0.05)。结论：1.中药“喘可治”及温阳补肾法治疗特应性皮炎具有一定的理论依据。2.中药“喘可治”对特应性皮炎样小鼠模型炎症形成过程具有明显抑制作用,其作用机制可能是通过调控Th1/Th2免疫失衡、抑制肥大细胞等方面发挥作用。3.中药“喘可治”对于成人期特应性皮炎具有改善病情,减缓复发,提高生活质量等方面的治疗作用。
[Abstract]:Objective: 1. to study the relationship between Warm Yang kidney tonifying method and traditional Chinese medicine "Chuan Kezhi" and atopic dermatitis. It provides a theoretical basis for the treatment of atopic dermatitis by Wenyang tonifying kidney method and traditional Chinese medicine "Chuan Kezhi" in the treatment of atopic dermatitis. The.2. study of 2,4- two nitrofluorobenzene (DNFB) exogenous induction method to establish atopic dermatitis model mice model reliability, preliminary exploration of atopic dermatitis The physiological and pathological characteristics of the mice model.3. study the inflammatory formation of the atopic dermatitis like DNFB induced by Chinese medicine "asthma treatment". The effect and mechanism of traditional Chinese medicine "Chuan Ke" on atopic dermatitis were preliminarily explored. The TCM syndrome type of atopic dermatitis in.4. study was divided and the kidney yang of adult atopic dermatitis was clarified. The characteristics of the foot syndrome type, evaluate the curative effect of adult atopic dermatitis in the past clinical use of traditional Chinese medicine "Chuan Ke Zhi", and provide a certain clinical basis for the treatment of atopic dermatitis by "asthma treatment" in Chinese medicine. The clinical effect of "Chuan Ke treatment" on adult atopic dermatitis is evaluated by.5.. Dermatitis provides definite evidence. Methods: 1. literature research, the Pubmed database, Cochrane library, Embase evidence-based medicine database, sinoMED database, CNKI database, VIP, WANFANG, selected Chinese patent medicine treatment atopic dermatitis, Chinese medicine "asthma treatment" treatment of allergic diseases, temperature A systematic analysis of the literature of Yang tonifying kidney and atopic dermatitis; the.2. experimental study on the treatment of allergic dermatosis and immune dermatosis by Wenyang tonifying kidney method: 1) establishment of atopic dermatitis like mice model by 2,4- two nitrofluoro benzene (DNFB) induced by skin sensitization induced by skin. The clinical manifestations, dermatology, serum IgE, IL-4, IFN- gamma, skin lesion microRNA-155.2) were randomly divided into the blank group, the model group, the large dose group, the small dose group of asthma can be treated, the clinical manifestation, the skin mirror performance, the back and the ear skin of the mice after the "asthma can be treated" after the Chinese medicine "asthma can be treated". Skin pathology, back and auricular toluidine blue staining pathology, serum IgE, IFN- gamma, IL-4 level, IFN- gamma, IL-4 mRNA expression in the analysis of.3. clinical study: 1) retrospective study on the general condition of 314 patients with atopic dermatitis, the stage of the disease, the clinical characteristics, the syndrome classification, and so on, the retrospective study on 28 cases by retrospective study. Patients with atopic dermatitis treated with Chinese medicine were treated with SCORAD score before and after treatment, the overall evaluation of the researchers (IGA) was evaluated by.3) using a prospective, random, controlled treatment scheme. The patients were randomly divided into the asthma treatment group (basic treatment + asthma treatment) and the control group (basic treatment). The observation period was 4 weeks and the follow-up period was followed up. 4 weeks, the SCORAD score of patients before treatment, second weeks, fourth weeks and eighth weeks, stratified analysis (severity of skin lesions, skin lesion area, itching degree, insomnia degree), overall evaluation (IGA), degree of cold, recurrence risk, serum IgE, symptoms of the patients were evaluated. Results: the results of the 1. literature study found the existence of "asthma treatment" and warm yang supplementation in Chinese medicine. The related research on the treatment of atopic dermatitis by kidney method, the pharmacologic action of "asthma can be treated" by Chinese traditional medicine.2. has been successfully established by using the exogenous induction of 2,4- two nitrofluorobenzene (DNFB) to establish a C57BL/6 atopic dermatitis mouse model. The clinical manifestations are erythema, drying, desquamation and scab skin, and the pathology accords with the sponge water. The changes of swollen dermatitis, elevated serum IgE, IL-4, and elevated microRNA-155 in skin lesions, the clinical symptoms and skin microscopic appearance of.3. in the mice with allergic dermatitis intervened by traditional Chinese medicine were obviously improved, the extent of the ear swelling was obviously reduced, and the thickness of the back and ear skin was reduced, and the number of dermis inflammatory cells decreased obviously. Less; toluidine blue staining suggested that the number of mast cells in the skin of the back and ear skin decreased significantly, the expression of serum IgE, IL-4 decreased, and the expression of IL-4 mRNA in the skin decreased obviously in.4. clinical retrospective study found that there was a deficiency of Kidney Yang Syndrome in patients with atopic dermatitis, especially in adult atopic dermatitis. After the treatment of atopic dermatitis, the SCORAD score and IGA score of the patients were decreased, and the difference was statistically significant (P0.05).5. randomized controlled study found that compared with the control group, the patients with "asthma treatment" treatment group were compared with the control group in the SCORAD score, stratified analysis (skin lesion area, skin lesion severity, The degree of itching, the degree of insomnia), the IGA score, the risk of relapse significantly improved, the difference was statistically significant (P0.05), the degree of fear of cold, the quality of life, the slight decreasing trend of serum IgE, the difference was not statistically significant (P0.05). Conclusion: 1. Chinese medicine "asthma can be treated" and warm yang tonifying kidney have a certain theoretical basis for the treatment of atopic dermatitis: ".2. Chinese herbal medicine" Chuan can " Treatment "has an obvious inhibitory effect on the process of inflammation in atopic dermatitis like mice. The mechanism of its action may be by regulating the imbalance of Th1/Th2 immunity and inhibiting mast cells to play the role of.3. Chinese medicine" asthma treatment "for adult atopic dermatitis, which can improve the condition of adult atopic dermatitis, slow down the recurrence and improve the quality of life. Effect.

【学位授予单位】：广州中医药大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R275.9

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