利湿泄热汤治疗脾胃湿热型口腔扁平苔藓临床观察与实验研究

发布时间：2018-08-20 18:48

【摘要】：目的:观察利湿泄热汤治疗脾胃湿热型口腔扁平苔藓临床效果并初步研究其作用机理。方法:选取我院2012年8月到2013年12月收治的脾胃湿热型口腔扁平苔藓120例作为研究对象。采用随机数字表法将120例入组病人随机分为对照组(60例)和治疗组(60例)。对照组患者予以口服转移因子胶囊治疗,治疗组患者给予口服利湿泄热汤治疗;两组分别治疗四周,治疗结束后观察两组的临床有效率、客观体征积分、主观症状积分、中医证候积分、治疗前后血清IgA,IgM及IgG水平变化,治疗前后血清T细胞亚群CD3+T细胞和CD4+T细胞水平变化;采用二甲基苯并蒽涂抹大鼠口腔黏膜法建立口腔扁平苔藓动物模型,将造模成功的60只大鼠随机分配至空白对照组,转移因子口服液组和利湿泄热汤组。每组20只,予以相应干预共4周。干预结束后处死大鼠,采用免疫组化法检测扁平苔藓局部CD4+T细胞和CD8+T细胞的表达情况,并计算CD4/CD8比值。结果:治疗组患者临床总有效率为86.66%,对照组患者临床总有效率为73.33%,,差异有统计学意义(P0.05)。治疗组中医症候总有效率为83.33%,对照组中医症候总有效率为73.33%,差异有统计学意义(P0.05)。两组患者治疗后症状体征积分和中医证候积分较治疗前显著改善,差异有显著统计学意义(P0.01),治疗组症状体征积分和中医证候积分优于对照组(P0.05)。两组患者治疗后全血清IgA较治疗前无明显改善。治疗组全血IgM和IgG水平较治疗前显著改善,差异有统计学意义(P0.05,P0.01)。治疗组血清CD4+T细胞水平较治疗前显著改善,差异有统计学意义(P0.05);动物实验显示口腔扁平苔藓局部CD4+T细胞和CD8+T浸润明显增多,与模型对照组相比,利湿泄热汤能显著减少口腔扁平苔藓局部CD4+T细胞和CD48+T浸润,CD4/CD8比值降低,差异有统计学意义(P0.05,P0.01)。结论:利湿泄热汤可明显改善脾胃湿热型口腔扁平苔藓患者的临床症状和体征,提高患者生活质量,利湿泄热汤治疗脾胃湿热型口腔扁平苔藓的机制与调节血清免疫球蛋白表达水平和下调CD4+T细胞、CD8+T细胞局部浸润有关。
[Abstract]:Objective: to observe the clinical effect of Lishi Xiere decoction in treating spleen and stomach damp-heat oral lichen planus and to study its mechanism. Methods: 120 cases of oral lichen planus with damp-heat type of spleen and stomach were selected from August 2012 to December 2013. 120 patients were randomly divided into control group (60 cases) and treatment group (60 cases). The patients in the control group were treated with transfer factor capsule, the patients in the treatment group were treated with Lishishieredecoction, and the two groups were treated for four weeks respectively. After the treatment, the clinical effective rate, objective sign integral, subjective symptom score were observed. Before and after treatment, the changes of serum IgA IgG and CD3 T cells and CD4 T cells were observed, and the oral lichen planus model was established by applying dimethyl benzanthracene to the oral mucosa of rats. 60 rats were randomly assigned to the blank control group, the transfer factor oral liquid group and the Lishishexieretang group. 20 rats in each group were given corresponding intervention for 4 weeks. After the intervention, the rats were killed. The expression of CD4 T cells and CD8 T cells in lichen planus was detected by immunohistochemical method, and the CD4/CD8 ratio was calculated. Results: the total effective rate was 86.66 in the treatment group and 73.33 in the control group (P0.05). The total effective rate of TCM syndrome was 83.33 in the treatment group and 73.33 in the control group (P0.05). Two groups of patients after treatment symptoms and signs score and TCM syndrome score significantly improved compared with before treatment, the difference was statistically significant (P0.01), the treatment group symptoms and signs score and TCM syndrome score was better than the control group (P0.05). There was no significant improvement in serum IgA after treatment in both groups. The levels of IgM and IgG in the whole blood of the treatment group were significantly improved compared with those before treatment (P 0.05 P 0.01). The levels of serum CD4 T cells in the treatment group were significantly improved compared with those before treatment (P0.05). Animal experiments showed that the infiltration of CD4 T cells and CD8 T cells in the oral lichen planus was significantly increased compared with the model control group. The ratio of CD4 T cells and CD4 / CD8 of CD48 T infiltrated in oral lichen planus was significantly decreased by Lishishexieretang (P0.05, P0.01). Conclusion: Lishishexieretang can obviously improve the clinical symptoms and signs of the patients with damp-heat oral lichen planus of spleen and stomach and improve the quality of life of the patients. The mechanism of the treatment of spleen and stomach damp-heat oral lichen planus with Lishishieye decoction is related to regulating the level of serum immunoglobulin and down-regulating the local infiltration of CD4 T cells and CD8 T cells.
【学位授予单位】：山东中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R276.8

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