| Psoriasis is a chronic,recurrent inflammatory skin disease with a genetic background,which caused by many factors,such as environment,immunity,spirit,infection and so on and is difficult to cure and the pathogenesis keeps unclear.In traditional Chinese medicine,it is believed that the main pathogenesis of psoriasis is the heat in blood.The most common type of psoriasis is blood-heat type,whose molecular mechanism keeps unknown and needs to be further investigated.Some research indicated that the amounts and functions of NKT cells and NK cells were abnormal in psoriasis,but their works in the pathogenesis of psoriasis remains unknown.Systemic immunosuppressive agents,retinoic acid,biological agents and topical glucocorticoids are used in the treatment of psoriasis,which are effective.But their adverse reactions lead to poor tolerance of the patients.Heat-Clarifying and Blood-Cooling decoction and Complex Prescription,which are efficient with less side effects and well tolerance,are used for the treatment of psoriasis with blood-heat type.However,their clinical application is limited because of the unclear mechanisms.Decoctions and complex prescriptions with Senecio are often used in the treatment of psoriasis with blood-heat type in traditional Chinese medicine.The clinical efficacy and safety of the single preparation of Senecio for the treatment of psoriasis has not been reported.The percentage and the activation and proliferation levels of NKT cell,NK cell,skin homing NKT cell and skin homing NK cell are detected to investigate their possible roles in the pathogenesis of psoriasis with blood-heat type.Besides,the clinical efficacy of Senecio combination with topical medicines for the treatment of psoriasis with blood-heat type are observed.Objective1.To investigate the relationship between the percentages,the activation levels,the proliferation levels of NKT cell,NK cell,their skin homing subpopulations in Peripheral blood(PB)and the pathogenesis of psoriasis with blood-heat type.2.To observe the clinical efficacy and safety of Senecio combined with topical medicines in the treatment of blood-heat type of psoriasis.Methods1.Experimental Research Percentage of NKT cell,NK cell,skin homing NKT cell,skin homing NK cell and the levels of activation related factors HLA-DR and proliferation related factors Ki-67 of those cells in PB of 30 psoriatic patients with blood-heat type and 21 healthy control groups were detected by Polychromatic Flow Cytometry.NKT cells were labeled with CD3+CD56+,NK cells were labeled with CD3-CD56+,their skin homing subset cells were labeled with CLA+respectively,their proliferation levels were labeled with Ki-67+,their activation levels were labeled with HLA-DR+.2.Clinical Research84 psoriatic patients with blood-heat type were from the dermatology department of China-Japan Friendship Hospital from May,2015 to March,2017,which were divided into treatment group and control group by random method.The control group were only treated with external medicines(halometasone cream was used at week 1 and 2;mometasone furoate cream was used at week 3 and 4;hydrocortisone butyrate cream was used at week 5 and 6;When using these topical glucocorticoids in the morning and evening every day).The treatment group was given Senecio orally(four capsules each time,three times a day)combined with topical glucocorticoids in the same way with that of the control group.Both groups were treated for 6 weeks.The efficacy was observed at 2 weeks,4 weeks and 6 weeks respectively.The Case Report Form(CRF)were filled at 0 week,2 weeks,4 weeks and 6 weeks after treatment respectively,in which PASI scores,BSA,and adverse reactions were recorded.After treatment of 6 weeks,total effective rates of both groups were calculated(the efficacy index was calculated according to the PASI scores before and after treatment,which was used to determine the effective rate).In order to evaluate the safety of the treatments,the changes of blood routine,urine routine,liver function with Senecio and kidney function were measured before and after treatment.Results1.Experimental research(1)The percentage of NKT cell(8.21 ± 12.59)%and NK cell(7.56±5.34)%in PB of psoriatic patients with blood-heat type were both significantly lower compared with those(11.61 ±8.25)%,(13.44±8.48)%of their control group(Z=-2.460,-2.689,P<0.05)respectively.The percentage of CLA+NKT cell(14.25±19.66)%and CLA+NK cell(15.21±23.19)%in PB of psoriatic patients with blood-heat type had no significant difference compared with those(21.29±30.27)%,(13.83±21.92)%of their control group(Z=-0.861,-1.101,P>0.05)respectively.Neither the percentage of NKT cell nor NK cell was significantly correlated to PAS scores(r=0.353,0.056,P>0.05)and BSA(r=0.340,0.03 5,P>0.05).(2)The percentage of NKT cell that expressed Ki-67(11.55±6.30)%and CLA+NKT cells that expressed Ki-67(42.85±19.89)%in PB of psoriatic patients with blood-heat type,were both significantly higher compared with those(9.69±7.73)%,(30.73± 15.15)%of their control group(Z=-2.460,-2.689,P<0.05)respectively.The percentage of NK cell that expressed Ki-67(18.02± 11.84)%and CLA+NK cells that expressed Ki-67(36.14± 17.64)%in PB of psoriatic patients with blood-heat type,had no significant difference compared with those(20.00±20.89)%,(33.86± 19.36)%of their control group(Z=-1.091.-0.354,P>0.05)respectively.Neither the percentage of NKT cell that expressed Ki-67 nor CLA+NKT cell that expressed Ki-67 was significantly correlated to PAS scores(r=0.142,0.078,P>0.05)and BSA(r=0.123,0.056,P>0.05).(3)The percentage of NKT cell that expressed HLA-DR(17.56±26.85)%,CLA+NKT cells that expressed HLA-DR(33.94 ±24.28)%and CLA+NK cells that expressed HLA-DR(44.40±32.14)%in PB of psoriatic patients with blood-heat type,had no significant difference compared with those(20.06±29.05)%,(33.70±29.14)%,(36.84±28.47)%of their control group(Z=-1.263,-1.359,-0.775,P>0.05)respectively.The percentage of NK cell that expressed HLA-DR(43.09 ± 34.28)%were significantly higher compared with that(26.55±27.17)%of the control group(Z=-2.239,P<0,05).The percentage of NK cell that expressed HLA-DR had no significant correlation with PAS scores(r =0.146,P>0.05)and BSA(r=0.180,P>0.05).2.Clinical research84 patients with psoriasis of blood-heat type were divided into two groups:treatment group(n=42)and control group(n = 42),Three patients in the-treatment group were lost during the course of treatment,four in the control group were lost during the course of treatment.Before treatment,the gender,age,duration,PASI scores and BSA are comparable between the two groups of patients.In the treatment group,the level of PASI scores after treament was 1.35±1.19,which was lower than that before treatment(3.32±2.03),and the difference was statistically significant(t=8.117,P<0.05);the level of BSA after treament was(2.07±1.86)%,which was lower than that before treatment(4.00±2.44)%,and the difference was statistically significant(Z=6.874,P<0.05).In the control group,the level of PASI scores after treament was 1.96±1.43,which was lower than that before treatment(3.29±2.11),and the difference was statistically significant(t=6.202,P<0.05);the level of BSA after treament was(2.73±3.20)%,which was lower than that before treatment(3.49±2.14)%,and the difference was statistically significant(t=1.607,P<0.05).After treatment,the PASI scores of the treatment group was 1.35 ± 1.19,which was lower than that of the control group(1.96 ±1.43).The difference was statistically significant(t=-1.997,P<0.05).After treatment,the BSA was(2.07 ± 1.86)%in the treatment group and(2.73 ± 3.20)%in the control group,there was no significant difference between the two groups(Z=-0.811,P>0.05).After treatment,the total effective rate of the treatment group was 89.74%,which was higher than that of the control group(71.05%),and the difference was statistically significant(χ2=3.178,P<0.05);the healed and markedly effective ratio of the treatment group was 56.41%,which was higher than that of the control group(28.95%),and the difference was statistically significant(χ2=5.927,P<0.05).The results of blood routine,urine routine,liver function,kidney function and other laboratory testing indicators of the combination group and the control group before and after treatment were generally normal.Conclusion1.The decreased percentages of NKT cells and NK cells in peripheral blood of psoriatic patients with blood heat type may be related to the increased percentage of NKT cells and NK cells in the psoriasis lesions,which suggests that it may be involved in the formation of psoriatic lesions,which needs to be further studied.2.Taking Senecio orally combination with using topical glucocorticoids in the treatment of psoriasis of blood-heat type were effective and safe,which deserves a large sample of clinical research in order to provide more choices for the treatment of psoriasis... |
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