| Part 1:Literature Research-Progress in the Treatment of PsoriasisObjectiveUnderstand the current progress in the treatment of psoriasis.MethodSearch Pubmed,Wanfang database,CNKI database,using keyword search strategy,the search terms are:psoriasis,epidemiology,mechanism,treatment,molecule,targeting,molecular targeted drugs,biological targeted drugs,signals Pathways,signal transduction pathways,inflammatory factors,inflammatory mediators,cytokines,psoriasis,prevalence,incidence,epidemiology,treatment,therapy,molecular-targeted therapies,cytokines,etc.ResultsThe pathogenesis of psoriasis is complex,and IL-23-mediated TH17 pathway activation is considered to be the main pathogenesis.The risk factors for the occurrence and development of psoriasis include genetics,environment and behavior,among which genetic factors are the most important risk factors.Psoriasis can be associated with multiple complications,involving joints and heart.The treatment of psoriasis should be individualized according to the severity of the disease and the specific conditions.The treatment of mild psoriasis is mainly topical medication and phototherapy.Moderate to severe patients need systemic medication supplemented by phototherapy and topical medication.After decades of research,Xiaoyi Decoction has clear efficacy and safety for psoriasis.ConclusionPsoriasis has made great progress in the treatment and mechanism research in recent years,mainly because of the abundant evidence-based medicine evidence obtained in molecular targeted therapy.Traditional Chinese medicine treatment methods are abundant and effective.Part 2:Predicting the molecular mechanism of Xiaobi Decoction in the treatment of psoriasis based on network pharmacologyObjectiveTo explore the main targets and signal pathways of Xiaobi Decoction in the treatment of psoriasis by means of network pharmacology,so as to reveal the multi-target and multi-channel intervention mechanism of Xiaobi Decoction in the treatment of psoriasis.MethodsTCM System Pharmacology Analysis Platform(TCMSP)database and literature(CNKI,PubMed)were searched for all the chemical components contained in the various medicines of Xiaobi Decoction.Through the TCMSP database,using ADME parameters(OB≥ 30%and DL≥0.15)or pharmacodynamic activity(reported in the literature)as the standard,the active chemical components of each medicine in Xiaobi Decoction were screened.And use PubChem database to find the chemical structural formula corresponding to the active chemical composition.Through the TCMSP database and the Swiss Target Prediction database,the target points of the active chemical components of each medicine were screened,and the component target point data set was established.Screen psoriasis-related genes and protein targets through GeneCards?:The Human Gene Database and the comprehensive database of human genes and genotypes,and establish a data set of disease targets.The drug target and the disease target were intersected,and 459 common targets were obtained.Through PPI analysis,construct a"drug-component-target-disease" network.Use Cytoscape 3.6.1 software to visually analyze the above network,and obtain the three topological parameters of Degree,Betweenness centrality,and Closeness centrality of each node.Select the above three topological parameter values to meet the target points that are greater than the median value of all points,as Core targets.Then use STRING to analyze the protein interaction relationship of the selected intersection targets.The selected core targets were analyzed using DAVID database for KEGG pathway analysis and GO(Gene Ontology)biological process analysis,with P value ≤0.001(the smaller the P value,the higher the significance)as the screening criteria.Use the KEGG Mapper function in the KEGG signaling pathway database to mark the core targets on the signaling pathways most closely related to the disease.ResultsThere are 13 traditional Chinese medicines in the prescription of Xiaobi Decoction,which contain at least 173 active ingredients.Through screening,750 possible targets for the active chemical components of the formula were obtained,of which 56 were core targets.A total of 37 targets may be related to the treatment of psoriasis by this prescription,involving 22 signal pathways.ConclusionThe treatment of psoriasis with Xiaobi Decoction involves multiple inflammatory mechanisms and has potential research value.Part 3:Effect of Xiaobi Decoction on Serum Inflammatory Marker Levels in Patients with Psoriasis Vulgaris:A Real-World StudyObjectiveTo observe the effect of Xiaobi Decoction on the levels of serum inflammatory markers in patients with psoriasis in the real world,and to provide an objective basis for the curative effect of Xiaobi Decoction.MethodsPatients with psoriasis vulgaris were selected.According to the inclusion and exclusion criteria,the patients were included in the statistical analysis,and they were divided into Xiaobi Decoction group and control group.Collect clinical data of patients,including demographic data,blood test results,auxiliary examination results,psoriasis condition score,treatment plan,follow-up results,etc.Compare the differences between the indicators of the two groups of patients.ResultsA total of 318 patients with psoriasis vulgaris were included.When analyzing the relationship between observation indicators and the condition of psoriasis,they were divided into three groups according to relevant guidelines:mild group,moderate group and severe group.(1)Compare patients with different conditions,baseline serum high-sensitivity C-reaction protein(hs-CRP)levels(0.85±0.38 vs.1.45±0.51 vs.2.07±0.73,P<0.001),neutral The neutrophil/lymphocyte ratio(NLR)(1.85±0.43 vs.2.01±0.58 vs.2.23±0.67,P<0.001)was statistically different among the groups,and hs-CRP and NLR compared with pSS The PASI score of the patient’s condition was significantly correlated;(2)Compared with the control group,Xiaobi Decoction treatment could significantly reduce the PASI(2.6±1.9 vs.8.3±3.5,P<0.001)and serum hs-CRP level(0.39±0.22 vs.1.29±0.39,P<0.001)and NLR ratio(1.65±0.40 vs.2.00±0.52,P<0.001);(2)Baseline serum hs-CRP level and NLR ratio can predict the curative effect of Xiaobi Decoction in the treatment of pSS;(4)baseline hs-CRP level Patients with a relatively low ratio of NLR may be more effective.ConclusionXiaobi Decoction treatment can reduce the serum hs-CRP level and NLR ratio in patients with psoriasis vulgaris.The baseline serum hs-CRP level and NLR ratio can predict the therapeutic effect of Xiaobi Decoction.Part 4:Real-world follow-up study of Xiaobi Decoction in the treatment of psoriasis patientsObjectiveTo observe the mid-and long-term efficacy and safety of Xiaobi Decoction in the treatment of psoriasis in the real world.MethodsAccording to the inclusion and exclusion criteria,the patients with psoriasis admitted to our hospital since 2015 were collected,and these patients were followed up,and the baseline data of the patients were collected.The demographic data included age and gender;the medical history data was divided into the history of psoriasis(Type of initial diagnosis,duration of medical history,treatment process),blood test data(including blood routine,liver and kidney function,electrolytes,autoimmune antibody profile,etc.),auxiliary examination data(including electrocardiogram,chest radiograph or chest CT,joint X-ray Films,etc.);through follow-up to collect the patient’s condition changes after treatment,including lesion features,symptoms,etc.According to whether Xiaobi Decoction is used or not,it is divided into Xiaobi Decoction group and control group.According to whether Xiaobi Decoction is used alone to treat psoriasis,the Xiaobi Decoction group is divided into single group and combined group.ResultsAccording to the inclusion and exclusion criteria,a total of 196 patients with psoriasis were included,of which 128 cases were in the Xiaobi Decoction group(45 cases in the single use group and 83 cases in the combined group),with an average follow-up time of 3.2±0.7 years;68 cases in the control group,with an average The follow-up time was 3.4±0.9 years.Comparison of baseline data of the two groups of patients showed that there was no statistical difference in each factor between the two groups.The follow-up results showed that compared with the control group,the recurrence rate of the two groups was not statistically different(32.0%vs.39.7,P=0.283);at the end of the follow-up,the ratios of PASI50,PASI75,and PASI90 were also between the two groups.There was no statistical difference(P>0.05);the last blood test results showed that the Xiaobi Decoction group compared with the control group,the main indicators(white blood cell count,hemoglobin,alanine aminotransferase,creatinine,C-reactive protein,etc.)in the two groups There was no statistical difference between the patients(P>0.05);there was no statistical difference in the quality of life between the two groups of patients.In the Xiaobi Decoction group,the recurrence rate of patients in the combination group was lower than that of the single-use group and the control group(26.5%vs.42.2%vs.39.7%,P=0.114),and the ratio of PASI75 and PASI90 at the end of follow-up was higher than that of the single-use group and the control group.Control group(95.2%vs.88.9%vs.92.6%;94.0%vs.82.2%vs.91.2%;P>0.05),main indicators(white blood cell count,hemoglobin,alanine aminotransferase,creatinine,C-reactive protein,etc.)There was no statistical difference between the three groups of patients.The quality of life of patients in the combination group was better than that of the single-use group and the control group(71.7±3.5 vs.68.8±3.8 vs.70.1±3.6,P=0.0001).ConclusionXiaobi Decoction has potential curative effect in the treatment of psoriasis,especially when combined with other treatment methods. |
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