The Role Of Confocal Laser Scanning Microscopy In Microcosmic Differentiation Of TCM Syndrome And Evaluation Of Therapeutic Effect In Psoriasis Vulgaris

Objective1.Ultraviolet phototherapy combined with halometasone cream was used to treat patients with psoriasis of different TCM syndrome,changes in psoriasis area and severity index(PASI)were evaluated before and after treatment,and to compare the differences of PASI scores among patients with different syndromes,and observe the response after treatment.2.The thickness of the supra-papillary epidermis and the diameter of dermal nipples of psoriatic lesions were observed by confocal laser scanning microscopy before and after treatment,and to analyze the difference of their expression in the lesions and normal skin and the correlation between them and psoriasis with different syndromes,and assess the correlation between micro change and changes in PASI scores.And evaluate the value of confocal laser scanning microscopy in the TCM discrimination of psoriasis and the therapeutic effect detection.MethodsSelecting the patients with psoriasis vulgaris from September 2019 to December 2019 in Wuhan NO.1 Hospital,who met the diagnostic criteria and inclusion criteria and with their informedconsent,perfecting the data information,classifying them by traditional Chinese medicine(TCM)dialectical classification,and carrying on the PASI score before the treatment.Confocal laser scanning microscopy used to measure the thickness of the supra-papillary epidermis and the diameter of dermal nipples in the typical lesions and normal skin of the adjacent area.After 4 weeks of routine treatment(ultraviolet phototherapy three times a week?halometasone cream once a day),the above steps were followed again in the same position.The patients.results of PASI scores,the thickness of the supra-papillary epidermis,the diameter of dermal nipples before and after treatment were compared and then statistically analyzed.Results1.A total of 30 patients with psoriasis vulgaris were included in this study,there are 12 patients with blood heat syndrome,9patients with blood stasis syndrome and 9 patients with blood dryness syndrome.PASI scores of patients with different syndromes were found by one-way variance test: PASI scores of patients with blood heat syndrome,blood stasis syndrome and blood dryness syndrome before treatment were not statistically significant(P<0.05).There was no significant difference in PASI score between blood heat syndrome and blood stasis syndrome,blood stasis syndrome and blood dryness syndrome after treatment(P>0.05).The PASI scores of patients before and after treatment were found by paired T-test: the PASI scores of patients with psoriasis vulgaris including different syndromes such as blood heat syndrome,blood stasis syndrome and blood dryness syndrome were significantly decreased after treatment compared with those before treatment.There was significant difference in score before and after treatment(P<0.05).2.The thickness of the supra-papillary epidermis and the diameter of dermal nipples in the skin lesions of patients with psoriasis vulgaris of patients were found by one-way variance test:The thickness of the supra-papillary epidermis and the diameter of dermal nipples of patients with blood heat syndrome,blood stasis syndrome and blood dryness syndrome before treatment were not statistically significant(P<0.05).The thickness of the supra-papillary epidermis and the diameter of dermal nipples of all the Patients with psoriasis decreased significantly after treatment,the difference was statistically significant(P<0.05).The thickness of the supra-papillary epidermis and the diameter of dermal nipples of the psoriatic lesions are significantly higher than normal skin.they were found by paired T-test: there was significant difference in score before and after treatment(P<0.05).3.There was no significant correlation between the numerical variation of the PASI score and the thickness of the supra-papillary epidermis and the diameter of dermal nipples among patients before and after treatment.ConclusionThe difference of PASI score and the thickness of the supra-papillary epidermis and the diameter of dermal nipples among patients with different syndrome types before and after treatment is statistically significant,but there was no significant correlation between the numerical variation of the PASI score and the thickness of the supra-papillary epidermis and the diameter ofdermal nipples among patients before and after treatment.The PASI score and the thickness of the supra-papillary epidermis and the diameter of dermal nipples can not be used as reference indexes to determine the efficacy,further experiments are needed.But the PASI score and the thickness of the supra-papillary epidermis and the diameter of dermal nipples of patients with blood heat syndrome,blood stasis syndrome and blood dryness syndrome before treatment were not statistically significant,PASI score and the thickness of the supra-papillary epidermis and the diameter of dermal nipples can not be used as reference indexes to typing.We mersured the thickness of the supra-papillary epidermis and the diameter of dermal nipples in this experment,which set a higher requirement for fine operation of the confocal laser scanning microscopy.