Therapeutic Effect And Immune Mechanism Of Chronic Urticaria With Rheumatic Fever Syndrome Combined With Differentiation And Syndrome Differentiation

Objective:To analysize the relationship and evolution of TCM constitutions by summarizing the epidemiological survey of 337cases of chronic urticaria;To observe whether the"physique differentiation+ syndrome differentiation" treatment can improve clinical efficiency of chronic urticaria compairing with single"syndrome differentiation" Treatment;To look for the effective therapeutic targets and analysize the variations of micro levels of Th2、Th1、Treg and corresponding cytokines through"physique differentiation+ syndrome differentiation" treatment.Methords:(1)In accordance with the principle of voluntary,337 cases of chronic urticaria to the outpatient department of dermatology in our hospital are required to fill in TCM constitution questionnaire,then calculate the constitution scores and get the final type of constitution.(2)According to the inclusion and exclusion criteria,51 cases of chronic urticaria with wind-heat syndrome were recruited into A and B group randomly,with 22 cases of A and 29 cases of B.A group received oral traditional Chinese medicine granules of "xiao feng san"and placebo,B group received oral "xiao feng san"and corresponding adjustment body granules,one bag one time,with 2 times a day.Both groups received external medication CalamineLotion recruit.All cases are received treatment for 28 days.Before and after treatment,the scores of UAS、pruritus、efficacy、quality of life and the improvement of symptoms,total efficiency of evaluation are statisticed and analysized.(3)According to the results of total efficiency,several"effect"cases are selected randomly between A and B group.Peripheral blood of patients with IL-4,IL-6,IL-10,IL-17,TGF-pare detected by Elisa before and after treatment,while STAT3、GATA3、RORC、Foxp3 mRNA in peripheral blood T cells are detected by RT-PCR.Results:(1)Concurrent constitution are the main type of chronic urticaria,and the" Yang-Qi deficiency constitution" as the basic type.There exists a precise and complex internal relationship among constitution types,one constitution can promote the formation of another constitution.Composite constitution is the ultimate outcome of CU constitution types,state of formation by weak-excess clip,cold-heat clip constitution.Allergic constitution often as the initial pathological types of CU,with the complicate of constitution type,the"Yang-deficiency constitution" and "Qi-deficiency constitution" become to the main type of constitution.(2)The "physique differentiation + syndrome differentiation" treatment can ease the clinical symptoms of chronic urticaria greatly,which enhancing the total effective rate from 54.5%to 72.4%.Qi-stagnation constitution and allergic constitution may be more advantageous in regulating body cndition,while Yang-deficiency constitution may be the potential factor for CU to be treated more diffculte.(3)There are significant differences of IL-10 and Thl7 in both groups.Group A works by reducing the level of IL-10,IL-17,while group B works by increasing the level of IL-4.Gene transcription of Th17 in group A increases significantly while group B decreased obviously.During the process of Th17 transcription,the activation state of STAT3 pathway is not concerted with RORC mRNA.Both two groups can decline the gene transcription of Th2,meanwhile,group A can also decline the gene transcription of Thl7and Treg,whereas group B can significantly enhance the ability of Treg differentiation,and activate other signaling pathways to enhance Thl7 differentiation by inhibiting the JAK/STAT3 pathway.(4)There are significant positive correlation among 1IL-4,IL-10 and IL-17(p<0.05),be-tween TGF-β and IL-17(p<0.05),and between GATA3 mRNA and RORC mRNA(p= 0.007<0.01).IL-6 may play a therapeutic effect alone.Decreased expression of STAT3 mRNA ma-y be a marker of clinical efficacy(p<0.05),the smaller the GATA3 mRNA、RORC mRNA change,the better the clinical symptoms improved(p<0.05);the smaller the Foxp3 mRNA ch-ange,the better the quality of life improved(p<0.05).Conclusions:(1)The confused constitution state of deficiency resulting from excess,or excess resulting from deficiency,may be an important reason for the recurrent and difficult to cure CU.So,the herbal medicine of warming-Yang and Qi-invigorating should be payed full attention in the treatment of CU as well as other appropriate specific drugs.(2)"Physique differentiation+ syndrome differentiation" treatment has a certain effect on improving clinical curative effect.Physical types can affect the clinical efficacy.Qi-stagnation constitution and allergic constitution may be more advantageous in regulating body cndition,while Yang-deficiency constitution may be the potential factors of CU to be treated more diffcult.(3)IL-10,IL-17 may be the potential sensitive curative index of group A,while IL-4 may be the potential sensitive curative index of group B.However,IL-4 may not the sensitive index of group A,and IL-10 may not the sensitive index of group B.Howerer,even both treatments have significant clinical effects but little serological change(p>0.05),indicates that Chinese medicine mainly lies on the coordination of immune network equilibrium among Th2,Th17 and Treg,but not limit to the impact on one or several indicators.(4)Differentiation of Th17 may exist other pathways without throughing the JAK/ST-AT3 to promote the formation of RORC mRNA.Th2 and Th17 had a significant positive cor-relation at the level of gene transcription and effector cytokines.STAT3 mRNA may be one of the potential targets for the clinical efficacy of CU.