| Objective:1.To observe the clinical effect of self-made Yangxue Qufeng Decoction(YXQFD)in the treatment of chronic eczema with blood deficiency and wind dryness.2.To explore the possible mechanism of YXQFD by using rat eczema model lesion,the difference of swelling degree and morphology,the different expression of IL-1β,IL-6,Claudin-1 and ZO-1 proteins in the back skin,the detection of IL-1β and IL-6 in serum were observed.Methods:The research was divided into two parts:1.Clinical observation on treatment of chronic eczema with Yangxue Qufeng Decoction.According to the diagnostic criteria of chronic eczema(blood deficiency and wind-drying syndrome),76 patients with blood-deficiency and chronic dry eczema who were treated in the dermatology clinic of Xiyuan Hospital CACMS were selected.Parallel randomized control method was used to seal the corresponding treatment distribution letter into the envelope with a closed envelope method and a random arrangement of the random number table according to the 1:1 production test group and the control group to form a random letter.Patients were randomly assigned to the test group or control group according to the order in which they were included.Both groups of patients were treated with oral and topical treatment.The external drugs were applied to 1%hydrocortisone butyrate cream twice a day.The patients in the test group were given oral decoction.The prescriptions were:Danggui 10g,Jixueteng 15g,Yejiaoteng 15g,Baijili 10g,Wushaoshe 10g,raw Longgu 30g,calcined Muli 30g,Gusuibu 15g.It is extracted into granules by the preparation room of our hospital,200ml boiling water,2 times/day.Patients in the control group were given loratadine tablets orally 10 mg/d once daily.The two groups were treated with 2 weeks as a course of treatment,and a total of 3 courses were treated.After the end of the 3 courses,the overall effect was evaluated.The patient was asked to return to the clinic once a week,and the investigator recorded changes in symptoms and signs and side effects.The disease scoring standard is classified according to the "Guidelines for Clinical Research of New Drugs for Treating Eczema".The main symptoms are according to the degree of itching,the area of skin lesions,the shape of skin lesions,and the secondary symptoms are respectively according to the symptoms of upset,pale,palpitated,tired,etc.Comprehensive efficacy evaluation the efficacy index was calculated based on the degree of pruritus and rash,and was determined by four levels.Finally calculate the total effective rate is the sum of the recovery rate and significant efficiency and efficiency.At the same time,the safety of the drug was monitored.Blood,urine routine and liver function(ALT)and renal function(Cr,BUN)were detected before and after treatment in the treatment group.Each visit point inquires about the patient’s test situation in detail,and judges whether the patient has an adverse event.2.Exploring the possible mechanism of Yangxue Qufeng Decoction(1)Morphological changes of back lesions in rat chronic eczema model.The acetone-olive oil solution of 2,4-dinitrofluorobenzene(DNFB)was used for modeling in the abdomen.After successful administration,the drug of Yangxue Qufeng Decoction was intervened,and the positive control loratadine group and the negative control model group(physiological saline)and blank group were established.Continuously administrate for one week,According to skin lesions edema,erythema,erosion,scales,graded in four grades to determine the efficacy.Then the back lesion of the rat was taken.Take the abdomen lesions to 10%formaldehyde solution.After routine paraffin sectioning,hematoxylin-eosin staining was performed.The pathological changes were observed under the microscope:squamous epithelial thickness,epidermal hyperkeratosis or insufficiency,dermal layer blood vessels and inflammatory cell infiltration.(2)Protein expression of IL-1β,IL-6,Claudin-1 and ZO-1 in rat back lesionsThe expressions of IL-1β,IL-6,Claudin-1 and ZO-1 in the back lesions of the Yangxue Qufeng Decoction group,loratadine group,model group and blank group were detected by immunohistochemistry.(3)Detection of serum IL-1β and IL-6 levels in ratsThe serum levels of IL-1β and IL-6 in the Yangxue Qufeng Decoction group,loratadine group,model group and blank group were detected by ELISA.Result:1.Clinical efficacy and safety analysis(1)Before treatment,there was no statistically significant difference in age,gender,disease duration,lesion area score,pruritus and sleep severity score,lesion severity score and total disease score between the test group and the control group(P>0.05).(2)After treatment,the scores of lesion severity,pruritus and sleep degree were compared between the two groups.There was significant difference between the two groups(P<0.05).There was no significant difference in the lesion area scores between the two groups after treatment,and there was no significant difference(P>0.05).(3)Skin lesion severity score,pruritus and sleep degree score,and lesion area score were compared between the two groups.The Wilcoxon symbol paired rank sum test showed significant difference between the two groups(P<0.05).(4)The total scores of the patients before and after treatment in the test group were statistically significant,P<0.01,which was statistically significant.The total scores of the control group before and after treatment were compared,P<0.01,which was statistically significant.After treatment,the scores of the two groups were compared,P<0.01,statistically significant.(5)The total effective rate of Yangxue Qufeng Decoction group in treating chronic eczema was 85.71%,and the total effective rate in the loratadine group was 70.59%.Statistical analysis P>0.05,no statistically significant difference.The Yangxue Qufeng Decoction group was equivalent to the loratadine group.(6)After the rank sum test,there was no significant difference between the two groups in safety test(P＞0.05).2.Experimental study on mechanism of action(1)Compared with the eczema model group,the rats induced by the Yangxue Qufeng Decoction group and the loratadine group had certain therapeutic effects on the area and degree of erythema of the back lesion,the degree of hypertrophy and the degree of scale.P<0.05);The effect of Yangxue Qufeng Decoction group was similar to that of loratadine group(P>0.05).(2)Pathological changes in back lesionsIn the blank control group,the squamous epithelial layer was as usual,about 3-5 layers,no hyperkeratosis or parakeratosis,no degeneration and necrosis of the cells,no obvious abnormalities in the dermis.In the model group,the number of squamous epithelial layers was thickened,about 6-9 layers,the nails were delayed,the cells were swollen and degenerated,the nuclei were large,the cytoplasm was filled,and the cells were disordered.The keratinization is incomplete,the surface of the skin is seen to be erosive,the vascular proliferation of the dermis is obvious,and the interstitial inflammatory cells are infiltrated.In the loratadine group,the number of squamous epithelial layers was thickened,about 5-8 layers,the nail spikes were slightly delayed,the cells were slightly swollen and degenerated,the nuclei were slightly larger,and the cells were arranged neatly.Mild keratosis,a little erosion on the surface of the skin,vascular proliferation of the dermis,moderate interstitial inflammatory cells infiltration.In the Yangxue Qufeng Decoction Group,The number of squamous epithelial layers is thickened,about 4-7 layers,the nail spikes are slightly delayed,the individual cells are slightly swollen,the nuclei are slightly larger,and the cells are arranged neatly.Mild keratosis,no obvious erosion on the surface of the skin,local vascular proliferation,a small amount of interstitial inflammatory cells infiltration.(3)Expression of IL-1β and IL-6 in back lesionsIL-1β:Compared with the blank control group,the expression of the model group increased,and the IOD value increased,showing significant difference(P<0.01).Compared with the model group,the western medicine group showed a slight decrease in expression and the IOD value decreased,but no Significant differences;compared with the model group,the expression of the Chinese medicine group was significantly reduced,the IOD value was significantly reduced,and significant differences were observed(P<0.05).There was no significant difference in IOD between western medicine group and traditional Chinese medicine group(P>0.05).IL-6:Compared with the blank control group,the expression of the model group increased significantly,and the IOD value increased significantly,showing significant difference(P<0.01).Compared with the model group,the expression of the western medicine group decreased,and the IOD value decreased,showing significant difference(P<0.01).Compared with the model group,the expression of the Chinese medicine group was significantly reduced,and the IOD value was significantly decreased,showing significant difference(P<0.01).There was no significant difference in IOD between western medicine group and traditional Chinese medicine group(P>0.05).(4)Protein expression of Claudin-1 and ZO-1 in back lesionsCompared with the blank control group,the expression of Claudin-1 and ZO-1 in the model group was significantly decreased,and the IOD value was significantly decreased,showing significant difference(P<0.01).Compared with the model group,the expression of loratadine group was increased.The IOD value increased,and the significant difference was observed(P<0.01).Compared with the model group,the expression of Yangxue Qufeng Decoction group was significantly increased,and the IOD value was increased,showing significant difference(P<0.01).Compared with the loratadine group,the IOD value of the Yangxue Qufeng Decoction group was more significant,and the difference was statistically significant(P<0.05).(5)Detection of serum IL-1β and IL-6Compared with the blank control group,IL-1β and IL-6 were significantly increased in the model group(P<0.01).Compared with the model group,the levels of IL-1β and IL-6 in the loratadine group were decreased(P<0.05).Compared with the model group,IL-1 β and IL-6 in the Yangxue Qufeng Decoction group were significantly lower(P<0.01).There was no significant difference in IL-1β and IL-6 levels between the loratadine group and the Yangxue Qufeng Decoction group(P>0.05).Conclusions:1.Yangxue Qufeng Decoction treats chronic eczema with blood deficiency and wind-drying,which is effective in relieving the degree of itching,improving sleep,reducing the skin hypertrophy and the degree of lichenification of patients,and is obviously superior to the medicine loratadine group.It can effectively alleviate the anxiety and tension,improve the quality of life.2.Yangxue Qufeng Decoction may reduce the inflammatory response in the body by reducing the release of inflammatory factors such as IL-1β and IL-6 in the process of eczema;and up-regulating the levels of Claudin-1 and ZO-1 in keratinocytes to achieve repair The role of the skin barrier function. |
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