| Objective:To observe the clinical efficacy of modified liangxue xiaofeng powder in the treatment of recurrent psoriasis vulgaris(blood-heat syndrome);By detecting the expression of Th1 and Th2 cells in peripheral blood of patients before and after the intervention of TCM,from the balance of Th1/Th2 to explore the therapeutic target and anti-inflammatory mechanism of modified liangxue xiaofeng powder in treating psoriasis with blood-heat syndrome,and the immune factors that psoriasis is prone to relapse.Method:Observational study:Based on the randomized controlled trial,65patients of relapsed psoriasis vulgaris with blood-heat syndrome were randomly assigned to the experimental group(33 cases)and the control group(32 cases),and were respectively treated with modified liangxue xiaofeng powder and acitretincapsu.The treatment period of the two groups was 8 weeks,and the patients were followed up every 2 weeks.PASI score,itching degree,skin disease quality of life score(DQOLS)and adverse events were observed and evaluated before and after treatment,to determine the clinical efficacy and safety.Laboratory testing:The experimental group and the control group were randomly selected 20 cases,Fasting venous blood was collected before enrollment and 8 weeks after treatment,flow cytometry was used to detect the expression of Th1(CD4~+IFN-γ~+)and Th2(CD4~+IL-4~+)cells in peripheral blood.At the same time,10 healthy volunteers were selected as the healthy group and 10 patients who have reached the clinical cure standard of psoriasis vulgaris for more than one year were selected as the cured group for comparative analysis.Results:Analysis of clinical observation indexes:The PASI score,skin lesion area,itching degree score and skin disease quality of life score of patients in the experimental group and the control group were significantly improved compared with those before treatment(P<0.05),there was no significant difference between the two groups(P>0.05).Clinical efficacy evaluation:The apparent efficiency rates of the experimental group and the control group respectively were 54.5%and 50%,and the effective rates were 100%and 96.9%,the efficacy of two groups was equal,without significant difference(P>0.05).No obvious adverse reactions were found during the test.Moreover,before and after the test,the blood routine,liver and kidney function related specific indexes were within the normal reference range.Analysis of flow cytometry results:(1)Th1 cells expression level analysis:Before treatment,Th1 cells in peripheral blood of the experimental group and the control group were higher than those in the healthy group and the cured group(P<0.05);However,there was no significant difference between the healthy group and the cured group(P>0.05).After the treatment of modified liangxue xiaofeng powder and acitretincapsu,the level of Th1 cells in peripheral blood of the two groups was lower than before treatment,the difference was statistically significant(P<0.05).Compared with the cured group and the healthy group,the difference of expression level was not significant(P>0.05).(2)Th2 cells expression level analysis:The level of Th2 cells in peripheral blood of patients in the experimental group and the control group before and after treatment showed no significant difference compared with that of the cured group and the healthy group(P>0.05).(3)Th1/Th2 ratio analysis:The ratio of Th1/Th2 in the experimental group was significantly lower than that before treatment(P<0.05).But there was no significant change in the control group before and after therapy(P>0.05).Correlation analysis:Before and after treatment,there was no significant correlation between Th1,Th2 cells and Th1/Th2 ratio in peripheral blood of patients with psoriasis and the corresponding PASI score,BSA(%),itching degree and DQOLS.Conclusion:Patients with relapsed psoriasis vulgaris have the advantage of Th1immune differentiation,and high expression of Th1 cells may be the immune factor for relapsing psoriasis.The therapeutic effect of modified liangxue xiaofeng powder on psoriasis of blood-heat syndrome is definite,and its immune mechanism may be to correct Th1/Th2 drift and restore its balance by reducing Th1 cell content and Th1/Th2 ratio,so as to achieve the therapeutic purpose.When the blood heat syndrome turned to normalization,the content of Th1 cells in peripheral blood decreased,approaching the level of healthy people.Th2 cells are not important in the pathogenesis of recurrent psoriasis. |
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