| Background:Atopic dermatitis is a chronic recurrent,genetically allergic disease.It is estimated that the global incidence of atopic dermatitis is close to 230 million,which is considered to be one of the most common chronic diseases.The disease has a serious impact on patients'quality of life and brings huge social and economic burden,making it a public health problem that must be solved.Objective:To observe the clinical efficacy of Shengyang Longdan Decoction in the treatment of atopic dermatitis through a series of prospective case studies;To explore the possible mechanism of Shengyang Longdan Decoction in the treatment of atopic dermatitis through the analysis of network pharmacology.Research methods:Research 1:Through a series of prospective case studies,we,in outpatient,continuously recruited patients with atopic dermatitis who met the diagnostic criteria of traditional Chinese and Western medicine.The clinical treatment was mainly based on the prescription of Shengyang Longdan decoction.The demographic data,medical history,lesion stage,BMI and other baseline data of atopic dermatitis patients were collected by questionnaire survey.The follow-up points were set as the first visit(0 week)and the 2nd,4th,6th,8th,10th and 12th weeks of medication.The main outcome measures were the area of skin lesions,the score of skin lesions,the score of pruritus and sleeping,and the score of SCORAD.We collected date,analyzed statistics.To observe the efficacy results,The efficacy with history,skin lesions stage,BMI and other baseline data,the clinical characteristics of ineffective patients were exploratory analyzed.Research 2:Based on the network pharmacology,screening the effective components of Shengyang Longdan decoction through the retrieval of TCSMP.Establishing the target gene database of the effective components.Searching the Geencard and OMIM database to establish the disease target database,and selecting the key target of Shengyang Longdan Decoction in the treatment of atopic dermatitis.Constructing the protein interaction network with string database,and analyzed by Go and KEGG.Searching for the literature support of the selected pathway,and preliminarily explore the possible mechanism of Shengyang Longdan Decoction in the treatment of atopic dermatitis.Research results:Research1:1.The inclusion of subjects:32 patients were included in this study,25 of them completed the clinical treatment,7 patients fell off due to the unsatisfactory effect.Generally speaking,there were 9 males and 23 females in the group.The average age was 42.22±19.61 years.2.Analysis of drug use:32 patients were enrolled,97 times in total.Among the oral drugs,97 times were used for decoction,12 times for cetirizine hydrochloride tablets and 6 times for Loratadine Tablets.Among the external drugs,triamcinolone acetonide econazole cream was used 28 times,Qingpeng ointment 11 times,external herbal medicine 11 times,urea ointment 7 times,tacrolimus 4 times,skin lotion 5 times,Longzhu ointment 2 times,hydrocortisonebutyrate 1 time,Chonglou Jiedu tincture 1 time.3.Evaluation of curative effect:the 3-month treatment period is over,the clinical recovery rate is 71.88%,significantly effective rate is 75%,effective rate is78.13%and the invalid rate is 21.87%.One case recurred within one month,one case after one month and one case after two months.Among the patients with clinical recovery,the average treatment period was 4.91 ± 2.81 weeks.The area of skin lesions decreased significantly(P=0.000<0.05).The tendence of skin damage score:The score of erythema decreased,the difference was statistically significant(P=0.000<0.05).The score of edema/papule decreased,the difference was statistically significant(P=0.000<0.05).There was no significant difference in the scores of exudation and scab formation(P=0.534>0.05).The bryophilic score decreased,the difference was statistically significant(P=0.000<0.05).Dry score decreased gradually,the difference was statistically significant(P=0.000<0.05).Itching and sleeping improvement:Pruritus improved significantly,the difference was statistically significant(P=0.000<0.05).The sleeping score was significantly improved(P=0.000<0.05).SCORAD decreased significantly before and after treatment(P = 0.000<0.05).4.Exploratory analysis results of medical history and efficacy evaluationWith the increase of the number of atopic disease history,the recovery rate gradually decreased,the difference was statistically significant(P=0.049<0.05),Gamma coefficient=-0.692,showing a comparison strong negative correlation.5.Exploratory analysis of disease situation and efficacy evaluationAll the patients in the group were mild and moderate,and the recovery rate of mild patients was slightly higher than that of moderate patients,the difference was statistically significant(P=0.005<0.05),Gamma coefficient=-1.000,showing a strong negative correlation.6.Exploratory analysis of clinical characteristics of invalid patientsSCORAD score of invalid patients was higher than that of effective patients,however,the difference was statistically significant(P=0.027<0.05).The bryophyte like change score was higher,the difference was statistically significant(P = 0.028<0.05).Research 2:The possible mechanism of Shengyang Longdan Decoction intervention on atopic dermatitis is AGE-RAGE signaling pathway,TNF signaling pathway,IL-17 signaling pathway,HIF-1 signaling pathway,Relaxin signaling pathway,C-type lectin receptor signaling pathway,Th17 cell differentiation,Toll-like receptor signaling pathway.Conclusion:Research 1:1.The clinical recovery rate was 71.88%,the effective rate was 78.13%,and the ineffective rate was 21.87%.One case recurred within one month,one case after one month and one case after two months.This study can not infer the clinical efficacy of Shengyang Longdan Decoction in the treatment of atopic dermatitis,which needs to be verified by a control experiment.2.Shengyang Longdan decoction can effectively improve the area of skin lesions,erythema,edema/papule,bryoidosis and dryness,but the improvement of exudation/scab score is not obvious.Shengyang Longdan decoction can effectively improve pruritus and sleeping.3.With the increase of the number of disease history,it is more difficult to treat.4.Mild patients are better than moderate patients.5.The SCORAD score of invalid patients was higher,and the lesions were more lichen like.Research 2:The possible mechanisms of Shengyang Longdan Decoction intervention on atopic dermatitis are AGE-RAGE signaling pathway,TNF signaling pathway,IL-17 signaling pathway,HIF-1 signaling pathway,Relaxin signaling pathway,C-type lectin receptor signaling pathway,Th17 cell differentiation,Toll-like receptor signaling pathway. |
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