Effect Of Puncture And Cupping Combined With Acitretin Capsules And NB-UVB On Moderate To Severe Plaque Psoriasis

Objective:To evaluate clinical efficacy of puncture and cupping combined with acitretin capsules and Narrow-band Ultraviolet radiation B（NB-UVB）on moderate to severe plaque psoriasis.Methods:1 76 patients with moderate to severe plaque psoriasis in the dermatology department of Cangzhou people’s hospital were randomly divided into control group and experimental group,38 cases in each group.The control group was given acitretin capsules（0.5mg/kg/day）orally,calcipotriol betamethasone ointment（1time/day）for external use,NB-UVB（2times/week）irradiation;the experimental group was additionally given puncture and cupping（2times/week）on the basis of the control group.Both groups were treated for 8weeks.Patients in each group were treated with vitamin E milk.2 The psoriasis area and severity index（PASI）,effective rate,skin quality of life index（DLQI）and adverse reactions during treatment were recorded by the same two dermatologists before treatment,at 4 weeks and 8 weeks of treatment.3 Enzyme linked immunosorbent assay（ELISA）was used to detect the levels of IL-17 and IL-23 in peripheral blood of the two groups before treatment,at 4 weeks and 8 weeks of treatment.4 The PASI,the levels of IL-17 and IL-23 in peripheral blood,the effective rate and DLQI were compared before treatment,at 4 weeks and 8weeks of treatment to judge the therapeutic effect of the two groups,and to compare the incidence of adverse reactions in the treatment process of the two groups.5 Spss23.0 software was used to analyze the data.If the measurement data obey the normal distribution,the data is expressed by the mean standard deviation（（?）±s）,and the independent sample t test is used when the variance is homogeneous;the independent sample corrected t test is used when the variance is uneven;if the measurement data do not obey the normal distribution,the data is expressed by the median and quartile M(P₂₅,P₇₅),and the nonparametric Wilcoxon rank sum test is used.The counting data were divided into ordered data and disordered data.If it was ordered data,the nonparametric Wilcoxon rank sum test was used;if it was disordered data,the test was used.Multiple time point data were analyzed by repeated measures ANOVA.The difference was statistically significant（P<0.05）.Results:1 Baseline equilibrium comparisonThere was no significant difference in gender,age,course of disease,PASI and DLQI before treatment between the two groups（P>0.05）.2 PASI comparison2.1 Comparison between groups at the same time pointBefore treatment,there was no significant difference in PASI between the two groups（P>0.05）;the PASI of the experimental group was lower than that of the control group at 4 weeks and 8 weeks of treatment,and there was statistically significant between the two groups（P<0.05）.2.2 Comparison of different treatment time points in the groupCompared with before treatment,PASI of the two groups at 4 weeks and8 weeks of treatment were significantly lower in the group,and the difference was statistically significant（P<0.05）.3 Comparison of IL-17 levels in peripheral blood3.1 Comparison between groups at the same time pointBefore treatment and at 4 weeks of treatment,there was no significant difference in the level of IL-17 between the two groups（P>0.05）;the level of IL-17 in the experimental group was lower than that of control group at 8weeks of treatment,and there was statistically significant between the two groups（P<0.05）.3.2 Comparison of different treatment time points in the groupCompared with before treatment,the levels of IL-17 in peripheral blood of the two groups at 4 weeks and 8 weeks of treatment were significantly lower in the group,and the difference was statistically significant（P<0.05）.4 Comparison of IL-23 levels in peripheral blood4.1 Comparison between groups at the same time pointBefore treatment and at 4 weeks of treatment,there was no significant difference in the level of IL-23 between the two groups（P>0.05）;the level of IL-23 in the experimental group was lower than that of the control group at 8weeks of treatment,and there was statistically significant between the two groups（P<0.05）.4.2 Comparison of different treatment time points in the groupCompared with before treatment,the levels of IL-23 in peripheral blood of the two groups at 4 weeks and 8 weeks of treatment were significantly lower in the group,and the difference was statistically significant（P<0.05）.5 Comparison of effective rateThere was no significant difference in the effective rate at 4 weeks of treatment between the two groups（P>0.05）;the effective rate of the experimental group was higher than that of the control group at 8 weeks of treatment,and the difference was statistically significant（P<0.05）.6 DLQI comparison6.1 Comparison between groups at the same time pointBefore treatment,there was no significant difference in DLQI between the two groups（P>0.05）;the DLQI of the experimental group was lower than that of the control group at 4 weeks and 8 weeks of treatment,and there was statistically significant between the two groups（P<0.05）.6.2 Comparison of different treatment time points in the groupCompared with before treatment,the DLQI of the two groups at 4 weeks and 8 weeks of treatment were significantly lower in the group,and the difference was statistically significant（P<0.05）.7 Comparison of adverse reaction rateIn the whole process of the experiment,there were no serious adverse reactions such as abnormal liver and kidney function,high blood lipid and so on in the two groups before and after treatment.There were 27 cases in the experimental group and 30 cases in the control group with dry mouth and dry eyes in varying degrees,and they were asked to drink more water without special treatment.One case in the experimental group had skin redness,itching,pain and other symptoms in the fifth week,increased the dosage of vitamin E milk,and readjusted NB-UVB when the patients could tolerate it.The symptoms disappeared after irradiation dose.In the experimental group,one patient developed small blisters at the cupping site,and was asked to keep the part clean and dry,and no special treatment was given,which did not affect the experimental process.There was no significant difference in the incidence of adverse reactions at 8 weeks of treatment between the two groups（P>0.05）.Conclusions:1 The therapeutic effect of puncture and cupping combined with acitretin capsules and NB-UVB in the treatment of moderate to severe plaque psoriasis is better than acitretin capsules and NB-UVB in the treatment of moderate to severe plaque psoriasis.2 Puncture and cupping may affect the levels of IL-17 and IL-23 in peripheral blood of patients with plaque psoriasis,and its effect on immunity remains to be further studied.3 Compared with acitretin capsules and NB-UVB,puncture and cupping combined with acitretin capsules and NB-UVB can improve the quality of life of patients.4 Puncture and cupping combined with acitretin capsules and NB-UVB in the treatment of moderate to severe plaque psoriasis is a green treatment with low price,high safety and easy operation.