Retrospective Analysis And Mechanism Of Action Of Cooling Blood And Detoxification In The Treatment Of White Boil And Blood Heat Syndrome

This paper mainly includes two parts:literature review and experimental research.1.Literature review:(1)Research progress of traditional Chinese medicine in the treatment of psoriasis vulgaris(2)Research progress of immunology related immune cells and cytokines in psoriasis2.The clinical research is as follows:Background:Blood heat syndrome is more common in the progressive stage of psoriasis vulgaris.Whether effective intervention is given during this period has an important impact on the disease progression.Traditional Chinese medicine is widely accepted because of its exact curative effect and small side effects.However,due to different individual factors,even if the treatment plan is the same,the prognosis of patients is still different.Objective:To investigate the clinical efficacy of blood heat syndrome of psoriasis vulgaris under the same treatment scheme,and to explore the related factors affecting the efficacy.Methods:the clinical data of 221 patients with blood heat syndrome of psoriasis vulgaris were retrospectively analyzed.PASI25 was used as the cut-off value of clinical efficacy and inefficacy,of which 52 cases were inefficacy and 169 cases were effective.Statistical analysis of patients with general personal data and differences in the results of the first laboratory examination,the indicators with statistical significance were included in the multivariate logistic regression analysis,and the independent related factors affecting the prognosis were obtained.Results:221 patients recieeved TCM treatment,the core recipe was Liangxue Jiedu decoction.The total effective rate was 76.9%.Through the analysis of PASI score,the overall score decline rate was 45.50%± 49%,and the decrease rates of infiltration,scale and erythema scores were 24.55%± 17.06%?46.48%± 16.55%?65.79%±27.29%respectively.Logistic regression analysis showed that NLR,PLR,CRP,hypoproteinemia,abnormal liver function,complex treatment and metabolic diseases were independent risk factors for prognosis.Conclusion:the comprehensive treatment of TCM with Liangxue Jiedu decoction as the core recipe has definite clinical effect.After treatment,the degree of infiltration was improved most obviously,followed by scales and erythema.The patients' previous treatment,whether they are complicated with metabolic diseases,NLR,PLR,CRP,liver function and albumin levels are helpful to evaluate the prognosis3.The experimental study is as follows:Background:Liangxue Jiedu Decoction is effective in treating psoriasis vulgaris,but its theraputical mechanism remains unknown.LL37,which is highly expressed in psoriasis lesions.plays an important role in the initial stage of psoriasis inflammation mainly in the form of Neutrophil extracellular traps(NETs).At the same time,the expression of NETs is regulated by histone deacetylases(HDACs).Therefore,the down-regulation of LL37 expression by inhibiting HDACs activity may be the mechanism of Liangxue Jiedu Decoction in the treatment of psoriasisObjective:To analyze the mechanism of Liangxue Jiedu Decoction in the treatment of psoriasis vulgaris with blood heat syndrome by inhibiting the activity of HDACs thus to regulate the expression level of LL37Methods:The model of psoriasis-like skin inflammation was induced by imiquimod(IMQ)on the back of balb/c mice,which were randomly divided into six groups,namely normal group.model group,Liangxuejiedu Decoction low-dose group,medium-dose group,high-dose group and positive drug MTX group,among which normal control group was coated with Vaseline The lesion were evaluated by international PASI before daily administration.HE staining was used to observe the thickness of skin tissue and the infiltration degree of inflammatory cells;The proliferation of epidermis was observed by immunohistochemistry PCNA;The number of microvessels was observed by immunohistochemistry CD31;The levels of IL-17.IL-22 and histone H3 and H4 were detected by ELISA;The number distribution of LL37 and VEGF were observed by immunofluorescence;The expression level of LL37,VEGF,hats and HDACs were detected by Western blot;The mRNA level of CAMP(LL37 encoding gene)was detected by Qrt-PCR;The activity of HATs and HDACs was detected by the kits.Results:1.In the psoriasis-like injury model induced by IMQ,HE staining showed that in the model group,the epidermis proliferated obviously,the acanthocyte layer thickened and inflammatory cells infiltrated in the dermis.Compared with the model group,the skin thickness of mice in Liangxue Jiedu Decoction group and positive drug group became thinner,and inflammatory infiltration and spinous layer thickening were alleviated.PCNA,CD31,1137 and VEGF were all over expressed in the model group,The PASI score of Liangxue Jiedu Decoction group was increased slowly than that in the model group,and the expression of PCNA and CD31 in the lesions was decreased,the infiltration of lymphocytes in the lesions was reduced,and the expression levels of LL3 7,VEGF,IL-17 and IL-22 was decreased.Among all the herbal groups,the high-dose group was the most effective,which has no statistical difference with the positive drug treatment effect.2.In psoriasis lesions,the levels of histone H3 and H4 acetylation were significantly lower than that in normal group,the expression level of HATs was low and HDACs was high.The level of histone acetylation and HATs in the lesions was up regulated by Liangxue Jiedu Decoction,and HDACs was down regulated,among which the high-dose group was the most obvious.Conclusion:Liangxue Jiedu Decoction can significantly alleviate the overall situation of erythema,scales and invasive thickness of psoriasis.The mechanism of Liangxue Jiedu Decoction in the treatment of psoriasis may be as follows:inhibiting the activity of HDACs to down regulate the expression level of LL37,thus to reduce the production of IL-17,IL-22 and other cytokines,and down regulate the expression level of VEGF to reduce angiogenesis.