| Objective: The aim of this study was to investigate the clinical efficacy of Gui Zhi Tang Plus in the treatment of progressive vitiligo in children with Qi and Blood disharmony,and to detect the changes of CXCL10 and CXCR3 expression in the peripheral blood of the children to explore the correlation.Methods:Sixty-two cases of vitiligo with progressive Qi and Blood disharmony were included according to the criteria and randomly divided into two groups.The treatment group was treated with Gui Zhi Tang plus flavor formula,while the control group was given oral compound glycyrrhizin tablets and both groups were given topical tacrolimus ointment;4 weeks was a course of treatment and 3 consecutive courses of treatment(12 weeks in total).Observe and record the data of white spot area of children before treatment,4 weeks after treatment,8 weeks after treatment and 12 weeks after treatment;The pigment score,TCM symptom score,CXCL10 and CXCR3 in peripheral serum were recorded before and after12 weeks of treatment.During the treatment,the children in both groups were monitored for adverse effects and treated promptly.Results:1.Comparison of baseline value: A total of 62 cases were included in this study,of which 3 cases were dislodged,and 59 cases were actually completed in the end,29 cases in the treatment group and 30 cases in the control group.The two groups of children were statistically insignificant(P>0.05)in terms of gender,age,course of disease,classification,white spot area,pigment score,TCM syndrome score and peripheral serum CXCL10 and CXCR3 before treatment,and were comparable.2.As for the white spot area:(1)After 4 weeks of treatment,the white spot area of both groups improved compared with that before the previous treatment(P<0.05),and the white spot area of the treatment group decreased to(10.62±5.31)and that of the control group decreased to(12.57±4.26),but there was no significant difference in the degree of improvement of the white spot area of the treatment group compared with that of the control group,P = 0.035>0.05.(2)After 8 weeks of treatment,the white spot area decreased to(7.48±4.49)in the treatment group and(10.33±3.70)in the control group,P=0.002<0.05,and the difference between the two groups was statistically significant;(3)After 12 weeks of treatment,the white spot area in the treatment and control groups was(4.55 ± 4.59)and(7.93 ± 4.03),respectively,and the former The improvement of lesion area was more significant in the former group than in the latter group,and the difference between the two groups was statistically significant(P=0.004<0.05).3.Pigmentation score before and after treatment: the pigmentation scores recorded before and after treatment were compared between the children in the treatment group,and it was found that P=0.000<0.01;the pigmentation scores recorded before and after treatment were also compared between the children in the control group,and P=0.000<0.01;both groups were compared within the group,and the pigmentation scores of both the treatment group and the control group increased after treatment compared with those before treatment,which reflected that the treatment methods of both groups had improved the recovery of skin color at the injury Both groups had improved skin color recovery.After 12 weeks of treatment,the pigmentation score of the treatment group was(1.79±0.81)and that of the control group was(1.07±0.91),and the comparison between the two groups showed that the former was significantly higher than the latter,P=0.003<0.01,which was statistically significant,reflecting that the treatment method of the treatment group was significantly higher than that of the control group in promoting the normal recovery of the skin color at the injury.4.The TCM symptom score before and after treatment: comparing the TCM syndrome points recorded before and after treatment for children in the treatment group,it was found that P=0.000<0.01;also comparing the TCM syndrome points recorded before and after treatment for children in the control group,P=0.637>0.05;both groups were compared within the group,and the TCM syndrome points in the treatment group after treatment(3.21 ± 1.74)were higher than those before treatment(9.10 ± 2.92)was significantly lower in the treatment group,while there was no significant difference in the TCM symptom scores before and after treatment in the control group,which reflected that the treatment method in the treatment group could improve the symptoms of spleen-lung deficiency in children with Qi-blood disharmony,while the control group had no significant effect on the improvement of TCM symptoms.5.Peripheral serum CXCL10 and CXCR3: Comparing the peripheral serum CXCL10 and CXCR3 levels recorded before and after treatment in children in the treatment group,CXCL10: before treatment(4.31±0.89)and after treatment(2.93±0.85),P=0.000<0.01;CXCR3: before treatment(9.31±0.98)and after treatment(Comparing the peripheral serum CXCL10 and CXCR3 levels recorded before and after treatment in control children,CXCL10: before treatment(4.33±0.86),after treatment(3.50±0.89),P=0.001<0.01;CXCR3:before treatment(9.57±1.11),after treatment(6.77±1.11),P=0.000<0.01.After treatment(6.77±1.74),P=0.000<0.01.Both groups were compared within groups,and it was found that the peripheral serum CXCL10 and CXCR3 levels decreased after treatment in both treatment and control groups,indicating that both treatments improved CXCL10 and CXCR3 levels.After 12 weeks of treatment,CXCL10 and CXCR3 in the treatment group were compared with those in the control group between groups,CXCL10: P=0.015 < 0.05;CXCR3: P=0.021 < 0.05,with statistically significant differences,reflecting that the treatment group was better than the control group in improving peripheral serum CXCL10 and CXCR3 levels.6.Clinical efficacy: treatment group: 29 patients,of which 6 were cured,15 were apparently effective,6 were effective,and 2 were ineffective,with an overall efficiency of 93.10% and a healing rate of72.41%.In the control group,there were 30 patients,of whom 3 were cured,8 were effective,13 were effective,and 6 were ineffective,with an overall efficiency of 80% and a healing rate of 36.67%.The differences between the two groups in terms of total effective rate and healing rate were statistically significant(P<0.05).Conclusion:1.1.Gui Zhi Tang plus flavor taken internally combined with tacrolimus ointment applied externally for the treatment of vitiligo(Qi and blood disharmony type)in children had significant efficacy and was better than the control group in reducing the area of white spots,improving the pigmentation score and improving the TCM symptoms in children,with no significant side effects and high safety.The results of this experiment showed that the expression levels of CXCL10 and CXCR3 in peripheral blood serum decreased after taking the modified Guizhi Decoction compared with those before treatment.It is speculated that CXCL10 and CXCR3 may participate in the immune related mechanism in the occurrence and development of vitiligo in children.The modified Guizhi Decoction promotes the prognosis of vitiligo by improving the expression of CXCL10 and CXCR3. |
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