Clinical observation on the treatment of middle-aged and senile patients with psoriasis

Navigation:Home > Skin > Std > Clinical observation on the treatment of middle-aged and senile patients with psoriasis

IntroductionVulgaris vulgaris (Psorisis, PV) is a common, refractory and relapsing chronic inflammatory skin disease. The incidence rate of

Content

Introduction

Vulgaris vulgaris (Psorisis, PV) is a common, refractory and relapsing chronic inflammatory skin disease. The incidence rate of natural population is usually 0.123%3%. Its high incidence, high recurrence rate, high medical costs are increasingly valued by both doctors and patients. The exact pathogenesis of this disease has not been elucidated and there is no ideal treatment. In recent years, the immunological pathogenesis of psoriasis have received increasing attention, the relationship of interleukin and psoriasis has become a hot research topic. Traditional Chinese medicine treatment of this disease has a long history, has accumulated a wealth of clinical experience, clinical efficacy, less toxic side effects have been recognized by the medical profession. To further explore the pathogenesis of psoriasis, to find more effective, can delay the recurrence of drugs, psoriasis has become the focus of research. This study uses the basic theory of TCM, combined with modern immunology experiment technology, from two aspects of clinical and cell factor, clinical observation from Yin Yang Decoction in the treatment of senile psoriasis, and compared with compound Qingdai pill. Through the detection of patients with psoriasis before and after treatment, IL-2, IL-6, IL-8 level, to explore the mechanism of cytokines in the pathogenesis of psoriasis may, from Yin Yang Decoction and provide the basis for the treatment of psoriasis vulgaris, and validation of traditional Chinese medicine in the treatment of psoriasis vulgaris in reality.

Materials and methods

General information

All cases were from the Affiliated Hospital of Shandong University of Traditional Chinese Medicine from May 2004 to January 2006 in the outpatient department of Dermatology, there were 87 cases of psoriasis vulgaris, were randomly divided into two groups, including 47 cases of treatment group, with drawing Yang from Yin decoction, 40 cases in the control group with compound Qingdai pill treatment. Age, sex, course of disease, predisposing factors, stage of disease, type of skin lesions, distribution of lesions, severity of illness score, lesion area integral, onset season, TCM syndrome differentiation type (see Table 1 ~ 8).

Table 1 Comparison of age, sex and course of disease between the two groups (+ S)

group

Number of cases (n)

Age

Gender

Course of disease

male

female

treatment group

Forty-seven

53.7 + 9.74

Thirty-one

Sixteen

13.49 + 8.96

Qingdai pill group

Forty

54 + 6.85

Twenty-three

Seventeen

13.48 + 8.46

There was no significant difference between the two groups in terms of age and mean duration of disease, t were 0.178 and 0.008, P>, respectively, and the difference between the two groups was not significantly different between and. The results showed that the difference between the two groups was X2=0.66, P > 0.05.

Table 2 Comparison of skin lesions between the two groups (case)

group

Number of cases (n)

Skin type

Drip shape

nummular

Patchy

Mixed form

Map shape

treatment group

Forty-seven

Six

Six

Nine

Twenty-one

Five

Qingdai pill group

Forty

Six

Seven

Eight

Seventeen

Two

There was no significant difference between the two groups (X2=0.68, P > 0.05).

Table 3 distribution of skin lesions in the two groups (case)

group

Number of cases (n)

Lesion distribution

head

Trunk cadre

Shank

Extremities

Whole body

treatment group

Forty-seven

Two

Two

Three

Four

Thirty-six

Qingdai pill group

Forty

One

Two

One

Three

Thirty-three

There was no significant difference in the distribution of skin lesions between the two groups (X2=1.05, P > 0.05).

Table 4 Comparison of TCM syndrome differentiation between the two groups (case)

group

Number of cases (n)

Syndrome differentiation

Blood heat syndrome

Blood heat with blood stasis syndrome

Blood deficiency and wind dryness

treatment group

Forty-seven

Twelve

Sixteen

Nineteen

Qingdai pill group

Forty

Twelve

Thirteen

Fifteen

There was no significant difference between the two groups in the distribution of TCM syndromes (X2=0.22, P > 0.05).

Table 5 Comparison of the degree of disease and lesion area in the two groups (case)

group

Number of cases (n)

Disease severity score (he felt symptoms + conscious symptoms)

Lesion area integral

Light

moderate

severe

Light

moderate

severe

treatment group

Forty-seven

Three

Eighteen

Twenty-six

Nine

Sixteen

Twenty-two

Qingdai pill group

Forty

Two

Fifteen

Twenty-three

Six

Twenty-one

Thirteen

There was no significant difference between the two groups (, 3.05, P > >), and the difference was statistically significant (X2 = 0.05, respectively).

Table 6 Comparison of the course of disease between the two groups (case)

group

Number of cases (n)

Course of disease

Less than 1 years

Less than 10 years

Less than 20 years

Less than 30 years

treatment group

Forty-seven

Two

Thirteen

Twenty-two

Ten

Five

Qingdai pill group

Forty

Two

Twelve

Twenty-one

There was no significant difference between the two groups in the course of disease (X2=1.17, P > 0.05), which was comparable.

Table 7 Comparison of the onset seasons of the two groups (case)

group

Number of cases (n)

Spring summer autumn winter

treatment group

Forty-seven

Twenty-two

Five

Seven

Thirteen

Qingdai pill group

Forty

Sixteen

Three

Eight

Thirteen

There was no significant difference between the two groups in the onset of the disease (X2=0.96, P > 0.05).

Table 8 Comparison of predisposing factors of patients in the two groups (case)

group

Number of cases (n)

Predisposing factors

inheritance

food

medicine

climate

Infected

spirit

Other

nothing

treatment group

Forty-seven

Thirteen

Three

Three

Six

Six

Six

Three

Seven

Qingdai pill group

Forty

Twelve

Two

One

Seven

Six

Six

Two

Four

There was no significant difference between the two groups (X2=1.78, P > 0.05).

Two, diagnostic criteria

According to the diagnostic standard of "clinical dermatology", "oral, Department of Dermatology disease diagnosis standard", "the people's Republic of China pharmaceutical industry standard of traditional Chinese Medicine Department of Dermatology syndrome diagnostic efficacy standards", referring to the people's Health Publishing House in 1999 version of "Chinese medicine surgery", in 1997 the Ministry of Health issued the "Chinese medicine clinical research guiding principle" (for the following third series):

(a) diagnostic standard of Western medicine for psoriasis vulgaris

1 with typical clinical manifestations, skin lesions with papules and maculopapules sizes of red patches, covered with dry layers of silver white scales, scraping scales visible light layer film, a film petechial hemorrhage, there have been new lesions.

2 skin lesions, can be divided into a bit like, coin shaped, patchy, map, mixed and other types of.

3 symptoms may be accompanied by varying degrees of itching.

4 a predilection for the scalp and the extensor extremities; but can occur on the surface around the hair on the scalp, hair bundles; in the deck (finger or toe), a point depression, was the top needle or deck is not flat, Huang Zenghou.

(two) TCM Syndrome Differentiation Standard

1 blood heat syndrome: primary or recurrent lesions, the rapid development of skin lesions with papules, maculopapule, infiltration, more basal scales, red skin color, punctate hemorrhage, can have the same type reaction; or have different degrees of itching, accompanied by upset thirsty and dry mouth, constipation, yellow urine, red tongue, yellow moss, pulse string number.

2 blood heat with blood stasis syndrome: there have been new rash, the lesions of basal red or dark red, and see the lesions was patchy, hypertrophy and hard, the color is dark red, scaly fastening, persistence, or with finger (toe) nail change, tongue or petechiae, petechiae, moss thin, or slow pulse astringent.

3 blood deficiency and wind dryness syndrome: the lesions of basal dim or dark purple, large scales, consciously itching, scrape scaly petechial hemorrhage was associated with dry throat, dry mouth, dry stool, yellow urine, pale tongue, thin white fur, pulse fine slow.

(three) clinical staging criteria

The 1 stage: acute onset, new rash and new lesions appear more visible, with a response.

2 stationary phase (stable phase): the condition is stable, temporarily stop the development, inflammation, no new rash.

3 involution (catagen): skin thinning, color light, scales significantly reduced, until the lesions subsided, leaving a light brown pigmentation or depigmentation spots pale white.

(four) disease classification criteria

1 winter type: Winter symptoms or recurrence, to reduce or subside in summer.

2 summer type: Summer symptoms or recurrence, to reduce or subside in winter.

Three. Inclusion criteria

1 over the age of 45.

2 accord with the diagnostic criteria of psoriasis vulgaris.

3 accord with TCM syndrome differentiation.

4 clinical stage.

5 in the past January years has not received a systematic treatment or within 2 weeks without the use of glucocorticoid preparations, retinoids, etc..

Four, exclusion criteria

1 under the age of 45.

2 allergic patients.

3 pregnant women who are pregnant, nursing, or taking birth control pills.

4 joint type, pustular type, erythrodermic psoriasis.

5 patients with severe cardiovascular and cerebrovascular diseases, liver, kidney, hematopoietic system diseases and congenital diseases.

6 suspect or have a history of alcohol and substance abuse.

7 combined with other drugs during treatment.

Five, remove the standard

Patients who are unable to take the medicine on time, according to the requirements, and those who have failed to record or voluntarily discontinue treatment.

Six, treatment

(1) drugs and methods of administration

1 treatment group: from Yin Yang soup (Polygonum 30g, angelica 12g, 9g, 15g, Radix Achyranthes 30g, 9g, Shanjia fried turtle shell 9g, 12g, 30g, zedoary Lithospermum Shuanghua 30g, soil Fuling 21g, 15g 12g, frost mulberry Zaocys, centipede 2, snake, clothing 3G ephedra 15g, cassia twig 15g, licorice 9g), Shuijianbi, a agent, CO decocting liquid is about 500ml, and the two, half an hour after a meal.

2 control group: fufangqingdaiwan (the main component of natural indigo, tuckahoe, salvia, angelica, Qu Jian), Shaanxi Tianning pharmaceutical limited liability company, approval number: ZZ-4356- Shan Wei yaozhun (1985) No. 000624, temperature boiling water delivery service, 1 bags / times, 3 / day, half an hour after a meal.

(two) the treatment: after treatment every 2 weeks for 1 times, sharing the medicine for 8 weeks.

Seven, observation index

(a) the clinical observation indexes: according to the Ministry of health in 1997 issued the "guiding principle" Chinese medicine clinical research Third Series) according to the psoriasis vulgaris distribution, severity of erythema, scaling, degree of infiltration and itching to score standard are as follows:

(two) laboratory testing

1.IL-2, IL-6, IL-8 detection index

In the treatment group, 20 cases were treated with blood before and after treatment, and the levels of IL-2, IL-6 and IL-8 were detected and compared with those of the normal group (healthy control group) of 10 patients without psoriasis. The age and sex were compared in table 9:

Table 9 Comparison of age and sex between the treatment group and the normal control group

group

Case number (n) age (age)

Gender

male

female

treatment group

2052.50 + 9.81

Thirteen

Seven

Normal control group

1056.50 + 9.70

Six

Four

The age of the two groups was T = - 1.06, (P > > > > > >, the sex comparison was X2=0.07 (P > 0.05), which was comparable to that of.

Methods: the treatment group and the healthy control group were taken out of the fasting venous blood 3ml, serum separation. Determination of IL-2, IL-6 and IL-8 by enzyme linked immunosorbent assay; kit provided by Roche; experimental instruments: E170 immune analyzer; the results were measured by the laboratory department of nuclear medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, according to the provisions of the operation.

2 security detection

Laboratory examination: (1) patients before and after treatment of blood routine, urine routine, stool routine + occult blood, liver and kidney function (ALT, BUN, Cr, etc.) detection.

(2) ECG examination

(3) vital signs: changes in blood pressure, respiration, body temperature and heart rate.

(three) observation of adverse events

1 after the drug treatment or every follow-up inquiry and record adverse reactions and patients may occur, no degree, light, medium and heavy four, detailed records of adverse symptoms, occurrence time, duration and extinction time.

2 adverse drug reactions and drug related, regardless of the points may be unrelated, may be related to.

3 the incidence of adverse reactions = the number of cases of adverse reactions / total cases * 100%.

4 after the treatment of patients with drug tolerance, according to the difference, moderate, mild, good comprehensive evaluation of the four.

Eight, efficacy criteria

Reference to the Ministry of Health issued in 2002, "Chinese medicine clinical research guidelines for new drugs," the formulation of the efficacy criteria for evaluation:

(a) comprehensive efficacy evaluation criteria

1 clinical cure: the integral reduction rate greater than 95%

2 Excellence: the integral reduction rate greater than 70%, < 95%

3: effective integral reduction rate greater than 30%, < 70%

4 invalid: not reach the effective standard

The calculation method of integrated score = rash area score + rash appearance score + pruritus score

Formula: comprehensive score reduction rate (n score before treatment score - after treatment before treatment), integral] * 100%.

(two) evaluation criteria of TCM Syndromes

1 Recovery: the total symptom score than before treatment and reduce the rate of more than 95%

2 Excellence: the total symptom score than before treatment and reduce the rate greater than 70%, < 95%

3: the total symptom score than before treatment and reduce the rate greater than 30%, < 70%

4 invalid: not reach the effective standard

(three) criteria for evaluating the efficacy of target lesion area

1 basic recovery: normal skin or pigmentation, the target lesion area reduced more than 95%.

2 Effect: 95%> target lesion area reduced more than 70%

3: 70%> target lesion area reduced more than 30%

4 invalid: target lesion area reduced by < 30%, or anti expanded

Formula: [(before treatment area after treatment before treatment, area) area] * 100%

(four) the effect of individual symptoms and signs

1 disappear: symptoms or signs disappear

2 improvement: the score after treatment was lower than that before treatment

3 unchanged: after treatment, the integral value has not changed or increased

Nine, statistical processing

All data input with Excel, SPSS12.0 software system for statistics. The measurement data is expressed by the S, and the data rate is expressed. The measurement data between the groups as compared with normal distribution and homogeneity of variance using independent samples t test group before and after treatment were compared using paired t test; if not accord with normal distribution and homogeneity of variance nonparametric test was used to compare. Comparison of measurement data using X2 test of row list data.

Result

Integral comparison

The two groups before treatment symptom scores showed no significant difference (T = 0.20, P> 0.05); the treatment group was significantly lower than that of the integral Qingdai pill group, there was significant difference (T = 2.00, P< 0.05); the two groups before and after treatment were significant points difference (P< 0.05). Specifically, numerical see table 10:

Table 10 comparison of the scores between the two groups before and after treatment (+ S)

Group number (n) score before treatment

The treatment group was 4718.72 + 4.88 + 4.21 + 4.93

4018.58 + 5.32 group Qingdai pill 8.58 + 6.82

The treatment group before and after treatment. The integral: T = 16.08, P< 0.05; integral comparison before and after treatment of Qingdai pill: T = 8.95, P< 0.05.

Two, clinical efficacy

(a) curative effect comparison

The total effects of the two groups: the treatment group was significantly better than Qingdai pill group, there was significant difference (X2=10.55, P< 0.05); the cure rate and total effective rate in the treatment group were significantly higher than that of Qingdai pill group, there was significant difference (P< 0.05) 3, the specific value is shown in table 11:

Table 11 comparison of clinical efficacy between the two groups (cases,%)

group

Number of cases (n)

curative effect

Cure rate (%)

Total effective rate (%)

recovery

Effective

effective

invalid

treatment group

Forty-seven

Nineteen

Seventeen

Eight

Three

Forty point four

Ninety-three point six two

Qingdai pill group

Forty

Six

Fourteen

Ten

Ten

Fifteen

Seventy-five

The cure rate comparison: X2=6.82, P< 0.05; the total efficiency comparison: X2=5.89, P< 0.05.

(two) comparison of TCM Syndrome Types

The effect of two kinds of drugs on the efficacy of the same syndrome of blood heat syndrome: the treatment group cure rate and total effective rate was significantly higher than the control group, but no significant difference (P> 0.05); two groups of blood heat with blood stasis syndrome total curative effect is no significant difference (P> 0.05), but the curative rate of treatment group obviously higher than the control group, there was significant difference (P< 0.05); treatment group was better than control blood deficiency and wind dryness effect, there was significant difference (P< 0.05), the curative rate of treatment group was significantly higher than the control group, there was significant difference (P< 0.05). Specific values are shown in table 12:

The effect of two kinds of drugs on the efficacy of different syndromes in treatment group: blood deficiency and wind dryness syndrome group and blood heat with blood stasis syndrome group cure rate and total effective rate were higher than the blood heat syndrome group, but there was no significant difference (P > 0.05); the control group of blood heat syndrome cure rate and total effective rate were the highest, blood deficiency and wind dryness the lowest card, but there was no significant difference (P > 0.05). Specific values are shown in table 12:

Table 12 comparison of curative effect of different syndromes in the two groups (cases,%)

TCM syndrome type

group

Number of cases (n)

curative effect

Recovery rate (%)

Total effective rate (%)

recovery

Effective

effective

invalid

Blood heat syndrome

treatment group

Twelve

Four

Three

Four

One

Fifty-eight point three three

Ninety-one point six seven

Qingdai pill group

Twelve

Two

Six

Three

One

Sixty-six point six seven

Ninety-one point six seven

Blood heat with blood stasis syndrome

treatment group

Sixteen

Seven

Six

Two

One

Eighty-one point two five

Ninety-three point seven five

Qingdai pill group

Thirteen

Two

Four

Four

Three

Forty-six point one five

Seventy-six point nine two

Blood deficiency and wind dryness

treatment group

Nineteen

Eight

Eight

Two

One

Eighty-four point two one

Ninety-four point seven four

Qingdai pill group

Fifteen

Two

Four

Three

Six

Forty

Sixty

Comparison of two groups of blood heat syndrome total curative effect: X2=1.81, P> 0.05; the cure rate comparison: X2 = 0.21, P> 0.05; the total efficiency comparison: X2 = 0.89, P> 0.05. Comparison of two groups of blood heat with blood stasis syndrome total curative effect: X2=4.58, P> 0.05; rate comparison: X2=3.91, P< 0.05. Comparison of two groups of blood deficiency and wind dryness, the total effect: X2=8.35, P< 0.05; rate comparison: X2=7.17, P< 0.05. The treatment group of three types of syndrome curative effect comparison: X2=1.81, P > 0.05; the control group of the efficacy of the three syndromes: X2=4.21, P > 0.05.

Tips from Yin Yang soup has good curative effect on three kinds of syndromes, more suitable for blood deficiency and wind dryness psoriasis, its clinical efficacy is superior to compound Qingdai pill.

Three, laboratory examination

The results of IL-2, IL-6 and IL-8 are shown in table 13.

The treatment group before and after treatment in 20 cases of serum IL-2, IL-6, IL-8, and 10 cases of normal people (normal control group) were compared: compared with normal control group was significantly elevated in patients with IL-2 before treatment, IL-6 and IL-8, there was significant difference (P< 0.05); after treatment, IL-6, IL-2 the level of IL-8 were significantly lower than before treatment, there was significant difference (P< 0.05); but after the treatment of IL-2, IL-6, IL-8 level was still higher than the normal control group, there was significant difference (P< 0.05).

Table 13 comparison of IL-2, IL-6 and IL-8 levels before and after treatment in the treatment group (+ S)

Number of groups (n)

IL-2 (ng/ml)

IL-6 (ng/ml)

IL-8 (ng/ml)

Normal control group

Ten

5.69 + 0.58

116.50 + 10.83

0.33 + 0.34

treatment group

Before treatment

Twenty

8.99 + 1.23

156.35 + 8.95

0.70 + 0.08

After treatment

Twenty

6.86 + 0.65

140.41 + 6.68

0.48 + 0.06

IL-2 and IL-6 before treatment and IL-8 levels compared with normal control group T values were 8.02, 10.72, 13.46, P< 0.05; IL-2, IL-6, IL-8 before and after treatment, compared the level of T = 10.47, 9.34, 15.86, P< 0.05; after treatment IL-2, IL-6, IL-8 levels compared with control group the T values were 4.76, 7.49, 7.29, P< 0.05.

Part four: comparison of the results of partial recovery

In 25 cases of PV cured patients were followed up for 6 months, compared to the risk of recurrence, the recurrence rate of treatment group was significantly lower than that of Qingdai pill group, there was significant difference (P< 0.05). Specific values are shown in table 14:

Table 14 comparison of the results of partial recovery (case,%)

Group

Follow up cases (n)

Recurrence (n)

No recurrence (n)

Recurrence rate (%)

treatment group

Nineteen

Two

Seventeen

Ten point five three

Qingdai pill group

Six

Three

Three

Fifty

There was significant difference between the two groups in recurrence rate, X2=4.44, P< 0.05.

Five, safety observation results

On the part of PV patients before and after treatment, blood routine, urine routine, stool routine + occult blood, liver and kidney function (ALT, BUN, Cr), electrocardiogram, blood pressure, respiration, body temperature, heart rate detection, found no obvious abnormalities.

Six, adverse reactions

The treatment group patients 1 cases had mild diarrhea, 2 cases had mild stomach discomfort, the incidence of adverse reaction was 6.38%, of which 1 cases of traditional Chinese medicine for cold clothes, before meals, after meals, hot clothes have their symptoms disappeared, the remaining 2 cases with less frequency of service or after meals, may also alleviate the symptoms. More than no discomfort. Qingdai pill group there were 3 cases of adverse reactions in 4 weeks after treatment, 1 cases with abdominal pain, diarrhea, medication reduction after remission; 1 cases with menorrhagia and 1 cases after medication withdrawal; poor appetite, poor sleep, but to take the medicine. The incidence of adverse reactions and adverse reactions were shown in table 15.

Table 15 comparison of adverse drug reactions between the two groups (cases,%)

Group

Number of cases (n)

Number of cases (n)

Incidence (%)

treatment group

Forty-seven

Three

Six point three eight

Qingdai pill group

Forty

Three

Seven point five

There was no significant difference in the incidence of adverse reactions between the two groups, X2=0.04, P > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > 0.05.

Table 16 distribution of adverse reactions (table)

group

Number of cases (n)

skin

Dry

Dry mouth

headache

diarrhea

abdominal pain

Stomach upset

menstruation

The amount of

Poor sleep

Skin Itch

treatment group

Forty-seven

One

Two

Qingdai pill group

Forty

One

One

One

Conclusion

An elderly. Psoriasis is mainly blood stasis symptoms or blood deficiency and wind dryness syndrome, syndrome with nourishing Yin, detoxification. From the treatment of Yin Yang soup, to the elderly in the pathogenesis of psoriasis, clinical observation, curative effect, significantly better than fufangqingdaiwan group, and the recurrence rate is low. Therefore, it is an ideal medicine to treat middle and old aged patients with psoriasis.

Two. The results indicated that detection of serum cytokines in patients with psoriasis, IL-2, IL-6, IL-8 increased significantly, cytokine levels decreased significantly after treatment, IL-2, IL-6 and IL-8 may be involved in the pathogenesis of psoriasis, development and outcome of the process, has an important significance in the pathogenesis of psoriasis; after treatment with symptoms and signs of improvement. IL-2, IL-6, IL-8 failed to return to normal levels, suggesting that IL-2, IL-6, IL-8 and recurrence of psoriasis may have a certain relationship, which may be a potential factor to the recurrence of psoriasis.

Three. From the Yin Yang decoction after treatment with clinical signs and symptoms improved, IL-2, IL-6 and IL-8 were significantly decreased, indicating a mechanism of action from the Yin Yang soup may play a therapeutic role by regulating cytokine levels, as to what role in regulating cytokines, still need further study.

Four.IL-2, IL-6, IL-8 are closely related to the occurrence, development and prognosis of psoriasis. Therefore, it may provide a new prospect for the treatment of psoriasis to seek IL-2IL-6 and IL-8 antagonists.

 

www.Cure001.comwww.Cure999.com

Cerebral Vascular Disease,Acne,Heart Disease,Deaf,Headache,Std,Condyloma Acuminatum,Fibroid,Pneumonia,Brain Trauma,。 Rehabilitation Blog 

Rehabilitation Blog @ 2017