论著
当归四逆汤对慢性荨麻疹患者的临床疗效分析
陈坚
【摘要】 【摘要】目的 探讨中药当归四逆汤对慢性荨麻疹患者血清炎性反应、免疫机制与临床疗效及生活质量影响。
【关键字】 荨麻疹,超敏C反应蛋白,血浆D-二聚体,慢性,中药,疗效
中图分类号：文献标识码：文章编号：
[Abstract] Objective To investigate the effect of Danggui Sini Decoction on serum inflammatory response,immune mechanism,clinical efficacy and quality of life in patients with chronic urticaria. Methods 180 cases of chronic urticaria diagnosed from December 2017 to October 2018 were selected and randomly divided into Chinese medicine group and control group. The patients in the control group were given mizolastine sustained-release tablets 10 mg/time/day, while the patients in the Chinese medicine group were given Danggui Sini Decoction on the basis of the control group for eight weeks. Before and after treatment, CD4+T lymphocyte subsets in peripheral venous blood were detected by flow cytometry, and the ratio of Th1/Th2 and Th17/Treg was calculated. Immunoturbidimetry was used to detect serum hypersensitive C-reactive protein,enzyme-linked immunosorbent assay was used to detect serum IL-17, and immunochemistry was used to detect plasma D-dimer. The changes of urticaria severity score (UAS7), dermatosis quality of life index (DLQI) and clinical efficacy were compared between the two groups. Results After treatment, Th1/Th2 in peripheral blood increased, Th17/Treg ratio decreased, serum hs-CRP,IL-17 and D-dimer levels decreased,symptom severity score decreased,skin disease quality of life index score improved and clinical efficacy improved in both groups. Among them,the improvement of the Chinese medicine group was better than that of the control group,and there was significant difference between the two groups before and after treatment(P<0.05). Conclusion Danggui Sini Decoction can significantly alleviate the clinical symptoms of chronic urticaria patients, improve the quality of life of patients, and improve the clinical efficacy. The mechanism of analysis is related to down-regulation of inflammatory reaction, correction of coagulation disorder and immune imbalance.
慢性荨麻疹是以自身免疫炎性反应为基础的皮肤科常见疾病，其临床主要以瘙痒、风团为典型表现，症状反复，经久不愈，给患者生活质量造成严重影响。针对慢性荨麻疹的治疗存在许多方案，但临床治疗多带来短期改善，治疗不彻底，难以痊愈。近年来，研究[1-3]显示免疫炎性反应与凝血机制异常是慢性荨麻疹主要发病机理。而传统医药对于抑炎、调节免疫等方面具有显著疗效，可以发挥其多靶点、多机制作用[4-5]。研究试分析中药当归四逆汤对慢性荨麻疹患者的临床疗效，从血清炎性反应、免疫机制等方面探讨其作用机制。
1 资料与方法
1.1 研究对象：选择2017年12月至2018年10月诊断慢性荨麻疹180例，男87例，女93例；年龄35～68岁，平均年龄（45.87±6.16）岁。荨麻疹诊断符合2009年美国荨麻疹诊断与分型指南。入组标准：①出现确定性风团皮疹，边界清楚；②剧痒症状，症状反复。排除标准：①药物性荨麻疹；②物理性荨麻疹；③合并肿瘤、急性感染性疾病者。研究得到医院伦理委员会批准，所有治疗方案获得患者或者家属的知情同意。
1.2 治疗方法：入组患者按照先后顺序，以随机数字表法分为中药组与对照组。2组患者性别、年龄差异无统计学意义（P＞0.05）。对照组患者给予咪唑斯汀缓释片10 mg/（次•d），中药组在对照组基础上给予加用当归四逆汤口服治疗，治疗时间8周。当归四逆汤组方：当归15 g、黄芪30 g、太子参10 g、云茯苓30 g、红花10 g、川穹9 g、防风30 g、生地黄15 g、全蝎10 g、地肤子10 g、白鲜皮10 g。每天水煎服至300 mL，分2次服用。
1.3 检验方法：治疗前后，流式细胞仪检测外周静脉血CD4+T淋巴细胞亚群、计算Th1/Th2、Th17/Treg比值变化。免疫比浊法检测血清超敏C反应蛋白、酶联免疫吸附法检测血IL-17，免疫化学法检测血浆D-二聚体，试剂盒购自南京建成生物科技有限公司，严格按照说明书操作进行。
1.4 临床疗效：比较2组患者荨麻疹严重程度评分（UAS7）、皮肤病生活质量指数评分（DLQI）变化。荨麻疹病情严重程度评分依据患者用药前后风团与瘙痒情况，总计42分，分数越高，代表病情越严重。皮肤病生活质量评分量表主要评估瘙痒对生活质量的影响，采用四级评分法，分值越少，代表病情越好。
1.5 统计学分析：采用SPSS 19.0统计软件进行数据分析，计数资料以率（%）表示，比较采用χ2检验，P＜0.05表示差异有统计学意义。