针灸联合自血疗法治疗慢性荨麻疹(血虚风燥型)效果及对UAS评分、外周血T淋巴细胞STAT3 mRNA表达水平的影响
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摘要
目的:探讨针灸联合自血疗法对血虚风燥型慢性荨麻疹患者的治疗效果及荨麻疹活动性评分(UAS)、外周血T淋巴细胞信号转导与转录激活因子3(STAT3)mRNA表达水平的影响。方法:将94例血虚风燥型慢性荨麻疹患者随机分为对照组与观察组,每组47例,对照组采用自血疗法治疗,观察组加用针灸疗法,评估两组疗效及中医症状、体征积分的改善情况,采用UAS评分评定患者治疗前后荨麻疹风团数量及瘙痒程度的变化,并于治疗前后留取外周血,测定患者外周血T淋巴亚群(CD~+_3、CD~+_4、CD~+_8、CD~+_4/CD~+_8)及STAT3 mRNA表达水平的变化。结果:①治疗4周,两组瘙痒程度、皮损分布、风团大小、皮损红斑、皮损数量等中医症状及体征积分积分均降低(P<0.05),观察组各积分均低于对照组(P<0.05);②观察组总有效率高于对照组(P<0.05);③治疗4周,两组UAS表各维度评分及总分均降低(P<0.05),观察组UAS评分低于对照组(P<0.05);④治疗4周,两组CD~+_4上升,CD~+_8降低,CD~+_4/CD~+_8上升及外周血T淋巴细胞STAT3 mRNA水平降低(P<0.05),观察组CD~+_4、CD~+_4/CD~+_8、STAT3 mRNA水平低于对照组,CD~+_8水平高于对照组(P<0.05)。结论:针灸联合自血疗法治疗血虚风燥型慢性荨麻疹可改善患者症状及体征,提高治疗效果,降低UAS评分,改善其免疫功能,下调外周血T淋巴细胞STAT3 mRNA表达水平。
Objective:To investigate the therapeutic effect of acupuncture combined with autohemotherapy on patients with blood-deficiency and wind-dryness type chronic urticaria and the influence on the urticaria activity score(UAS) and expression level of T lymphocyte signal transduction and transcriptional activator 3(STAT3) mRNA in peripheral blood. Methods:Ninety-four patients with blood-deficiency and wind-dryness type chronic urticaria were randomly divided into the control group and the observation group, 47 patients in each group. The control group was treated with autohemotherapy and the observation group was additionally treated with acupuncture. The curative effect, improvement of TCM symptoms and signs in both groups were evaluated. Changes in the number of urticaria and the degree of pruritus before and after treatment were evaluated with UAS score. Peripheral blood was collected before and after treatment to determine changes in expression levels of T lymphocyte subsets(CD~+_3, CD~+_4, CD~+_8, CD~+_4/CD~+_8) and STAT3 mRNA. Results:①Scores of TCM symptoms and signs such as the degree of pruritus, distribution of skin lesions, size of urticaria, erythema of skin lesions and number of lesions in both groups were decreased after 4 weeks treatment(P<0.05), and the scores of the observation group were lower than those of the control group(P<0.05). ②The total effective rate of the observation group was higher than that of the control group(P<0.05).③UAS scores and the total score were decreased after 4 weeks treatment(P<0.05), and the UAS score of the observation group was lower than that of the control group(P<0.05). ④CD~+_4 and CD~+_4/CD~+_8 were increased, while CD~+_8 and the level of T lymphocyte STAT3 mRNA in peripheral blood were decreased after 4 weeks treatment(P<0.05). Levels of CD~+_4, CD~+_4/CD~+_8 and STAT3 mRNA in the observation group were lower than those in the control group, and the level of CD~+_8 was higher than that of the control group(P<0.05). Conclusion:Acupuncture combined with autohemotherapy for blood-deficiency and wind-dryness type chronic urticaria can improve the symptoms and signs and the therapeutic effect, decrease the UAS score, improve the immune function, and down-regulate the expression of T lymphocyte STAT3 mRNA in peripheral blood.
Objective:To investigate the therapeutic effect of acupuncture combined with autohemotherapy on patients with blood-deficiency and wind-dryness type chronic urticaria and the influence on the urticaria activity score(UAS) and expression level of T lymphocyte signal transduction and transcriptional activator 3(STAT3) mRNA in peripheral blood. Methods:Ninety-four patients with blood-deficiency and wind-dryness type chronic urticaria were randomly divided into the control group and the observation group, 47 patients in each group. The control group was treated with autohemotherapy and the observation group was additionally treated with acupuncture. The curative effect, improvement of TCM symptoms and signs in both groups were evaluated. Changes in the number of urticaria and the degree of pruritus before and after treatment were evaluated with UAS score. Peripheral blood was collected before and after treatment to determine changes in expression levels of T lymphocyte subsets(CD~+_3, CD~+_4, CD~+_8, CD~+_4/CD~+_8) and STAT3 mRNA. Results:①Scores of TCM symptoms and signs such as the degree of pruritus, distribution of skin lesions, size of urticaria, erythema of skin lesions and number of lesions in both groups were decreased after 4 weeks treatment(P<0.05), and the scores of the observation group were lower than those of the control group(P<0.05). ②The total effective rate of the observation group was higher than that of the control group(P<0.05).③UAS scores and the total score were decreased after 4 weeks treatment(P<0.05), and the UAS score of the observation group was lower than that of the control group(P<0.05). ④CD~+_4 and CD~+_4/CD~+_8 were increased, while CD~+_8 and the level of T lymphocyte STAT3 mRNA in peripheral blood were decreased after 4 weeks treatment(P<0.05). Levels of CD~+_4, CD~+_4/CD~+_8 and STAT3 mRNA in the observation group were lower than those in the control group, and the level of CD~+_8 was higher than that of the control group(P<0.05). Conclusion:Acupuncture combined with autohemotherapy for blood-deficiency and wind-dryness type chronic urticaria can improve the symptoms and signs and the therapeutic effect, decrease the UAS score, improve the immune function, and down-regulate the expression of T lymphocyte STAT3 mRNA in peripheral blood.
引文
[1] 周策,张福蓉,王栩芮,等.刺络放血疗法联合消风散治疗血虚风燥型慢性荨麻疹的临床观察[J].中华中医药杂志,2016,31(4):1496-1499.
[2] Metz M,Ohanyan T,Church MK,et al.Omalizumab is an effective and rapidly acting therapy in difficult-to-treat chronic urticaria:a retrospective clinical analysis[J].Journal of Dermatological Science,2014,73(1):57-62.
[3] 郭静,周策.自拟消风散治疗血虚风燥型慢性荨麻疹的临床疗效观察[J].广州中医药大学学报,2014,31(4):514-517.
[4] Rorie A,Goldner WS,Lyden E,et al.Beneficial role for supplemental vitamin D3 treatment in chronic urticaria:a randomized study[J].Annals of Allergy Asthma & Immunology,2014,112(4):376-382.
[5] 李俞晓,韩婷梅,芦洁,等.非索非那定联合润燥止痒胶囊治疗血虚风燥型慢性荨麻疹临床观察[J].中国中西医结合皮肤性病学杂志,2017,16(3):236-237.
[6] 中华医学会皮肤性病学分会免疫学组.中国荨麻疹诊疗指南[S].中华皮肤科杂志,2014,47(7):514-516.
[7] 赵尚华.中医外科学[S].北京:人民卫生出版社,2007:126-131.
[8] 郑筱萸.中药新药临床研究指导原则[S].中国医药科技出版社,2002:126-128.
[9] M?ynek A,Zalewskajanowska A,Martus P,et al.How to assess disease activity in patients with chronic urticaria?[J].Allergy,2008,63(6):777-780.
[10] 刘月,陈春海,刘春,等.纪青山教授针灸治疗血虚风燥型慢性湿疹[J].长春中医药大学学报,2016,32(6):1107-1109.
[11] 唐苏为,谢韶琼,宋勋,等.中药慢湿煎剂治疗血虚风燥型湿疹的疗效评价[J].现代中西医结合杂志,2016,25(12):1255-1257.
[12] Zhong H,Song Z,Chen W,et al.Chronic urticaria in Chinese population:a hospital‐based multicenter epidemiological study[J].Allergy,2014,69(3):359-364.
[13] 谭克平,李新伟,吴欣.穴位埋线结合中药治疗慢性荨麻疹临床疗效观察[J].中华中医药学刊,2016,34(4):991-993.
[14] Moy AP,Murali M,Nazarian RM.Identification of a Th2- and Th17-skewed immune phenotype in chronic urticaria with Th22 reduction dependent on autoimmunity and thyroid disease markers[J].Journal of Cutaneous Pathology,2016,43(4):372-378.
[15] 王进,陈健.中西医结合治疗慢性荨麻疹临床疗效观察及安全性评价[J].中华中医药学刊,2015,33(3):766-768.
[16] Kutlu A,Karabacak E,Aydin E,et al.A patient with steroids and antihistaminic drug allergy and newly occurred chronic urticaria angioedema:What about Omalizumab?[J].Human & Experimental Toxicology,2014,33(8):882-885.
[17] 邓晶晶.针刺联合穴位自血疗法治疗慢性湿疹的临床研究[J].针灸临床杂志,2018,34(1):15-18.
[18] Gorczyza M,Schoepke N,Krause K,et al.Patients with chronic cold urticaria may benefit from doxycycline therapy[J].British Journal of Dermatology,2016,176(1):259-261.
[19] 阳媚,吴钱红,杨红杰.穴位自血疗法治疗慢性荨麻疹及对Th1/Th2细胞因子的影响[J].针灸临床杂志,2016,32(1):5-8.
[20] 陈平,颜纯钏,王万春,等.热敏灸联合自血穴位注射治疗卫外不固型慢性荨麻疹的临床研究[J].中华中医药杂志,2017,32(5):2075-2078.
[21] 李小莎.自血穴位注射联合盐酸奥洛他定治疗慢性荨麻疹48例临床疗效及安全性评价[J].湖南中医药大学学报,2016,36(9):75-78.
[22] 王小琴,温馨,赵鹏.自血穴位注射疗法联合氯雷他定治疗ASST阳性的慢性荨麻疹120例疗效观察[J].重庆医学,2015,44(4):490-491.
[23] Sharma M,Bennett C,Carter B,et al.H1-antihistamines for chronic spontaneous urticaria:An abridged Cochrane Systematic Review[J].Journal of the American Academy of Dermatology,2015,73(4):710-716.
[24] 由丽娜,陈丽蓉,宋国宏,等.足三里穴位自血疗法联合地氯雷他定治疗胆碱能性荨麻疹的临床观察[J].中国现代医学杂志,2016,26(17):72-74.
[25] 陈耿明,黄国强,黄亿平.自血疗法肌肉注射治疗慢性荨麻疹的疗效观察及对免疫学指标的影响[J].临床和实验医学杂志,2017,16(14):1376-1379.
[2] Metz M,Ohanyan T,Church MK,et al.Omalizumab is an effective and rapidly acting therapy in difficult-to-treat chronic urticaria:a retrospective clinical analysis[J].Journal of Dermatological Science,2014,73(1):57-62.
[3] 郭静,周策.自拟消风散治疗血虚风燥型慢性荨麻疹的临床疗效观察[J].广州中医药大学学报,2014,31(4):514-517.
[4] Rorie A,Goldner WS,Lyden E,et al.Beneficial role for supplemental vitamin D3 treatment in chronic urticaria:a randomized study[J].Annals of Allergy Asthma & Immunology,2014,112(4):376-382.
[5] 李俞晓,韩婷梅,芦洁,等.非索非那定联合润燥止痒胶囊治疗血虚风燥型慢性荨麻疹临床观察[J].中国中西医结合皮肤性病学杂志,2017,16(3):236-237.
[6] 中华医学会皮肤性病学分会免疫学组.中国荨麻疹诊疗指南[S].中华皮肤科杂志,2014,47(7):514-516.
[7] 赵尚华.中医外科学[S].北京:人民卫生出版社,2007:126-131.
[8] 郑筱萸.中药新药临床研究指导原则[S].中国医药科技出版社,2002:126-128.
[9] M?ynek A,Zalewskajanowska A,Martus P,et al.How to assess disease activity in patients with chronic urticaria?[J].Allergy,2008,63(6):777-780.
[10] 刘月,陈春海,刘春,等.纪青山教授针灸治疗血虚风燥型慢性湿疹[J].长春中医药大学学报,2016,32(6):1107-1109.
[11] 唐苏为,谢韶琼,宋勋,等.中药慢湿煎剂治疗血虚风燥型湿疹的疗效评价[J].现代中西医结合杂志,2016,25(12):1255-1257.
[12] Zhong H,Song Z,Chen W,et al.Chronic urticaria in Chinese population:a hospital‐based multicenter epidemiological study[J].Allergy,2014,69(3):359-364.
[13] 谭克平,李新伟,吴欣.穴位埋线结合中药治疗慢性荨麻疹临床疗效观察[J].中华中医药学刊,2016,34(4):991-993.
[14] Moy AP,Murali M,Nazarian RM.Identification of a Th2- and Th17-skewed immune phenotype in chronic urticaria with Th22 reduction dependent on autoimmunity and thyroid disease markers[J].Journal of Cutaneous Pathology,2016,43(4):372-378.
[15] 王进,陈健.中西医结合治疗慢性荨麻疹临床疗效观察及安全性评价[J].中华中医药学刊,2015,33(3):766-768.
[16] Kutlu A,Karabacak E,Aydin E,et al.A patient with steroids and antihistaminic drug allergy and newly occurred chronic urticaria angioedema:What about Omalizumab?[J].Human & Experimental Toxicology,2014,33(8):882-885.
[17] 邓晶晶.针刺联合穴位自血疗法治疗慢性湿疹的临床研究[J].针灸临床杂志,2018,34(1):15-18.
[18] Gorczyza M,Schoepke N,Krause K,et al.Patients with chronic cold urticaria may benefit from doxycycline therapy[J].British Journal of Dermatology,2016,176(1):259-261.
[19] 阳媚,吴钱红,杨红杰.穴位自血疗法治疗慢性荨麻疹及对Th1/Th2细胞因子的影响[J].针灸临床杂志,2016,32(1):5-8.
[20] 陈平,颜纯钏,王万春,等.热敏灸联合自血穴位注射治疗卫外不固型慢性荨麻疹的临床研究[J].中华中医药杂志,2017,32(5):2075-2078.
[21] 李小莎.自血穴位注射联合盐酸奥洛他定治疗慢性荨麻疹48例临床疗效及安全性评价[J].湖南中医药大学学报,2016,36(9):75-78.
[22] 王小琴,温馨,赵鹏.自血穴位注射疗法联合氯雷他定治疗ASST阳性的慢性荨麻疹120例疗效观察[J].重庆医学,2015,44(4):490-491.
[23] Sharma M,Bennett C,Carter B,et al.H1-antihistamines for chronic spontaneous urticaria:An abridged Cochrane Systematic Review[J].Journal of the American Academy of Dermatology,2015,73(4):710-716.
[24] 由丽娜,陈丽蓉,宋国宏,等.足三里穴位自血疗法联合地氯雷他定治疗胆碱能性荨麻疹的临床观察[J].中国现代医学杂志,2016,26(17):72-74.
[25] 陈耿明,黄国强,黄亿平.自血疗法肌肉注射治疗慢性荨麻疹的疗效观察及对免疫学指标的影响[J].临床和实验医学杂志,2017,16(14):1376-1379.