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重组人表皮生长因子凝胶联合中药治疗面部糖皮质激素依赖性皮炎疗效分析

2020-03-25尹诗张静罗丽娜韩俊

中国美容医学 2020年2期
关键词:依赖性皮炎生长因子

尹诗 张静 罗丽娜 韩俊

[摘要]目的:探討重组人表皮生长因子凝胶联合中药治疗面部糖皮质激素依赖性皮炎(FCAD)的疗效。方法:收集124例FCAD(热毒蕴结型)患者资料,随机分为对照组和观察组,两组均给予口服复方甘草酸苷片,对照组加用重组人表皮生长因子凝胶外敷治疗,观察组在对照组用药基础上加服中药(清热解毒方)治疗。观察两组治疗前及治疗4周后的中医症状积分,评估两组临床疗效,对比两组治疗前及治疗4周的皮肤功能指标和T淋巴亚群细胞水平。结果:治疗4周后,两组患者的红斑、丘疹、干燥脱屑及痛痒灼热四项中医症状评分均显著降低(P<0.05),观察组下降幅度显著大于对照组(P<0.05);观察组临床总有效率可达88.71%,显著高于对照组的72.58%(P<0.05);治疗4周后,两组患者的表皮油脂含水量、表皮含水量显著提高(P<0.05),经皮水分丢失(TEWL)值显著降低,两组患者的外周血CD4+、CD8+ T淋巴细胞亚群含量和CD4+/CD8+ T淋巴细胞亚群比值显著降低(P<0.05),观察组变化幅度显著大于对照组(P<0.05)。结论:重组人表皮生长因子凝胶联合中药治疗FCAD疗效确切,能明显减轻其红斑、丘疹、干燥脱屑及痛痒灼热等症状,有效促进皮损及早修复和皮肤屏障功能提高。

[关键词]面部糖皮质激素依赖性皮炎;重组人表皮生长因子凝胶;中药;皮肤功能指标;T淋巴亚群细胞水平

[中图分类号]R758.22    [文献标志码]A     [文章编号]1008-6455(2020)02-0095-04

Abstract: Objective To investigate the efficacy of recombinant human epidermal growth factor gel combined with traditional Chinese medicine in the treatment of facial corticosteroid addictive dermatitis (FCAD). Methods The data of 124 cases of FCAD patients (heat-toxic accumulating type of drug toxicity) were collected, and the patients were randomly divided into control group and observation group. They were given compound glycyrrhizin tablets, and control group was treated with external application of recombinant human epidermal growth factor gel, and observation group was additionally given traditional Chinese medicine (Qingre Jiedu prescription) on the basis of control group. The TCM symptoms scores were observed in the two groups before treatment and after 4 weeks of treatment. The clinical efficacy in the two groups was evaluated. The skin function indexes and T lymphocyte subsets were compared between the two groups before treatment and after 4 weeks of treatment. Results After 4 weeks of treatment, the scores of four items of TCM symptoms of erythema, papules, dry desquamation and itching and burning were significantly decreased in the two groups (P<0.05), and the decreases in observation group were significantly greater than those in control group (P<0.05). The total clinical effective rate was up to 88.71% in observation group, which was significantly higher than 72.58% in control group (P<0.05). After 4 weeks of treatment, the epidermal grease water content and epidermal water content were significantly increased in the two groups (P<0.05), and the transepidermal water loss (TEWL) value was significantly decreased, and the CD4+ and CD8+ T lymphocyte subsets and ratio of CD4+/CD8+ T lymphocyte subsets in peripheral blood in the two groups were significantly decreased (P<0.05), and the changes in observation group were significantly greater than those in control group (P<0.05). Conclusion Recombinant human epidermal growth factor gel combined with traditional Chinese medicine has exact efficacy in the treatment of FCAD, and it can significantly reduce the symptoms of erythema, papules, dry desquamation and itching and burning, and effectively promote the early repair of skin lesions and the improvement of skin barrier function.

2.3 两组治疗前后的皮肤功能指标对比:治疗4周后,两组患者的表皮油脂含水量、表皮含水量显著提高(P<0.05),TEWL值显著降低,观察组变化幅度显著大于对照组(P<0.05),见表4。

2.4 两组治疗前后T淋巴亚群细胞水平:治疗4周后,两组患者的外周血CD4+、CD8+T淋巴细胞亚群含量和CD4+/CD8+T淋巴细胞亚群比值显著降低(P<0.05),观察组变化幅度显著大于对照组(P<0.05),见表5。

3  讨论

中医认为,激素性温而燥,久用能助热生火,湿热邪积聚,蕴于肌肤,致局部皮肤气血运行失畅,迫血妄行;或心火炽盛,灼伤精血,或日久阴血耗伤,营卫不和,血行无力,瘀血内生,阻于肌表而生,出现红肿、痛痒等症[8]。中医治拟清热解毒、凉血泻火、散瘀消痈、利湿通淋之法。本研究中药采用清热解毒方疗之,其中以白花蛇舌草、金银花共2味药物能清血分之热,解气分蕴结之毒,共为君药;以黄芩、栀子共为臣药,共奏清热燥湿之功;佐以大黄、当归、丹参、枇杷叶、薏苡仁共6味药既能清热燥湿,泻火解毒,又能除瘀活血、抗菌消炎;使以甘草,多用于热毒证,能清热解毒、缓解止痛,调和诸药药性。

重组人表皮生长因子凝胶是通过基因重组技术合成高纯度的生物活性多肽,不仅能有效促进皮肤创面组织的DNA和RNA与羟脯氨酸的结合,以促进皮肤创面细胞再上皮化和细胞外基质合成,加速表皮增殖和创面覆盖修复,还可极强地促进多层面上表皮细胞增殖和表皮层厚度增加,改善正常表皮细胞的新陈代谢,以增强表皮屏障功能修复和重建[3]。本研究将重组人表皮生长因子凝胶联合中药治疗62例FCAD患者,治疗4周后的红斑、丘疹、干燥脱屑及痛痒灼热共4项中医症状评分有明显降低,且低于采用重组人表皮生长因子凝胶外敷治疗的62例患者,且观察组的临床总有效率可达88.71%,较对照组的72.58%高,提示上述治疗方案可缓解FCAD患者的红斑、丘疹、干燥脱屑及痛痒灼热等症状,提高临床疗效,与李红霞等[9]报道结果一致。

本文研究结果显示,观察组治疗4周的表皮油脂含水量、表皮含水量有明显提高,TEWL值有所降低,且以上改善效果优于对照组,提示重组人表皮生长因子凝胶联合中藥能改善FCAD患者的皮肤状态,促进其皮损修复。考虑患者皮肤改善的原因在于,清热解毒方中金银花不仅可抑制金黄色葡萄球菌、乙型链球菌的增殖,还可有效清除活性氧和羧基自由基;白花蛇舌草抑菌、消炎及镇静效果作用显著;黄芩能改善微血管通透性,抑制过敏介质失控性释放,并减轻急慢性炎症反应;而栀子抗菌、消炎、镇静、镇痛、降温、安眠等功效卓著;大黄、当归、丹参、枇杷叶、薏苡仁共5味中药的光谱抗菌作用显著,能降低细血管透性,抑制脂质过氧化,对炎症早期渗出和白细胞游走起明显的对抗作用。以上中药能以有效戒断糖皮质激素依赖症状,明显改善皮肤炎症反应,抑制皮肤微生物增殖,从而改善皮肤功能指标,促进皮损修复[10-12]。

其次,FCAD发生与皮肤局部T淋巴细胞水平失衡有关,由于长期使用糖皮质激素,造成CD4+T淋巴细胞亚群表达含量有所降低,而一旦中止高效糖皮质激素治疗后,对具有糖皮质激素效应的内源性抑制因子产生一定影响,进而导致免疫监视失调,促使免疫系统抵抗外来抗原反应能力减弱和自身抗原免疫应答亢进,造成CD4+/CD8+比值失衡,从而介导细胞因子和炎症介质的异常释放,引发面部酵母菌、毛囊蠕形螨等微生物大量增殖和变态反应性炎症增强,从而造成皮炎反复发生[13]。而本文中观察组治疗4周的外周血CD4+、CD8+T淋巴细胞亚群含量和CD4+/CD8+T淋巴细胞亚群比值均明显降低,且明显低于对照组,提示重组人表皮生长因子凝胶联合中药能有效纠正FCAD患者的T淋巴细胞亚群水平紊乱,减轻皮肤局部自身抗原免疫应答亢进状态,提高皮肤屏障功能。

综上,重组人表皮生长因子凝胶联合中药能有效改善FCAD患者相关临床症状,改善皮肤状态,促进皮损处修复,并提高皮肤屏障功能,疗效确切,考虑其机制可能与纠正局部皮肤细胞免疫功能紊乱,减轻自身抗原免疫应答亢进状态密切相关。

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[收稿日期]2019-07-31

本文引用格式:尹诗,张静,罗丽娜,等.重组人表皮生长因子凝胶联合中药治疗面部糖皮质激素依赖性皮炎疗效分析[J].中国美容医学,2020,29(2):95-98.

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