张丽霞 王倩 赵蓓 卢葳 段西凌

[摘要]目的：觀察雷公藤多苷与甘草酸制剂分别联合抗组胺药治疗特应性皮炎（Atopic dermatitis，AD）的疗效。方法：将80例特应性皮炎（AD）患者，按随机数字表法分为雷公藤组及甘草酸苷组。其中甘草酸苷组给予甘草酸制剂+枸地氯雷他定+依巴斯汀治疗;雷公藤组除给予雷公藤多苷代替甘草酸制剂外，其余治疗同甘草酸苷组，治疗期间每2周观察患者治疗前后临床症状积分（SCORAD评分及VAS评分）、白细胞介素-4（IL-4）、干扰素-γ（INF-γ）、血常规、嗜酸性粒细胞计数变化及不良反应发生情况，计算相关指标下降百分比，共观察8周。结果：在2周后观察到雷公藤组及甘草酸苷组患者病情均有缓解，雷公藤组症状有效改善率为40%，明显高于甘草酸苷组的22.5%;追踪病情至8周，雷公藤组症状有效改善率为94.7%，明显高于甘草酸苷组的73.6%，差异均有统计学意义（P<0.05）。每2周检测相关指标并进行分析，各个时间点雷公藤组各相关指标下降（上升）百分比较甘草酸苷组下降（上升）速度更快，且在2周左右各指标下降（上升）最快，之后各百分比下降（上升）速度减慢。两组药物疗效均与药物在体内积累有直接关系。两组不良反应发生率比较：雷公藤多苷白细胞降低发生率较甘草酸苷组增多，多发生在治疗2～4周，停止用药后给予升白片对症治疗，可恢复正常。甘草酸制剂引起面部水肿2例，停药后可恢复正常。结论：雷公藤多苷配合抗组胺药较甘草酸制剂配合抗组胺药治疗AD具有治疗起效快，疗效更持久特点。

[关键词]特应性皮炎;雷公藤多苷;甘草酸苷;抗组胺药物;白细胞介素-4;疗效

[中图分类号]R751.05    [文献标志码]A    [文章编号]1008-6455（2019）02-0073-04

Abstract：  Objective  To observe the effect of tripterygium glycosides and compound glycyrrhizin combined with antihistamines in treatment of atopic dermatitis. Methods  80 patients with AD were divided into two groups according to random number table method： Tripterygium wilfordii group and glycyrrhizin group， Glycyrrhizin group was given glycyrrhizic acid preparation + desloratadine citrate + ebastine treatment scheme， Tripterygium wilfordii group was given Tripterygium wilfordii polyglycosides instead of glycyrrhizin preparation， the rest of the treatment was the same， observed for 8 weeks.The clinical symptom scores （SCORAD score and VAS score）， IL-4， INF-γ， blood routine， eosinophil count change and adverse reaction were observed every 2 weeks before and after treatment， and the decrease percentage was also calculated （pre treatment index treatment index） /pre treatment index. Results  After 2 weeks， the condition of Tripterygium wilfordii group and glycyrrhizin group were relieved. The effective improvement rate of Tripterygium wilfordii group was 40% ， which was significantly higher than that of glycyrrhizin group （22.5% ）.After 8 weeks， the effective improvement rate of the Tripterygium wilfordii group was 94.7%， which was still significantly higher than that of the glycyrrhizin group （P<0.05） .By analyzing the related indicators detected every two weeks， it was found that the percentage of related indicators in Tripterygium wilfordii group decreased （increased） faster than that in glycyrrhizin group at each time point， and the index decreased （increased） fastest in about 2 weeks， then the percentage decreased （increased） slowed down.The efficacy of both groups was directly related to the accumulation of drugs in vivo.The incidence of adverse reaction： the incidence of leucocytosis of Tripterygium wilfordii was increased more than that in the experimental group， which occurred more in the 2-4 week treatment. Two cases of facial edema were caused by glycyrrhizin preparation. Conclusion  Tripterygium wilfordii polyglycoside combined with antihistamine is more effective than glycyrrhizic acid combined with antihistamine in the treatment of AD.

Key words： atopic dermatitis; tripterygium wilfordii glycosides; glycyrrhizin preparation; antihistamine; IL-4; curative effect

AD是皮肤科发病率及复发率最高的疾病之一，其发病机制复杂[1]，严重影响患者生活质量和工作。激素疗法是目前用于治疗AD最常用的方法，但激素也是患者最惧怕的药物之一。而雷公藤多苷与甘草酸制剂是最常用激素的有效替代药物，本文目的在于比较雷公藤多苷与甘草酸制剂配合抗组胺药治疗特应性皮炎的疗效，现报道如下。

1  资料和方法

1.1 一般资料：选取2016年1月-2018年5月在四川省人民医院皮肤科门诊治疗的80例AD患者为研究对象，按照随机数字表法分为雷公藤组及甘草酸苷组，每组各40例。……