摘要
目的评定艾灸治疗伴肥胖斑块型银屑病患者的有效性及对辅助性T细胞17(Th17)相关炎性因子的影响,以探讨其作用机制。方法选取2020年10月2022年3月期间,诊断为斑块型银屑病并伴随肥胖的住院患者,共52例,按照简单随机化法分为艾灸组和对照组,治疗过程中对照组有2例病例脱落,最后实际观察共50例。其中艾灸组26例,对照组24例;又实际观察了10例诊断为斑块型银屑病而体质量正常的患者,作为非肥胖对照组。对照组和非肥胖对照组均给予常规治疗及中药黄连膏封包治疗;艾灸组在此基础上给予艾灸治疗。取穴:局部靶皮损处;足三里、丰隆、中脘、曲池、天枢和上巨虚,艾灸皮损处及以上穴位每日1次,每次15min,共4周。观察艾灸组与对照组治疗前后体质量、腰围、体质量指数(BMI)及银屑病皮损面积和严重程度指数(PASI)评分变化情况,血清白细胞介素-17A(IL-17A)、IL-23、IL-6、IL-22、瘦素(LEP)和肿瘤坏死因子-α(TNF-α)水平变化情况,以及艾灸组与非肥胖对照组治疗前后以上6个炎性因子水平变化情况。结果艾灸组治疗后较治疗前体质量、腰围、BMI和PASI评分均降低,差异有统计学意义(均P=0.000);对照组治疗前后只有PASI评分降低,差异有统计学意义(P=0.000);治疗后的艾灸组PASI评分较对照组降低,差异有统计学意义(P=0.020);艾灸组总有效率高于对照组,差异有统计学意义(P=0.016)。艾灸组治疗后较治疗前血清IL-17A、IL-23、IL-6、IL-22、LEP和TNF-α水平均下降,差异有统计学意义(P=0.000);对照组治疗后只有IL-17A和LEP水平较治疗前下降明显(P=0.008,P=0.000);治疗后的艾灸组IL-23、IL-6和TNF-α水平低于对照组,且差异有统计学意义(P=0.000,P=0.024,P=0.033)。治疗前的艾灸组与非肥胖对照组,血清IL-23、IL-17A、IL-6、IL-22、LEP和TNF-α水平比较差异无统计学意义(P>0.05);以上6个指标,2组治疗后较治疗前均下降(P=0.003,P=0.001,P=0.000,P=0.002);治疗后的艾灸组IL-17A、IL-22水平与非肥胖对照组比较差异无统计学意义(P>0.05)。结论艾灸治疗对肥胖患者体质量、腰围及BMI降低较对照组效果佳,并可降低银屑病患者PASI评分,主要对血清IL-23、IL-6和TNF-α水平降低明显;相对于非肥胖银屑病患者,艾灸组干预后IL-17A和IL-22水平降低可达到非肥胖对照组的水平。
Objective In order to evaluate the efficacy of moxibustion in the treatment of obese plaque psoriasis patients and its effects on T helper cell 17(Th17)-related inflammatory factors,so as to explore its mechanism of action.Methods From October 2020 to March 2022,a total of 52 hospitalized patients with plaque psoriasis and obesity were selected and randomly divided into the moxibustion group and the control group according to the random number table method.The process of the treatment,two cases dropped out in the control group,and finally a total of 50 cases were actually observed.Among them,there were 26 cases in the moxibustion group and 24 cases in the control group;10 cases of patients with normal weight who were diagnosed with plaque psoriasis were actually observed as the non-obese control group.Both the control group and the non-obese control group were given routine treatment and Chinese medicine Huanglian ointment for encapsulation treatment;the moxibustion group was given moxibustion treatment on this basis.Acupoint selection:local target skin lesions;Zusanli,Fenglong,Zhongwan,Quchi,Tianshu,Shangjuxu,and moxibustion at the skin lesions and above points once a day for 15 minutes each time,for four weeks.The changes of body weight,waist circumference,body mass index(BMI)and psoriasis area and severity index(PASI)score,and the changes of serum interleukin-17A(IL-17A),IL-23,IL-6,IL-22,leptin(LEP)and tumor necrosis factor-α(TNF-α)levels in the moxibustion group and the control group before and after treatment were measured.Changes in the levels of the above six inflammatory factors before and after treatment in the moxibustion group and the non-obese control group.Results After treatment,the weight,waist circumference,BMI and PASI score of the moxibustion group were lower than those before treatment,the differences were statistically significant(P=0.000).In the control group,only PASI scores decreased before and after treatment,the differences were statistically significant(P=0.000).After treatment,the PASI score reduction rate of the moxibustion group was significantly higher than that of the control group,the differences were statistically significant(P=0.020).The total effective rate in the moxibustion group was higher than that in the control group,the differences were statistically significant(P=0.016).After treatment,the serum levels of IL-17A,IL-23,IL-6,IL-22,LEP and TNF-αin the moxibustion group were significantly lower than those before treatment,the differences were statistically significant(P=0.000).In the control group,only the IL-17A and LEP levels decreased significantly compared with those before treatment(P=0.008,P=0.000).The levels of IL-23,IL-6 and TNF-αin the moxibustion group were lower than those in the control group after treatment,and there were significant differences(P=0.000,P=0.024,P=0.033).Before treatment,there were no significant differences in serum IL-23,IL-17A,IL-6,IL-22,LEP and TNF-αlevels between the moxibustion group and the non-obese control group(P>0.05).For the above six indicators,all the groups decreased compared with before treatment(P=0.003,P=0.001,P=0.000,P=0.002).The levels of IL-17A and IL-22 in the moxibustion group after treatment were not significantly different from those in the non-obese control group(P>0.05).Conclusion Moxibustion treatment has better effects on the reduction of body weight,waist circumference and BMI in obese patients than in the control group,and can reduce the PASI score of psoriasis patients,mainly on serum IL-23,IL-6 and TNF-αlevels.In non-obese patients with psoriasis,the levels of IL-17A and IL-22 in the moxibustion group after intervention decreased to the levels in the non-obese control group.
作者
李隽
韩静倩
李群燕
李芸芸
李悦
董玲玲
张楠楠
聂振华
Li Jun;Han Jingqian;Li Qunyan;Li Yunyun;Li Yue;Dong Lingling;Zhang Nannan;Nie Zhenhua(Affiliated Hospital of Tianjin Academy of Traditional Chinese Medicine,Tianjin 300120,China;Tianjin University of Traditional Chinese Medicine,Tianjin 301617,China)
出处
《中国中西医结合皮肤性病学杂志》
CAS
2024年第5期391-396,共6页
Chinese Journal of Dermatovenereology of Integrated Traditional and Western Medicine
基金
天津市卫生健康委员会中医药重点领域科研项目(编号:2020005)。
关键词
银屑病
肥胖
艾灸
炎性因子
Psoriasis
Obesity
Moxibustion
Inflammatory factors
