【摘要】：目的:痤瘡是臨床常見皮膚病,與中醫(yī)的“肺風(fēng)粉刺”相類似,發(fā)病機(jī)制較為復(fù)雜,現(xiàn)代醫(yī)學(xué)認(rèn)為痤瘡丙酸桿菌及炎癥反應(yīng)在整個痤瘡發(fā)病過程中尤為重要,痤瘡丙酸桿菌可刺激機(jī)體產(chǎn)生多種炎癥因子,有研究報道IL-17、IL-18和IFN-γ與炎癥反應(yīng)相關(guān),但與痤瘡具體關(guān)系尚不明確。痤瘡影響因素多,治療困難,臨床上多采用內(nèi)外同治、中西醫(yī)結(jié)合聯(lián)合抗炎的方法治療,其中,口服丹參酮膠囊、米諾環(huán)素聯(lián)合外用夫西地酸乳膏的治療方案取得較滿意療效。因此,為了研究IL-17、IL-18和IFN-γ與痤瘡的相關(guān)性,我們選擇口服丹參酮膠囊、米諾環(huán)素聯(lián)合外用夫西地酸乳膏的治療方案治療中重度痤瘡患者,檢測患者治療前后外周血中IL-17、IL-18和IFN-γ的水平,并且與健康對照組進(jìn)行比較,探討這些炎癥因子水平與中重度痤瘡之間的關(guān)系。方法:1.選擇符合入選標(biāo)準(zhǔn)的中重度痤瘡患者30例作為試驗組,選擇20例健康志愿者作為對照組。2.試驗組給予丹參酮膠囊(規(guī)格:250mg×24粒,河北興隆希力藥業(yè))1.0g,每日3次口服;鹽酸米諾環(huán)素膠囊(規(guī)格:50mg×20粒,惠氏制藥有限公司)50mg,每日2次口服;夫西地酸乳膏(規(guī)格:5g:0.1g,香港澳美制藥廠),適量,每天2次涂于患處,連續(xù)治療8周。對照組不做任何處理。3.分別抽取對照組,試驗組治療前、試驗組治療后的清晨空腹靜脈血3ml,離心取上清,-20℃保存?zhèn)溆谩?.用IL-17、IL-18和IFN-γ酶聯(lián)免疫吸附測定(ELISA)試劑盒(伊萊瑞特生物科技有限公司)分別檢測IL-17、IL-18和IFN-γ的血清水平。結(jié)果:1.口服丹參酮膠囊聯(lián)合鹽酸米諾環(huán)素膠囊配合外用夫西地酸乳膏治療中重度痤瘡,有效率達(dá)90%,不良反應(yīng)少。2.血清中IL-17的水平:對照組為(9.78±1.04)pg/ml,試驗組治療前為(15.27±3.79)pg/ml,試驗組治療后為(10.88±1.42)pg/ml。試驗組治療后較治療前水平降低(P0.05),試驗組治療前后的水平均高于對照組(P0.05)。3.血清中IL-18的水平:對照組為(14.65±2.17)pg/ml,試驗組治療前為(21.87±5.93)pg/ml,試驗組治療后為(15.91±4.81)pg/ml。試驗組治療后較治療前水平降低(P0.05),試驗組治療后的水平與對照組無統(tǒng)計學(xué)差異(P0.05)。4.血清中IFN-γ的水平:對照組為(889.79±197.82)pg/ml,試驗組治療前為(504.91±186.70)pg/ml,試驗組治療后為(767.74±200.45)pg/ml。試驗組治療后的水平較治療前升高(P0.05),但是仍低于對照組(P0.05)。結(jié)論:1.口服丹參酮膠囊聯(lián)合鹽酸米諾環(huán)素膠囊配合外用夫西地酸乳膏治療中重度痤瘡,療效好,不良反應(yīng)少。2.中重度痤瘡患者外周血IL-17和IL-18的水平高于健康人,IFN-γ的水平低于健康人。3.經(jīng)中西醫(yī)結(jié)合聯(lián)合抗炎治療8周后,中重度痤瘡患者皮疹好轉(zhuǎn),炎癥減輕,外周血IL-17和IL-18的水平降低,IFN-γ的水平升高。
[Abstract]:Objective: acne is a common clinical skin disease, similar to the traditional Chinese medicine "lung wind acne", the pathogenesis is more complex, modern medicine believes that acne Propionibacterium and inflammatory reaction in the whole process of acne is particularly important. Propionibacterium acnes can stimulate the production of many inflammatory factors. It has been reported that IL-17,IL-18 and IFN- 緯 are related to inflammatory reaction, but the specific relationship with acne is not clear. Acne is affected by many factors and difficult to treat. It is often treated with both internal and external treatment and combination of traditional Chinese and western medicine with anti-inflammatory methods. Among them, oral tanshinone capsule and minocycline combined with external Fusidic acid cream have achieved satisfactory curative effect. Therefore, in order to study the correlation between IL-17,IL-18 and IFN- 緯 and acne, we chose oral tanshinone capsule, minocycline combined with topical Fusidic acid cream to treat moderate and severe acne patients. The levels of IL-17,IL-18 and IFN- 緯 in peripheral blood of patients before and after treatment were measured and compared with those of healthy controls to explore the relationship between the levels of these inflammatory factors and moderate and severe acne. Methods: 1. Thirty moderate and severe acne patients were selected as trial group and 20 healthy volunteers as control group. Tanshinone capsules (specification: 250mg 脳 24, Hebei Xinglong Xili Pharmaceutical Industry) 1.0 g, Minocycline Hydrochloride capsules (50mg 脳 20, Wyeth Pharmaceutical Co., Ltd.) 50mg twice a day; Fossidy yoghurt cream (5 g: 0.1 g, Hong Kong, Australia and American Pharmaceutical Factory), 2 times a day, applied to affected area, continuous treatment for 8 weeks. The control group did not do any treatment. 3. The control group, the experimental group before treatment, the test group after treatment of fasting venous blood 3 ml in the morning, centrifuged supernatant, -20 鈩，

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