Clinical Observation And Mechanism Study Of Tripterygium Wilfordii In The Treatment Of Psoriasis

Part oneObjective To observe the efficacy and safety of Tripterygium wilfordii tablets combined with methotrexate in the treatment of moderate and severe psoriasis.Methods Patients with moderate and severe plaque psoriasis treated in Shandong Dermatology Hospital were collected and randomly divided into observation group and control group.The observation group was treated with Tripterygium wilfordii tablets combined with methotrexate,and the observation group was treated with methotrexate.The patients were followed up at 2 weeks,4 weeks and 8 weeks respectively.Before each administration,blood routine examination,liver and kidney function examination,skin lesions and tongue photos were taken,and pulse,PASI score,skin lesion area(BSA),static physician score(s PGA)and psoriasis quality of life score(DLQI)were recorded.Results 120 patients were included in this study,26 patients were discontinued and excluded,and 94 patients were followed up.There were46 cases in the observation group and 48 cases in the control group.The PASI scores of the observation group and the control group were 13.11±9.04,14.69 ±9.07 and 3.77 ±3.80,5.18 ±4.59 respectively after 8weeks(P < 0.05).The mean decrease of BSA in observation group and control group was 18.48 ±15.44 and 18.58 ±15.46 respectively after 8weeks,and the difference was statistically significant(P < 0.05),and the baseline data of s PGA observation group and control group were 1.54±0.84 and 1.94 ±0.81 after 8 weeks,respectively(P < 0.006).The baseline scores of DLQI observation group and control group were 12.93±4.78 and 12.60 ±4.58 respectively,and the difference was statistically significant.In terms of peripheral blood laboratory indexes,there was no significant difference in surface cell count,red blood cell count,liver and kidney function between the two groups,but red blood cell count and white blood cell count decreased with the cumulative dose of drugs in the two groups compared with the baseline phase.Compared with the baseline stage,the index of liver function increased,and the renal function was not significantly abnormal.For the occurrence of adverse events,the main adverse events of the two groups were stomach discomfort,elevated liver function and so on.According to the distribution of TCM syndrome types and TCM syndrome differentiation,there were 23 cases of blood heat syndrome,14 cases of blood stasis syndrome and 9 cases of blood dryness syndrome in the observation group.in the control group,there were 21 cases of blood heat syndrome,18 cases of blood stasis syndrome and 9 cases of blood dryness syndrome.According to the curative effect statistics,there was no significant difference in PASI score,BSA score,s PGA score and DLQI score at the 8th week.There was no significant difference among the three groups in the compliance rate of PASI50/PASI75/PASI90.Conclusion The effect of Tripterygium wilfordii tablets combined with methotrexate in the treatment of psoriasis is significantly better than that of methotrexate alone.Tripterygium wilfordii tablets combined with methotrexate will not lead to more adverse events.In the distribution of syndrome types of patients with psoriasis,the number of patients with blood-heat syndrome was the most,followed by blood stasis syndrome and blood dryness syndrome.Tripterygium wilfordii combined with methotrexate was higher than blood stasis syndrome.Part twoObjective To analyze the potential mechanism of triptolide in the treatment of psoriasis through transcriptome data,and verify it.Methods HaCat cells were cultured with triptolide and then cultured with triptolide for 24 hours.Total RNA was extracted,c DNA library was established,gene sequencing and differential expression of genes were counted.The differentially expressed genes were analyzed by KEGG and GO enrichment analysis,after enrichment of high and low expression genes,and highly differentially expressed genes.To explore the possible mechanism of triptolide on HaCat cells and the potential targeting genes.Results Through KEGG and GO enrichment analysis of differentially expressed genes,it was found that triptolide could exert antiinflammatory and anti-proliferation effects on known psoriasis-related signal pathways,such as KF-k B signal pathway,MAPK signal pathway,TGFbeta signal pathway,Wnt signal pathway,Fox O signal pathway and protein kinase signal pathway and NADH dehydrogenase complex Ⅰ.The genes with high specificity and high differential expression were screened,such as AURKA,PRSS8,NFKBIA,SNAI2 and TBX2.Highly specific expression of Lnc RNA,MIR222 HG,MIR17HG and so on was found.Verified by QRT-PCR,the expression of some genes such as ANRKA and SNAI2 was consistent with the transcriptome data.In terms of cytokine expression,triptolide significantly inhibited the expression of IL-6 and IL-8,and significantly inhibited the growth of HaCat cells.Conclusion Through transcriptome data analysis,we found the potential mechanism of triptolide on the inhibitory effect of triptolide on HaCat cells,which may be a potential mechanism for the treatment of psoriasis,and further verified some pathways.The inhibitory effect of triptolide on HaCat cells is clear and can significantly inhibit the expression of IL-6 and IL-8.