| Objective:Current studies have shown that sustained inflammatory response and uncontrolle d excessive keratinocyte proliferation are the key characteristics of the development of psorias is.In the clinical study,the efficacy of WaiYong YingJi ointment combined with Runzao Huo xue Jiedu decoction in the treatment of quiescent psoriasis vulgaris(blood dryness syndrome)was observed.The experimental study was based on p38MAPK/NF-κB signaling pathway to r egulate the expression of inflammatory cytokines and cell proliferation,so as to further explor e the mechanism of WaiYong YingJi ointment in the treatment of psoriasis vulgaris.Methods:This paper includes two parts:clinical study and animal study.Clinical part to obse rve the clinical efficacy of WaiYong YingJi ointment combined with Runzao Huoxue Jiedu de coction in the treatment of quiescent psoriasis vulgaris(blood dryness syndrome).Patients wit h quiescent psoriasis vulgaris in the dermatology Department of DongFang Hospital,of Beijin g University of Chinese Medicine were included and randomly divided into control group and observation group.On the basis of oral treatment of Runzao Huoxue Jiedu decoction,the two groups were respectively treated with Calcipotriol ointment and WaiYong YingJi ointment for a total of 8 weeks.Psoriasis area and severity index(PASI)score,visual analogue of pruritus(VAS)score,Development of Quality of Life(DLQI)and total effective rate of patients w ere observed and compared before treatment,4 weeks and 8 weeks after treatment,in order to explore the clinical efficacy of WaiYong YingJi ointment in the treatment of quiescent psorias is vulgaris.Animal studies were divided into three parts.Experiment 1 explored the effect of WaiYo ng YingJi ointment on mitosis of mouse vaginal epithelial cells in the estrogen stage,and esta blished the proliferation model of mouse vaginal epithelial cells with estrogen.After 7 days of treatment of the vagina of model group,control group and observation group with Vaseline.c arpotriol ointment and external emergency ointment,vaginal tissues were taken and pathologi cal sections were prepared.The mitotic index of vaginal epithelial cells in each group was co mpared.In experiment 2,to investigate the effect of topical WaiYong YingJi on the expression of PCNA and Involucrin in psoriasis Mice induced by imiquimod and establish the psoriasis mouse model induced by imiquimod.The psoriasis mice in control group and observation gro up were treated with Calcipotriol ointment and WaiYong YingJi ointment for 7 days,respectiv ely.The expressions of PCNA and Involucrin were detected and compared by immunohistoch emistry.Experiment 3 was based on p38MAPK/NF-κB signaling pathway to explore the mec hanism of WaiYong YingJi ointment in the treatment of psoriasis.The same animal model and intervention method as in the second part was used to observe the psoriasis lesions of mice,p erform PASI score,take the lesion tissue,perform Baker score and epidermal thickness measu rement,and detect the expression of inflammatory factors by ELISA.The expression and distr ibution of p38MAPK/NF-κB signaling pathway related proteins were detected by Western Bl ot and immunohistochemistry.Results:A total of 69 patients were included in the clinical study,including 33 patients in the control group and 36 patients in the observation group.There was no statistical significance in gender,age,course of disease and other aspects,indicating comparability(P>0.05).In the psoriasis PASI score comparison,before treatment,there was no statistical significance betwe en the two groups(P>0.05),which was comparable.GEE analysis showed that PASI scor es of the two groups were different at different time points,and the time effect was significant,with statistical significance(P<0.001).The interaction effect was significant,and the diff erence was statistically significant(P<0.001).After 4 weeks of treatment,the difference b etween the observation group and the control group was statistically significant(P<0.05).With the increase of treatment time,PASI score of both groups decreased compared with befo re,and the PASI score of the control group was better than that of the observation control grou p after 4 weeks of treatment.In the comparison of erythema,scale and infiltration scores,before treatment,there was no statistical significance between the two groups(P>0.05)which was comparable.GEE a nalysis showed that the scores of the two groups were different at different time points,and th e time effect of score change was significant,with statistical significance(P<0.001).Eryth ema interaction effect was not statistically significant.The interaction effect of scale and infilt ration was significant,with statistical significance(P<0.001).Among them,there was a st atistically significant difference in scale score between the observation group and the control group after 8 weeks of treatment(P<0.05).With the increase of treatment time,the scores of erythema,scale and infiltration in both groups were lower than before,and the scale score i n the observation group was better than that in the control group after 8 weeks of treatment.In the comparison of the total effective rate,the control group was 84.8%,and the observ ation group was 83.3%,the difference was not statistically significant(P>0.05),the effica cy of the two groups was similar.In terms of relieving pruritus,the effective rate was 58.1%i n the control group and 74.2%in the observation group,the difference was not statistically sig nificant(P>0.05).Before treatment,there was no significant difference in quality of life sc ore between the two groups(P>0.05),which was comparable.GEE analysis showed that DLQI scores of the two groups were different at different time points,the time effect was sign ificant,the difference was statistically significant(P<0.001),but the interaction effect was not statistically significant(P>0.05).With the increase of treatment time,both groups cou ld relieve itching symptoms and quality of life of patients,and the efficacy of the two groups was comparable.In animal studies,results of experiment 1:Compared with blank group,mitotic cell inde x of vaginal epithelial cells in model group was significantly increased,with statistical signifi cance(P<0.05);Compared with the model group,the mitotic index of the control group a nd the observation group was significantly decreased,the difference was statistically significa nt(P<0.05),while the mitotic index of the observation group was higher than that of the c ontrol group,but the difference was not statistically significant(P>0.05).External emerge ncy ointment could inhibit the proliferation of epithelial cells.Results of Experiment 2:Comp ared with blank group,the expressions of PCNA and Involucrin in model group increased sig nificantly.with statistical significance(P<0.05).Compared with model group,the expressi on in control group and observation group decreased,and the difference was statistically signi ficant(P<0.05).There was no significant difference between the observation group and th e control grou(P<0.05).External emergency ointment could inhibit the excessive prolifer ation and differentiation of epidermal cells.Results of Experiment 3:In the comparison of Baker score and epidermal thickness of m ice,there were significant differences between model group and blank group(P<0.05).T here was no significant difference between the observation group and control group(P>0.05),In comparison of the expression levels of inflammatory factors,the expression levels of I L-17a,IL-6,TNF-α,IFN-γ and IL-1β in the skin tissue and serum of the model group were si gnificantly higher than those of the blank group,the difference was statistically significant(P<0.05).The levels of IL-17a,TNF-α,IFN-γ and IL-1β in the skin tissue and serum of the o bservation group were significantly lower than those of the model group,with statistical signif icance(P<0.05).Compared with blank group,the protein expression ratios of p-p38/p38,p-IκBα/IκBα and p-p65/GAPDH in model group were significantly increased(P<0.05).C ompared with model group,histone expression ratio was significantly decreased(P<0.05).The distribution and expression of p38MAPK/NF-κB signaling pathway related proteins sho wed that the positive expression of p-p38MAPK protein was mainly located in the nucleus,th e positive expression of p-IκBα protein was mainly located in the cytoplasm and the positive e xpression of p-p65 protein was mainly located in the nucleus.Compared with blank group,th e positive expression levels of p-p38MAPK,p-IκBα and p-p65 in model group were significa ntly increased(P<0.05).Compared with model group,the positive expression level in obs ervation group was significantly decreased(P<0.05).WaiYong YingJi ointment can inhibit the expression of p38MAPK/NF-κB signaling pathway related proteins,reduce the expressio n of inflammatory factors,reduce the aggregation of inflammatory cells,and reduce the epider mal thickness of psoriasis mice.Conclusions:1.WaiYong YingJi ointment in the treatment of quipid psoriasis vulgaris(blood dryness syndrome)can reduce PASI score,improve erythema,scale and infiltration,relieve pr uritus and thus relieve psoriasis,and improve the quality of life of psoriasis patients.Its clinic al efficacy is comparable to that of Calcipotriol ointment.Meanwhile,the WaiYong YingJi of ntment was better than Calcipotriol ointment in improving scaling symptoms,and the onset ti me of Calcipotriol ointment was better than WaiYong YingJi ointment.2.WaiYong YingJi oi ntment has the effect of inhibiting vaginal epithelial cell mitosis,and is comparable to Calcipo triol ointment,can be used as a drug for psoriasis.3.WaiYong YingJi ointment may alleviate psoriasis by inhibiting excessive proliferation and differentiation of epidermal cells.4.WaiYo ng YingJi can inhibit p38MAPK/NF-κB signaling pathway,reduce the expression of IL-17a,TNF-α,IFN-γ and IL-1β inflammatory factors,and play a role in reducing the aggregation of i nflammatory cells,inhibiting inflammatory response,inhibiting proliferation and reducing epi dermal thickness,so as to relieve the erythema,scale and infiltration of psoriasis.Reduce PAS I score to treat psoriasis.and reduce PASI score to treat psoriasis. |
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