| Objective:Modern medicine believes that the immunological pathological mechanism of psoriasis is an important aspect of the disease,Clinical and experimental studies have also shown that patients with psoriasis do have imbalances in varying degrees of immune status.This article cuts in from the perspective of PD-1/PD-L1 regulating the balance of Th17 and Treg cells,to explore the immunological mechanism of DiHuai Xiao Yin Granule in preventing and treating blood-heat psoriasisThe paper includes two parts:literature review and research report.The literature review focuses on the research on the prevention and treatment of psoriasis in Chinese medicine and the research on the pathological mechanism of psoriasis immunology.The research report includes both clinical observation and experimental research.First,observe the clinical effect of DiHuai Xiao Yin Granule on blood stasis syndrome of psoriasis vulgaris;Second,observe the effect of DiHuai Xiao Yin Granule on Th cell differentiation and related inflammatory factors in peripheral blood of patients with psoriasis vulgaris syndrome;Third,the difference and correlation of PD-1/PD-L1 expression on peripheral blood Th17/Treg cells between patients with psoriasis blood heat syndrome and normal people,to observe the effect of dihuai Xiaoyin Granule on PD-1/PD-L1 expression on peripheral blood Th17/Treg cells in patients with psoriasis blood heat syndrome,and to preliminarily explore the role of PD-1/PD-L1 pathway in the occurrence and development of psoriasis blood heat syndrome.It plays a role.Method:Twenty-five cases of psoriasis vulgaris were randomly divided into 15 cases of DiHuai XiaoYino group,10 cases of Fufang Qingdai group and 10 cases of normal control group.The two groups of patients were given DiHuai Xiao Yin Granules and Fufang Qinglan Capsules respectively,and use whitening Vaseline to relieve the desiccation of skin.Before enrollment and on the 8th weekend of treatment.Clinically,the clinical efficacy of DiHuai Xiao Yin Granules was summarized by observing PASI score,itching score and quality of life score.In the experimental part,flow cytometry was used to detect the proportion of Treg and Th17 cells in peripheral blood T lymphocyte subsets;real time PCR was used to detect the gene expression of Foxp3 and ror y T;real time PCR was used to detect the gene expression levels of IL-17,IL-22,IL-23 and IL-10 in PBMC;flow cytometry was used to detect the expression levels of Th17 and PD-1 and PD-L1 in Treg cells.Results:Clinical part:1.Before treatment,there was no significant difference in PASI score between patients in the DiHuai Xiao Yin group and the Fufang Qingdai group(p>0.05).After 8 weeks of treatment,the PASI scores of patients in the DiHuai Xiao Yin group and the Fufang Qingdai group were significantly lower than those before treatment(p<0.01;p<0.05).There was no significant difference in the difference between the pre-treatment and post-treatment PASI scores in the DiHuai Xiao Yin group and the Fufang Qingdai group(p>0.05).2.Before treatment,there was no significant difference in the itching score between the DiHuai XiaoYin group and the Fufang Qingdai group(p>0.05).After 8 weeks of treatment,the itch scores of the patients in the DiHuai Xiao Yin group and the Fufang Qingdai group decreased compared with those before treatment(p<0.01;p<0.01).There was no significant difference in the difference between the pruritus scores before and after treatment in the DiHuai XiaoYin group and the Fufang Qingdai group(p>0.05).3.Before treatment,there was no significant difference in DLQI score between patients in DiHuai XiaoYin group and Fufang Qingdai group(p>0.05).After 8 weeks of treatment,the DLQI scores of the patients in the DiHuai XiaoYin group and the Fufang Qingdai group decreased compared with those before treatment(p<0.05;p<0.05).There was no significant difference in the difference between the pre-and post-treatment DLQI scores in the DiHuai XiaoYin group and the Fufang Qingdai group(p>0.05).4.Compare the total effective rate of the two groups of patients after 8 weeks of treatment,The total effective rate of the DiHuai XiaoYin group was 93.3%.The total effective rate of the compound barley group is 90%.There was no significant difference between the two groups(p>0.05).Experimental part:1.The serum levels of Th17 in the patients in the DiHuai XiaoYin group and the Fufang Qingdai group were significantly higher than those in the healthy control group(p<0.01;p<0.01).The amount of Th17 in the serum of patients treated with DiHuai XiaoYin group decreased significantly,and the difference was statistically significant(p<0.01).The amount of Th17 in the serum of patients treated with Fufang Qingdai group decreased significantly,and the difference was statistically significant compared with that before treatment(p<0.01).There was no significant difference between the DiHuai XiaoYin group and the Fufang Qingdai group before and after treatment(p>0.05).2.The number of Treg cells in the serum of patients in the Dihuaixiaoyin group and the compound Qingdai group before treatment was significantly higher than that in the healthy control group(p<0.01).After treatment,the proportion of Treg cells in the Dihuaixiaoyin group was higher than that before treatment(p<0.05),and there was no significant difference in the compound Qingdai group after treatment and before treatment(p>0.05).There was no statistical difference in the difference d between the Dihuaixiaoyin group and the compound Qingdai group before and after treatment(p>0.05).3.The ratio of Th17/Treg was significantly higher in the DiHuai XiaoYin group and the Fufang Qingdai group than in the healthy control group(p<0.05;p<0.05).The ratio of Th17/Treg decreased significantly after treatment with DiHuai Xiao Yin group(p<0.01),The ratio of Th17/Treg decreased significantly after treatment with Fufang Qingdai group(p<0.01).There was no significant difference between the DiHuai Xiao Yin group and the Fufang Qingdai group before and after treatment(p>0.05).4.The expression of ROR-yt mRNA in peripheral blood of patients with DiHuai Xiao Yin group and Fufang Qingdai group before treatment was significantly higher than that of healthy controls(p<0.01;p<0.01).The expression of ROR-yt mRNA in peripheral blood of DiHuai Xiao Yin group was significantly down-regulated after treatment(p<0.01).The expression of ROR-yt mRNA in peripheral blood of Fufang Qingdai group was significantly down-regulated after treatment(p<0.01).There was no significant difference between the DiHuai Xiao Yin group and the Fufang Qingdai before and after treatment(p>0.05).Before treatment the expression of Foxp3 mRNA in peripheral blood of patients in the DiHuai Xiao Yin group and the Fufang Qingdai group was significantly higher than that in the healthy control group(p<0.01;p<0.01).There was no significant difference between the DiHuai Xiao Yin group and the pre-treatment group(p>0.05).There was no significant difference between the Fufang Qingdai group and the pre-treatment group(p>0.05).There was no significant difference between the DiHuai Xiao Yin group and the Fufang Qingdai before and after treatment(p>0.05).6.The expression of IL-17 mRNA in peripheral blood of patients with DiHuai Xiao Yin group and Fufang Qingdai group was significantly higher than that of healthy control group(p<0.01;p<0.01).The expression of IL-17 mRNA in peripheral blood was significantly down-regulated after treatment with DiHuai XiaoYino(p<0.01).The expression of IL-17 mRNA in peripheral blood of the Fufang Qingdai group was significantly down-regulated(p<0.01).There was no significant difference between the DiHuai Xiao Yin group and the Fufang Qingdai group before and after treatment(p>0.05).7.The expression of IL-22 mRNA in peripheral blood of patients with DiHuai Xiao Yin group and Fufang Qingdai was significantly higher than that of healthy controls(p<0.01;p<0.01).The expression of IL-22 mRNA in peripheral blood of patients treated with DiHuai Xiao Yin group decreased significantly(p<0.01).The expression of IL-22 mRNA in peripheral blood of patients treated with Fufang Qingdai group was significantly decreased(p<0.01).There was no significant difference between the DiHuai Xiao Yin group and the Fufang Qingdai group before and after treatment(p>0.05).8.The expression of IL-23 mRNA in peripheral blood of the patients in the DiHuai Xiao Yin group and the Fufang Qingdai group before treatment was significantly higher than that in the healthy control group(p<0.01;p<0.01).The expression of IL-23 mRNA in peripheral blood of patients after treatment with DiHuai Xiao Yin group decreased significantly(p<0.01).The expression of IL-23 mRNA in peripheral blood of patients treated with Fufang Qingdai group decreased significantly(p<0.01).There was no significant difference between the DiHuai Xiao Yin group and the Fufang Qingdai group before and after treatment(p>0.05).9.The expression of IL-10 mRNA in peripheral blood of patients in the DiHuai Xiao Yin group and the Fufang Qingdai group was significantly higher than that in the healthy control group(p<0.01;p<0.01).There was no significant difference between the DiHuai XiaoYin group and the pre-treatment group(p>0.05).There was no significant difference between the Fufang Qingdai group and the pre-treatment group(p>0.05).There was no significant difference between the DiHuai XiaoYin group and the Fufang Qingdai group before and after treatment(p>0.05).10.The PD-1 expression level of Th17 cells in PBMC of patients in DiHuai XiaoYin group and compound indigo naturalis group before treatment was significantly lower than that of healthy control group(t=-3.54,p=0.00<0.01).After treatment,the PD-1 expression level of Th17 cells in DiHuai XiaoYin group was significantly higher than that of patients before treatment(t=-5.80,p=0.00<0.01),but there was no significant difference in compound indigo naturalis group after treatment(t=0.09,p=0.93>0.05).11.The proportion of PD-1 expression of Treg cells in PBMC of patients in both groups before treatment was higher than that of healthy control group(t=6.50,p=0.00<0.01).Compared with before treatment,the expression level of PD-1 in Treg cells increased in group A(t=9.91,p=0.00<0.01),and in group B(t=2.22,p=0.04<0.05).There was no significant difference between the two groups(t=-0.186,p>0.05).12.The expression levels of PD-L1 in Th17 cells of the two groups before treatment were higher than those of the healthy control group(t=2.47,p=0.03<0.05).Compared with before treatment,the expression level of PD-L1 in Th17 cells decreased in group A(t=3.51,p=0.00<0.01),but there was no significant difference in group B(t=0.22,p=0.83>0.05).13.The expression level of PD-L1 in Treg cells of the two groups before treatment was lower than that of the healthy control group(t=-2.38,p=0.02<0.05).Compared with before treatment,PD-L1 expression level of Th17 cells in group A was increased(t=-2.29,p=0.02<0.05),but there was no significant difference in group B(t=-0.83,p=0.41>0.05).14.Correlation analysis:there was a significant positive correlation between Th17 cells and PASI score,r=0.303,p<0.01;there was a positive correlation between Th17/Treg ratio and PASI score,r=0.226,p<0.05;there was a significant negative correlation between Th17 cells and DLQI score,r=-0.293,p<0.01.There was a significant positive correlation between Th17 and roryt(r=0.614,p<0.01),between Th17 and IL-17(r=0.498,p<0.01),between Th17 and IL-22(r=0.624,p<0.01),between Th17 and IL-23(r=0.467,p<0.01).Treg was positively correlated with Foxp3(r=0.355,p<0.01),Treg was positively correlated with IL-10(r=0.473,p<0.01).There was a significant negative correlation between Th17 and PD-1 expression in Th17 cells(r=-0.61,p=0.00<0.01).PD-1 expression of Th17 cells was positively correlated with PD-L1 expression of Treg cells(r=0.32,p=0.04<0.05).Conclusions:1.DiHuai Xiao Yin Granule has a good clinical effect on the blood-heat syndrome of psoriasis vulgaris,which is equivalent to the efficacy of Fufang Qingdai Capsule.2.DiHuai Xiao Yin Granules and Fufang Qinglan Capsule can reduce the level of Th17 cells in peripheral blood.3.DiHuai Xiao Yin Granules and Fufang Qingdai Capsule can reduce the expression of related inflammatory factors in peripheral blood4.DiHuai Xiao Yin granule may exert its clinical effect by regulating the PD-1/PD-L1 pathway of Th17/Treg. |
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