| Objective1.Through the inclusion of healthy subjects and patients with various syndrome types of eczema,and symptomatic treatment of patients with dampness-heat immersion syndrome and spleen deficiency and dampness accumulation syndrome,the situation of each group was analyzed,and the clinical effect of symptomatic treatment was discussed.2.Through the metabonomic detection and analysis of urine in healthy wet syndrome and non-wet syndrome,the characteristics of urine metabolism in wet syndrome and non-wet syndrome were discussed,and the potential biomarkers of damp syndrome were found.3.The included people were divided into groups according to the presence or absence of greasy tongue,tooth-marked tongue and loose stool.through inter-group analysis,thepotential biomarkers of greasy fur,tooth-marked tongue and stool were found.4.Through the detection and analysis of urine metabonomics in patients with eczema with damp-heat immersion syndrome and spleen deficiency and dampness accumulation syndrome before and after treatment,the characteristics of urine metabolism in eczema population and patients with different syndrome types before and after treatment were discussed.to find the different metabolites,pathogenesis and treatment mechanism of different syndrome types of eczema.5.Through the detection and analysis of targeted amino acids in urine of patients with eczema with damp-heat immersion syndrome and spleen deficiency and dampness accumulation syndrome before and after treatment,the changes of amino acid metabolism before and after treatment in different syndrome types of eczema were discussed.to explore the metabolic characteristics,pathogenesis and treatment mechanism of different syndrome types of eczema from the point of view of amino acid metabolism.Methods:1.Clinical study:all subjects were enrolled from July 2020 to January 2021.Patients with eczema came from the dermatology clinic of Guangdong Hospital of traditional Chinese Medicine.A total of 158 patients with eczema who met the diagnostic criteria of eczema(refer to Clinical Dermatology(Zhao Jian,Jiangsu Science and Technology Press,4th Edition,201 0)).The patients were evaluated with eczema area and severity index(EASI),researchers'overall evaluation(IGA),eczema patient self scale(POEM),skin quality of life index questionnaire(DLQI/CDLQI),Visual Analog Scale evaluation(VAS)and other scales.And fill in the eczema related questionnaire.A total of 50 healthy controls were included,and the urine samples of all subjects were collected by filling out the dampness syndrome and clinical questionnaire.According to the consensus of TCM experts in eczema(eczema)of Dermatology Branch of Chinese traditional Chinese Medicine Association in 2016,patients with eczema were classified into damp-heat immersion syndrome and spleen deficiency and dampness accumulation syndrome.Longdan Xiegan decoction,dehumidifying Weiling decoction/Shenling Baizhu Powder were treated for 8 weeks,and the observation time was 2 weeks,4 weeks,6 weeks and 8 weeks,respectively.The EASI score,IGA,POEM,DLQI/CDLQI score and VAS score were recorded and analyzed at each time point,and the urine samples of patients with eczema were collected at each time point.2.Metabonomic analysis:the collected urine samples were tested by urine metabonomics.The differential metabolites and metabolic pathways in different urine were analyzed according to the screening criteria of foldchange(FC)?1.2 or?0.83and P<0.05.The metabolic pathways of different urine samples were analyzed.3.Detection and analysis of targeted amino acids:some urine samples collected were detected for targeted amino acids in urine,and the data were combined with clinical data.Foldchange(FC)?1.2 or ?0.83 and P<0.05.The differential amino acids and metabolic pathways in urine of different syndrome types before and after treatment were analyzed.Results:1.In terms of symptomatic treatment,compared with before treatment,after 2 and 4 weeks of treatment with Longdan Xiegan decoction,the subjects' EASI score,POEM score,IGA grade,pruritus score,insomnia score,DLQI/CDLQI score and dampness syndrome score decreased with the increase of treatment time,which played a significant role in improving the severity and quality of life of patients with eczema.Clinical observation and data statistics found that the best time to use Longdan Xiegan decoction in the treatment of eczema with damp-heat immersion syndrome was basically in the 4th week.The EASI score,POEM score,IGA grade,pruritus score,DLQI/CDLQI score and dampness syndrome score decreased with the increase of treatment time in spleen deficiency Shiyun group after treatment with Qushi Weiling decoction or Shenling Baizhu Powder.However,in terms of insomnia score,there was significant difference between 8 weeks after treatment and before treatment(P<0.05),However,there was no significant difference between 2 weeks,4 weeks and 6 weeks after treatment and before treatment(P>0.05).In terms of safety evaluation,there were no obvious adverse reactions in the whole intervention process between the two groups.The blood routine,liver function and renal function of the patients with eczema before and after treatment were not abnormal.2.Through the OPLS-DA model analysis of urine metabolites in the healthy group,before and after eczema treatment,the urine metabolites of the three groups could be significantly separated,and the urine metabolites of eczema before and after treatment also had an obvious separation trend,and had a tendency to return to the healthy group.3.There are 70 differential metabolites in urine between healthy non-dampness syndrome group and healthy dampness syndrome group,involving 13 pathways.4.The differential metabolites related to greasy liverwort are lpyrm 5anthradiaminopentane and Sphingosine.Dihydrouracil is a closely related metabolite of dentate tongue.Methyl Indole-3-Acetate,6-(2-[4-ray 6-methyl-2-methoxymethyl-3-(3-methylbut-2-en-1-yl)phenyl]-2-hydroxyacetyloxy)-3-(5-methoxymethoxymethoxylic)acid is closely related to loose stool,and is closely related to 5-ray trihydroxyoxane-2-carboxylic acid.5.There were 205 differential metabolites in eczema.Compared with the healthy group,89 metabolites were up-regulated and 116 down-regulated in the eczema group.There were 307 differential metabolites in damp-heat immersion syndrome before and after treatment.Compared with those before treatment,44 metabolites were up-regulated and 263 metabolites were down-regulated after treatment.Taking the intersection of the two groups of differential metabolites and excluding the metabolites with meaningless regulation direction,a total of 36 differential metabolites of eczema damp-heat immersion syndrome before and after treatment were obtained,and all of them showed a downward trend after treatment,involving a total of 7 metabolic pathways.6.There were 102 differential metabolites in spleen deficiency and dampnessaccumulation syndrome before and after treatment.Compared with those before treatment,23 metabolites were up-regulated and 79 metabolites were down-regulated after treatment.According to the intersection of differential metabolites of eczema and spleen deficiency and dampness accumulation syndrome before and after treatment,37 differential metabolites were obtained,of which 11 metabolites were up-regulated and 26 metabolites were down-regulated after treatment.a total of 12 metabolic pathways were involved.7.In terms of amino acid detection,38 differential amino acids involving 28 pathways were screened in the damp-heat immersion group before and after treatment,while 28 differential amino acids were screened in the spleen deficiency and dampness accumulation group before and after treatment,involving 29 pathways.All differential amino acids were down-regulated after treatment.Conclusion1.In terms of clinical observation,TCM syndrome differentiation and treatment can significantly improve the condition of various syndrome types of eczema and improve the quality of life.Among them,the best time for Longdan Xiegan decoction to treat eczema patients with damp-heat immersion syndrome is about 4 weeks.2.There may be tyrosine metabolic disorder in people with dampness syndrome,and its mechanism may be related to slow metabolism and the regulation of epinephrine.Thyroxine,3-iodotyrosine and epinephrine are important targets.3.In the aspect of dampness syndrome,greasy fur is negatively correlated with 5pentanediamine and sphingosine,and the production of greasy fur may be related to the abnormality of energy circulation and lipid metabolism.4.In terms of non-targeted metabonomics,the therapeutic mechanism of damp-heat immersion syndrome of eczema may be closely related to taurine and sub-taurine metabolic pathway,and taurine may be an important target in the pathway.The treatment of eczema with spleen deficiency and dampness accumulation syndrome may be related to arginine biosynthesis pathway,and carbamyl phosphate is a target worthy of attention.5.in the study of targeted amino acids,the biosynthetic pathways and phenylalanine metabolic pathways of phenylalanine,tyrosine and tryptophan may be involved in the pathogenesis and treatment of damp-heat immersion syndrome,and its mechanism may be related to the intervention of the synthesis and release of neurotransmitters.The pathogenesis and treatment of spleen deficiency and dampness accumulation syndrome may be related to glycine,serine and threonine metabolic pathway,alanine,aspartic acid and glutamine metabolic pathway and glyoxylic acid and dicarboxylic acid metabolic pathway,and its mechanism may be related to anti-inflammation,regulation of immunity and energy metabolism. |
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