The Clinical Research Of TGP Clinical Treatment On OLP Patients With Hemorrheology Change

Oral lichen planus (OLP) is a chronic inflammatory disease with different clinical types. Incomplete epithelial hyperkeratosis, liquefaction of basal layer and intensive lymphocytes'infiltration zoster in lamina propria are its typical pathological manifestations.Most studies have found and confirmed OLP patients possess such characteristics, which include increased platelet aggregation and changes of hemorheology. At the same time, mood, inflammation, trauma, climate and other factors may influence the state of blood viscosity. Blood regulation of the oral drug can usually get more satisfactory results. Incidence of OLP has a great relationship with immunoregulatory dysfunction, because of this, the regulation of immune function become also an important aspect of effective treatment.Total glucosides of paeony (TGP), a monoterpene glucoside, is extracted from the root of Paeonia lactiflora.Pharmacological and clinical study have found that TGP has anti-inflammatory, immunoregulatory,anti-inflammatory, antio- xidative,antithrombotic, analgesic and antihepatic injury activities.The main function of immune cells in vitro experiments show that, TGP is concentration- dependent bi-directional regulation of T, B lymphocyte proliferation and subsets balance of T lymphocyte (Th/Ts).It can reduce the level of immunoglobulin and macromolecular exists in blood.And also it can reduce the probability of destruction of platelets,improving local situation of blood flow. Ingredients of TGP can promote or inhibit a number of inflammatory cytokines'production, such as IL-1,IL-2 and tumor necrosis factor (TNF-α),with a dose-dependent manner. TGP can regulate in vivo IL-6,IL-4 levels,inhibite the level of leuko- triene B and NO,which is produced by macrophages. TGP can also reduce inflammation and cell damage,lower blood viscosity and improve micr- ocir- culation.TGP may clean out free radicals.By detecting rat adjuvant arthritis- related indicators,cerebral ischemia in mice as well as substantial clinical research,experts observed that the TGP can reduce lipid peroxidation, recede release of oxygen free radicals, restore activity of antioxidant enzymes and protect the integrity of membrane structure. In addition, TGP can protect the liver, and is also provided with analgesic,sedative and antidepressant effects. Expe- riments confirmed the security of TGP, it has no significant toxicity damage.Aim:Through the comparision of the local injection of triamcinolone acetonide (glucocorticoid) injection with the oral treatment of OLP in patients with TGP to observe the TGP's effect on OLP. And, on the basis of TGP clinical treatment of OLP in patients with hemorrheology change, to observe the impact of TGP on hemorheology effect of OLP patients. At the same time, we discuss the possible pathogenesis of OLP, in order to provide theoretical basis and reference value for clinical treatment on OLP. Methods: Randomly select 60 patients,diagnosed mainly based clinical performance.(Excluding who suffering from angina, coronary heart disease and other cardiovascular diseases; who simultaneously with other oral mucosa diseases; who suffering from diabetes, renal failure and other serious systemic disease; who can not tolerate long-term systemic drug users; liver and kidney function abnormal; who would not be cured as prescription, surrender course of treatment or recorded uncompletely).Experiment is divided into two parts:1.We randomly divided the 60 OLP patients into two groups (GroupⅠ: local injections of glucocorticoid (triamcinolone acetonide) group ; GroupⅡ: oral TGP group). We respectively record two group patients with symptoms and signs before and after treatment. By the use of atrophic-erosive OLP efficacy evaluation criteria, which is established by Chinese Stomatological Association Professional Committee of oral mucosal disease, we made comprehensive evaluation after scorecard.2.We adopt LBY-N6A self-cleaning rotary viscometer, which is produced by Beijing Percil Group to inspect the selected peripheral blood hemorrheology of 30 OLP patients. (We collect fasting venous blood samples before and after treatment. All of the drugs, which affect the test results, are not allowed to take orally within the previous week of blood collection.) The content of detection includes the whole blood viscosity (high and low shear), plasma viscosity, erythrocyte aggregation index, Carson yield value, Carson viscosity, erythrocyte electrophoresis time and erythrocyte sedimentation rate.Results:1.We use two criteria to estimate OLP lesions damage situation. After 3 months of medication treatment, the first group,(local injection of triamcinolone acetonide)30cases of OLP patients have a total efficiency about 86.7%. The second group(oral TGP), 30 cases of OLP patients with the total effective rate of approximately 70%. Efficacy of two methods deal with statistical data shows P> 0.05. There was no significant difference.2.After 3 months of oral TGP treatment, all 30 OLP patients'hemorrheology has improved significantly. Above all, the whole blood viscosity (high shear and low shear), plasma viscosity, erythrocyte aggregation index, electrophoresis time and erythrocyte sedimentation rate can be seen decreased significantly than that of before the treatment.During the period of 3 months course of treatment, all the OLP patients who were selected for the study does not appear obvious adverse reaction, all 30 patients can adhere to the last minute of the medication treatment.Conclusions:1.There was no significant difference between local corticosteroid injection and oral TGP in the overall efficacy (P> 0.05), it proves that TGP does have exact effect on OLP.At the same time,observations show that the short term efficacy of GC is better than that of oral TGP.2.OLP in patients exists with blood microcirculation and hemorheology changes. TGP can improve the OLP patients with hemorheology and micro- circulation,with the role of reduced blood viscosity.The result of this study shows that oral treatment of OLP can make TGP has 70% efficiency for the purpose of the clinical treatment. TGP simultaneously can improve OLP patients hemorheology. These results are gratifying. Hormones and other immunosuppressive drugs are classical medicines on the treatment of OLP, but long-term use will cause a lot of adverse reactions. TGP, an effective site which extracts from the homeland of paeony root, has immunomodulatory and anti-inflammatory effects, also it has liver protection and analgesic effects. We may consider TGP as substitution of glucocorticoid, or select it as combination of a reasonable drug use alternation.However,in this experiment none of patients with oral TGP recovered, and significant efficiency is low. These results reveal that TGP on the treatment of OLP has a certain effect, but the effect is not ideal. We still need further exploration to seek the pathogenesis of OLP.