Study On The Clinical And Immune Mechanism Of Shaoyao Gancao Granules In The Treatment Of Severe Alopecia Areata

Alopecia areata(Alopecia areata,AA)is a common autoimmune disease characterized by patchy alopecia.It can be divided into many types clinically,from single plaque alopecia,multiple plaque alopecia to complete scalp alopecia or generalized alopecia.The etiology and pathogenesis of alopecia areata are not completely clear,which may be related to heredity,immunity,mental and neurological factors,allergy,lack of trace elements and so on.Many studies believe that alopecia areata is a disease related to the imbalance of T cell immunity.Up to now,there is no radical cure for alopecia areata.The main treatment methods include glucocorticoid,immunosuppressant,contact sensitizer and JAK enzyme inhibitor.Although these methods can play a certain effect,there are some problems in long-term use,such as safety risk,poor patient dependence,high price and so on.The treatment of alopecia areata with traditional Chinese medicine has a long history,clear curative effect and relative safety.In recent years,we have found that Shaoyao Gancao decoction is safe and effective in the treatment of alopecia areata.In order to further study the clinical efficacy and mechanism of Shaoyao Gancao decoction in the treatment of alopecia areata,an autologous pre-and post-control trial was used.Protein suspension chip,enzyme-linked immunosorbent assay and flow cytometry were used.To observe the clinical efficacy of oral Shaoyao Gancao granule in patients with severe alopecia areata and the changes of Th1,Th2,Th17,Treg cell percentage and related factors in peripheral blood before and after treatment,and to explore the mechanism of Shaoyao Gancao granule in the treatment of severe alopecia areata.1 Objective:1.1 To explore the clinical efficacy and safety of oral Shaoyao Gancao granule in patients with severe alopecia areata.1.2 To explore the regulatory effect of Shaoyao Gancao granule on Th1,Th2,Th17,Treg cells and related factors in peripheral blood of patients with severe alopecia areata.2 Method:2.1 To explore the clinical efficacy and safety of Shaoyao Gancao granule in the treatment of severe alopecia areata.In this study,patients were treated with Shaoyao Glycyrrhiza granule lOg in the morning,in the middle and lOg in the evening for a total of 12 weeks.During the treatment period,the patients were revisited every 4 weeks for a total of 3 times.The general law of the incidence of alopecia areata was summarized by analyzing the general clinical data of patients,such as age,sex and the distribution of TCM syndromes.The changes of white or black hair growth,exclamation mark,hair amputation,scalp inflammation before and after treatment were observed by hair microscope,and the clinical efficacy of Shaoyao Gancao decoction was comprehensively judged after treatment.At the same time,the safety of Shaoyao Gancao granule was evaluated by testing the renal function creatinine clearance rate of liver function alanine aminotransferase(ALT)and aspartate aminotransferase(AST),before and after treatment.2.2 Regulation of Shaoyao Glycyrrhiza granule on Thl,Th2,Th 17,Treg cells and their related factors.The levels of Thl-related factors IFN-gamma,IL-12p70,Th2-related factors IL-4,IL-10,Th17-related factors IL-17A,IL-22 and IL-6,Treg-related factors TGF-? in peripheral blood of patients with severe alopecia areata before and after treatment were detected by protein suspension microarray and enzyme-linked immunosorbent assay(Elisa).Flow cytometry was used to detect the contents of Thl cells,Th2 cells,Th17 cells and Treg cells in patients with alopecia areata.3 Result:3.1 Clinical efficacy of Shaoyao Gancao granule in the treatment of severe alopecia areata.After 12 weeks of oral administration of Shaoyao Gancao granule,the main evaluation indexes included SALT score and hair mirror image,while the secondary evaluation indexes included scalp color,hair color,scalp pruritus,scalp pain/numbness,sebum secretion,dandruff and hair pull test.The total score of subjective symptoms was significantly lower than that before treatment,and the difference was statistically significant(P<0.001).After treatment,the contents of N,CD3+,CD3+CD4+and CD3+CD8+ in peripheral blood T lymphocyte subsets were significantly different from those before treatment.ALT,AST and creatinine clearance rate of liver and kidney function before and after treatment had no significant change compared with those before treatment,and they were all in the normal range.The clinical effective rate is 84%.3.2 Changes of Th1,Th2,Th17,Treg cells and their related factors in peripheral blood of patients with severe alopecia areata before and after treatment.In the severe alopecia group,IFN-gamma,IL-12p70,IL-17A and IL-6 decreased significantly after treatment,and the difference was statistically significant TGF-?,IL-4 and IL-10 increased after treatment,and the difference was statistically significant.The contents of Thl and Th17 cells after treatment were significantly lower than those before treatment(P<0.05).The number of Th2 and Treg cells after treatment was significantly higher than that before treatment.4 Conclusion:(1)Shaoyao Gancao granule is safe and effective in treating severe alopecia areata.(2)Shaoyao Gancao granule can regulate the expression of Th1/Th2,Th17/Treg cells and their related factors.