【作者】 王欣；

【导师】 禤国维；

【作者基本信息】 广州中医药大学 ， 中医外科学， 2006， 博士

【摘要】 目的 探讨AD患者外周血清IgE、Th2/Th1型细胞因子分布以及外周血PBMC中GATA-3基因的表达状况,以期对AD的病机进一步深入认识;并初步探讨导师健脾渗湿法治疗AD的经验方特应性皮炎方对脾虚湿蕴型AD患者的疗效以及其可能的免疫学机制,指导临床实践,并为新药开发奠定基础。 方法 本研究选择28例脾虚湿蕴型AD患者为研究对象,治疗前及治疗后1个月、3个月分别记录SCORAD积分的改善。并在28名患者中随机选取15名于治疗前及治疗后3个月时以及15例正常人分别采用ELISA法检测血清总IgE、Th2/Th1型细胞因子(选用白介素4、白介素10代表Th2型细胞因子,以白介素12代表Th1型细胞因子),同时用RT-PCR法检测外周血PBMC中GATA-3基因的表达状况。 结果 28例AD患者经特应性皮炎方治疗1个月后SCORAD积分即有明显降低,3个月后SCORAD积分进一步下降,差异有非常显著性(P<0.01),说明特应性皮炎方对AD有确切的疗效。 AD患者的治疗前血清IgE水平显著高于正常对照组(P<0.01),Th2型细胞因子(IL-4、IL-10)较正常对照组明显升高(P<0.05),Th1型细胞因子(IL-12)较正常对照组明显降低(P<0.05),外周血PBMC中GATA-3mRNA水平显著高于正常对照组(P<0.05)。治疗后血清IgE水平较治疗前略有降低(P>0.05),IL-4水平较治疗前降低(P<0.05),IL-10水平与治疗前无明显变化(P>0.05),IL-12水平较治疗前有升高,但差异无统计学意义(P>0.05),GATA-3mRNA水平较治疗前明显降低(P<0.05)。相关性分析表明:SCORAD积分与IgE呈正相关(R=0.639,P<0.05);IL-4与IL-10呈非常显著正相关(R=0.935,P<0.01);IL-4与GATA-3呈显著正相关(R=0.673,P<0.05);GATA-3与IL-10呈显著正相关(R=0.705,P<0.01);余细胞因子间无明显相关性。 结论 1.特应性皮炎方治疗后1个月,AD患者的SCORAD积分就开始有显著的下降(P<0.05);而治疗后3个月后,SCORAD积分较1个月时进一步明显的下降(P<0.01),说明特应性皮炎方治疗AD有确切疗效。另外,从SCORAD积分随疗程的变化也可以看出,应用特应性皮炎方治疗AD 1个月即有较明显的好转,但如要达到更好、更稳定的疗效,应继续治疗一段时间。 2.28例AD患者中随机选取15例,在治疗前与治疗后3个月,连同15例正常对照组分别采用ELISA法检测外周血清总IgE、Th2/Th1型细胞因子(选用白介素4、白介素10代更多还原

【Abstract】 ObjectivesFirst to investigate the mechanism of Atopic Dermatitis(AD)more deeply through measuring IgE、 Th2/ Th1 Types Cytokines in serum and the expression of Transcription factor GATA-3mRNA in PBMC of the patients with AD. Then to investigate the clinical effect of ADC (Atopic Dermatitis Compound) in treating AD, and to find its possible mechanism to direct our clinical practice and to make basis of the development of new Traditional Chinese medicine . MethodsIn the clinical part, select 28 AD patients with symptoms of spleen-deficiency and retention of dampness to be the object, and then give them ADC to eat for three months, recording their SCORAD before and after the treatment one month and three months respectively.In the exprimental part, pick 15 out of the 28 patients with AD randomly and select 15 healthy controls, then apply ELISA technique to detect their IgE、 Th2/ Th1 Types Cytokines in serum and RT-PCR technique to detect the expression of Transcription factor GATA-3mRNA in PBMC respectively. ResultsAfter treated by ADC for three months, the SCORAD of the 28 patients with AD decreased magnificiently compared with that before treating (P<0.05) .Before treating, IgE in serum of the patients were higher than those of the healthy controls (P<0. 05) , and the Th2 Types Cytokines in serum(IL-4.10) , the expression of Transcription factor GATA-3mRNA in PBMC were higher too (P<0. 05) . On the contrary, the Thl Types Cytokines in serum(IL-12) of the patients were lower than those of the healthy controls (P<0.05) .After treating, IL-4 in serum , and the expression of Transcription factorGATA-3mRNA in PBMC were both decreased markedly (P<0. 05) compared with those before treating. IgE , IL-10 had no much change after treating (P>0. 05) . IL—12 in serum were slightly elevated after treating, but with no statistical signification (P>0. 05) . Correlating analysis showed that there were markedly correlationship between SCORAD and IgE (R=0. 639 , P<0. 05) , IL-4 and GATA-3 (R=0. 673, P<0. 05) , GATA-3 and IL-10 (R=0. 705, P<0. 01) . ConclusionsAfter treated by ADC for three months, the SCORAD of the 28 patients with AD decreased magnificiently compared with that before treating. The clinical part showed that ADC is an effective Traditional Chinese Medicine in treating AD.Before treating, IgE in serum of the patients were higher than those of the healthy controls, and the Th2 Types Cytokines in serum(IL-4.10),the expression of Transcription factor GATA-3mRNA in PBMC were higher too. On the contrary, the Thl Types Cytokines in serum(IL-12) of the patients were lower than those of the healthy controls. Then we can see that, besides the classical AD mechanism of higher IgE in serum and ill-balance between Th2 and Thl Types Cytokines, the overabundant expression of Transcription factor GATA-3mRNA in PBMC is another important , or probably the most important mechanism of AD.ADC can down-regulate Th2 Types Cytokines in serum and the expression of Transcription factor GATA-3mRNA in PBMC of patients with AD. These may be the immunological mechanism of ADC in treating AD effectively.更多还原