银屑灵全方及拆方对角质形成细胞HaCaT增殖的影响

[目的]观察银屑灵全方及拆方时角质形成细胞HaCat增殖的影响,寻找银屑灵的有效组成.[方法]采用正交试验法将银屑灵全方拆分为12个组合方,选用脂多糖(LPS)为刺激因子,建立人角质形成细胞HacaT体外过度增殖模型,采用四甲基偶氮唑盐(MTT)法检测银屑灵全方及各拆方组不同浓度及作用时间对HacaT细胞增殖的影响.[...     

放血加电针治疗银屑病158例临床观察

取大椎、陶道、肝俞，用三棱针点刺后拔火罐５～１０分钟，每穴出血０．３～０．５ｍｌ。然后取肺俞、脾俞、肾俞，毫针沿皮刺，得气后接电针治疗仪，选疏密波，电流强度以病人耐受为度。再针刺曲池、四渎、足三里、三阴交等穴，留针２０～３０分钟。隔日治疗１次，１５次为１疗程。经３～５疗程治疗，痊愈８０例（５０．６３％），显效３６例（２２．７９％），好转２７例（１７．０９％），无效１５例（９．４９％），有效率为９０．５１％。文中还讨论了该病的发病机理及治疗机制。     

寻常型银屑病中医基本证候与疾病分期及病情的相关性探讨

【目的】了解银屑病中医基本证候在人群中的分布,探讨银屑病中医基本证候与疾病分期及病情严重程度的相关性。【方法】采用横断面调查的流行病学研究方法,纳入280例寻常型银屑病患者进行问卷调查,运用统计学方法分析寻常型银屑病基本证候与疾病分期及各项病情严重程度指标的相关性。【结果】(1)寻常型银屑病患者中医基本证候分布依次为:血瘀证(70.3%)>血燥证(17.3%)>风热证(12.4%);疾病分期依次为:稳定期(57.5%)>进行期(26.9%)>消退期(15.7%)。(2)中医基本证候与疾病分期的关系:风热证在进行期中所占比例较大,血瘀证和血燥证在静止期中所占比例较大。风热证与进行期相关,血瘀证与稳定期相关,消退期与血燥证相关。(3)中医基本证候与各项病情评判指标的关系:不同中医证型间银屑病的疾病严重程度具有显著差异(P<0.01),PASI评分风热证>血瘀证>血燥证;瘙痒评分风热证>血燥证>血瘀证。回归分析发现:躯干部的PASI评分和瘙痒评分对3种证型的影响程度不同,与血燥证和风热证正相关,与血瘀证负相关;年龄分段与血燥证负相关。【结论】血瘀证与稳定期的病人在本次研究中所占比例最高。不同中医证型间银屑病的疾病严重程度存在差异,证型与银屑病分期可能有对应关系:风热证与进行期相关,血瘀证与稳定期相关,消退期与血燥证相关。     

Psoriasis Remission after Laparoscopic Roux-En-Y Gastric Bypass for Morbid Obesity

Background: Psoriasis is a chronic skin disease characterized by epithelial hyperplasia and an accelerated rate of epithelial turnover affecting approximately 1-3% of the population. Exogenous and endogenous factors including morbid obesity can increase the morbidity of psoriasis. Case Report: A 55-year-old male, who weighed 131 kg with BMI 41 kg/m², underwent laparoscopic Roux-en-Y gastric bypass (LRYGBP). He had a 15-year duration of severe psoriasis and was being medically treated. At 12 months after LRYGBP, he had lost 39 kg (68% EWL), and had complete resolution of the psoriasis and had discontinued all preoperative medications related to the disease. At 2 years after LRYGBP, psoriasis has not recurred. Conclusion: Weight loss after LRYGBP should be considered as a strategy in the treatment of severe psoriasis in morbidly obese patients.     

在针对风、热、湿邪基础上着重从血论治寻常型银屑病的临床疗效观察

【目的】观察中医从血论治法对寻常型银屑病的临床疗效的影响。【方法】将206例寻常型银屑病患者随机分为两组,对照组70例内服开瑞坦、维生素C、雷公藤多甙片、罗红霉素,外用质量分数为5%硫磺软膏或恩肤霜治疗;治疗组136例在对照组西药治疗的基础上,根据中医从血论治理论给予内服中药治疗(基本方:土茯苓、板蓝根、大青叶、生地、丹皮、白花蛇舌草、半边莲、蜂房、川芎、泽泻、车前草、地肤子、白鲜皮、甘草,并分血热、血瘀、血燥3型辨证加减);两组均以1个月为1个疗程,治疗3个疗程后判定疗效,并观察两组的副作用和复发情况。【结果】两组临床疗效比较:治疗组痊愈71例,显效22例,有效26例,无效17例,总有效率为87.50%;对照组痊愈23例,显效15例,有效21例,无效11例,总有效率为84.28%,两组比较,治疗组疗效优于对照组(P<0.05)。两组复发情况比较:治疗组随访6个月内和12个月内的复发率分别为3.68%、6.62%,对照组复发率分别为8.57%、15.71%,两组复发率比较,差异有统计学意义(P<0.05)。两组均未发现明显毒副作用。【结论】采用清热凉血、养阴润燥、活血化瘀中药能提高寻常型银屑病的疗效,表明从血论治能切中病机,值得进一步深入研究。     

Quantitative and Qualitative Changes of Bone in Psoriasis and Psoriatic Arthritis Patients

Psoriatic arthritis (PsA) is a chronic inflammatory disease characterized by periarticular bone loss and new bone formation. Current data regarding systemic bone loss and bone mineral density (BMD) in PsA are conflicting. The aim of this study was to evaluate bone microstructure and volumetric BMD (vBMD) in patients with PsA and psoriasis. We performed HR‐pQCT scans at the ultradistal and periarticular radius in 50 PsA patients, 30 psoriasis patients, and 70 healthy, age‐ and sex‐related controls assessing trabecular bone volume (BV/TV), trabecular number (Tb.N), inhomogeneity of the trabecular network, cortical thickness (Ct.Th), and cortical porosity (Ct.Po), as well as vBMD. Trabecular BMD (Tb.BMD, p = 0.021, 12.0%), BV/TV (p = 0.020, –11.9%), and Tb.N (p = 0.035, 7.1%) were significantly decreased at the ultradistal radius and the periarticular radius in PsA patients compared to controls. In contrast, bone architecture of the ultradistal radius and periarticular radius was similar in patients with psoriasis and healthy controls. Duration of skin disease was associated with low BV/TV and Tb.N in patients with PsA. These data suggest that trabecular BMD and bone microstructure are decreased in PsA patients. The observation that duration of skin disease determines bone loss in PsA supports the concept of subclinical musculoskeletal disease in psoriasis patients. © 2015 American Society for Bone and Mineral Research.     

Remission of Psoriasis after Open Gastric Bypass

Psoriasis is a frequent skin disease, affecting 2% of the world's population. Stress, alcohol, smoking and obesity may be associated with psoriasis. A 56-year-old man with BMI 46.9 kg/m², hypertension and gastroesophageal reflux, had severe psoriasis for the last 39 years, without any remission on multiple treatments. Psoriatic papules and plaques were noted on his face, dorsum of hands, buttocks, knees, and elbows. He underwent open Roux-en-Y gastric bypass. At 4-month follow-up, the patient had lost 23 kg or 34.8% of excess weight, and presented complete remission of the psoriasis without medications. Bariatric surgery for positive metabolic, psychological and lifestyle consequences should be considered a treatment of psoriasis. Long-term observation is necessary.     

银屑灵片治疗寻常型银屑病的临床观察

[目的]观察中药制剂银屑灵片治疗寻常型银屑病的临床疗效.[方法]将纳入研究的48例寻常型银屑病患者,按随机化原则分为对照组和治疗组各24例.治疗组给予口服银屑灵片(由生地黄、当归、赤芍、川芎、紫草、莪术、金粟兰、土茯苓、乌梅、甘草等组成)治疗,对照组给予口服阿维A胶囊治疗,同时两组均外用本院制剂肤必润.两组均以4周为1个疗程,共治疗2个疗程.参照银屑病患者皮损程度评分(PASI)比较两组的临床疗效,并记录药物不良反应,检测血清干扰素-γ(IFN-γ)水平.[结果](1)第1疗程(4周)后,两组疗效比较差异有显著性意义(P<0.05),提示阿维A胶囊起效较银屑灵片快;第2疗程(8周)后,两组疗效比较差异无显著性意义(P>0.05),说明两组长期疗效相仿.(2)治疗4周后,两组患者血清IFN-γ水平均有显著性降低(与治疗前比较,P<0.05),治疗前后差值比较差异也有显著性意义(P<0.05).治疗8周后,两组患者血清IFN-γ水平下降更显著(与治疗前比较,P<0.01),但治疗前后差值比较差异无显著性意义(P>0.05).(3)两组在皮肤干燥、腹部不适、唇干、肝肾功能异常等不良反应方面差异均有显著性意义(P<0.05或P<0.01),提示银屑灵片的副作用较阿维A胶囊少.[结论]银屑灵片治疗寻常型银屑病的疗效与阿维A胶囊相仿,但副作用较阿维A胶囊少.其作用机制可能与银屑灵片能降低患者血清IFN-γ水平有关.