Objective: Based on bioinformatics, gene set enrichment analysis (GSEA) and immune infiltration analysis were carried out on the microarray data of psoriasis expression profile to further understand the pathogenesis of psoriasis. Methods: GSE6710 chip data were obtained from gene expression database (GEO), and gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis were performed using GSEA software. 22 kinds of immune cell gene expression matrices and R packages were downloaded from CIBERSOFT official website, and the immune cell infiltration matrix was obtained by R software and related graphs were drawn. Results: The pathways related to cell proliferation and innate immunity were highly expressed in psoriatic lesions, and some cancer-related pathways were highly expressed in psoriatic lesions. Immunized cell infiltration analysis showed that activated memory T cells, follicular helper T cells, M0 macrophages and activated dendritic cells were up-regulated in psoriatic skin lesion group, and inactive mast cells were down-regulated in psoriatic skin lesion group. Activated dendritic cells are positively correlated with follicular helper T cells, activated mast cells are positively correlated with M0 macrophages. Inactivated mast cells are negatively correlated with activated memory T cells, M1 macrophages are negatively correlated with regulatory T cells, M0 macrophages are negatively correlated with inactive mast cells. Conclusion: Cell proliferation and innate immunity are of great significance in the pathogenesis of psoriasis. Immune cell infiltration analysis is generally consistent with the current psoriasis pathogenesis model. Macrophages and mast cells also play a certain role in psoriasis.

目的 基于网络药理学研究枇杷清肺饮治疗痤疮的作用机制.方法 使用TCMSP数据库获取枇杷清肺饮6味中药的有效成分及作用靶点;使用OMIM数据库和GeneCards数据库获取痤疮相关的疾病靶点,并筛选得出枇杷清肺饮治疗痤疮的潜在作用靶点;使用CytoScape软件和String数据库构建药物-活性成分-靶点-疾病网络和蛋白质-蛋白质相互作用(PPI)网络,借助R语言对药物-疾病共同靶点进行基因本体功能富集分析(GO)与京都基因和基因组百科全书(KEGG)通路富集分析;然后通过AutoDock-Vina软件实现核心靶点与关键成分的分子对接.结果 枇杷清肺饮中筛选出与痤疮相关的175个潜在有效成分和127个潜在作用靶点;主要通过调控磷脂酰肌醇3-激酶/丝苏氨酸蛋白激酶(PI3K-Akt)、丝裂原活化蛋白激酶(MAPK)、肿瘤坏死因子(TNF)等信号通路来治疗痤疮.分子对接结果提示关键成分与核心靶点结合活性好.结论 枇杷清肺饮治疗痤疮的有效成分可能通过干预痤疮中炎性反应、雄激素水平、皮脂分泌等生物过程,调节PI3K-Akt、MAPK、TNF等信号通路等发挥治疗痤疮的作用.

目的 使用网络药理学方法及分子对接技术探究当归饮子治疗慢性自发性荨麻疹(CSU)多成分-多靶点-多通路的作用机制.方法 通过TCMSP数据库、BATMAN-TCM数据库、GeneCards数据库及OMIM数据库获取当归饮子的主要活性成分、作用靶点以及CSU疾病相关靶点.通过CytoScape软件和String数据库构建药物-活性成分-靶点-疾病网络和蛋白质-蛋白质相互作用(PPI)网络,借助DAVID数据库对药物-疾病共同靶点进行基因功能和通路富集分析,以AutoDock-Vina软件实现核心靶点与关键成分的分子对接.结果 从当归饮子中筛选得到138个活性成分,涉及CSU疾病靶点120个,得到基因功能和通路富集分析结果共709条,分子对接结果显示核心靶点与关键成分结合活性较好.结论 黄酮类化合物是当归饮子治疗CSU的主要有效成分,可能通过干预CSU中炎性反应、血管通透性、氧化应激和自身免疫等生物过程,调节肿瘤坏死因子(TNF)信号通路、磷脂酰肌醇3-激酶-蛋白激酶B(PI3K-Akt)信号通路和缺氧诱导因子-1(HIF-1)信号通路等来发挥治疗CSU的作用.

黄褐斑在中医属"黧黑斑"范畴,以络病理论为指导,黄褐斑的中医病因病机可概括为肝气不畅、气络失和为先,脏腑络脉空虚为本,瘀阻络脉为标.结合西医病理机制与络病理论的相关性,可将其归纳为血管因子炎症反应(络热)、血液循环障碍(络瘀)、氧化应激反应(络毒).本文以络病理论为理论指导,结合西医病理药理机制,探讨调气补虚祛瘀三法对黄褐斑的治疗意义.

目的 研究细胞分裂周期蛋白7(cdc7)在银屑病角质细胞增殖中的作用机制.方法 利用生物信息学方法分析cdc7在人银屑病皮损中的表达,并预测其转录因子结合位点;将Hacat细胞分为Hacat组、Hacat+白介素-22(IL-22)50 ng/mL组、Hacat+IL-22 100 ng/mL组、Hacat+IL-22 200 ng/mL组,应用 CCK8法、实时定量聚合酶链式反应(RT-qPCR)法检测各组细胞的增殖活性和cdc7的表达量;将小鼠随机分为对照组、模型组(咪喹莫特乳膏外涂建模),应用RT-qPCR法、免疫组化法检测各组小鼠cdc7表达量;将小鼠随机分为对照组、模型组、实验组(咪喹莫特乳膏外涂+cdc7抑制剂灌胃建模),每日观察皮损动态变化,并绘制银屑病面积与严重指数(PASI)趋势图.结果 cdc7在人银屑病皮损中高表达(P＜0.05),cdc7可能是作为信号转导和转录激活因子家族转录因子的下游靶点而发挥作用;Hacat组、Hacat+IL-22 50 ng/mL组、Hacat+IL-22 100 ng/mL组、Hacat+IL-22 200 ng/mL组细胞中 cdc7 mRNA表达量分别为(1.00±0.01)、(1.16±0.06)、(4.45±0.08)、(5.53±0.33)(F=139.300,P＜0.01),细胞增殖活性分别为(0.54±0.02)、(0.64±0.02)、(0.83±0.02)、(1.00±0.04)(F=176.600,P＜0.01).模型组小鼠 cdc7 mRNA 表达量(2.18±0.15)、cdc7细胞阳性率(21.10±0.46)％,显著高于对照组的(1.02±0.05)、(7.11±0.32)％,差异均有统计学意义(P＜0.01).与模型组比较,实验组小鼠背部皮损较轻,PASI评分上升较缓慢.结论 cdc7具有促进银屑病角质细胞增殖的作用.

目的 分析和总结近30年文献中对于寻常型银屑病血热证的用药规律,为临床治疗提供参考.方法 通过检索中国期刊全文数据库知网、万方、维普数据库近30年来中医药治疗寻常型银屑病血热证的相关文献,基于中医传承辅助平台软件建立方剂数据库从而分析组方规律.结果 共筛选出中医药治疗寻常型银屑病血热证随机对照试验文献55篇,中药处方64首,中药118味.处方中核心药物有生地黄、牡丹皮、赤芍、金银花、紫草、土茯苓等,并挖掘出10个潜在新方.结论 银屑病血热证用药主要以清热解毒、凉血活血为主.

目的:明确消银解毒饮通过细胞分裂周期蛋白7(cdc7)对小鼠银屑病模型角质细胞增殖的干预作用.方法:将20只健康雄性BALB/c小鼠随机分为对照组、银屑病模型组、消银解毒饮组与cdc7抑制剂TAK-931组,每组5只,除对照组外,每组背部涂抹咪喹莫特诱导银屑病模型,连续5天.对照组和银屑病模型组予蒸馏水10 mL/kg,消银解毒饮组和cdc7抑制剂TAK-931组小鼠分别予消银解毒饮23.4 g/kg,TAK-9312 mg/kg灌胃处理,每天2次,连续5天.每日观察皮损情况进行PASI评分;HE染色观察皮损组织形态学改变及表皮厚度;免疫组化法检测皮损表皮中cdc7表达.结果:银屑病模型建模成功.与银屑病模型组相比,消银解毒饮组与TAK-931组小鼠背部皮损PASI评分低,表皮增生程度较轻,炎性细胞浸润较少(均P<0.05);消银解毒饮组表皮cdc7阳性表达细胞较银屑病模型组明显减少(P<0.05).结论:消银解毒饮可能通过下调cdc7表达,抑制角质形成细胞的过度增殖,改善咪喹莫特诱导的小鼠银屑病样皮损.

目的:应用蛋白芯片筛选寻常型银屑病血热证、血瘀证血清中的蛋白表达差异,从蛋白水平揭示不同证候的生物学基础.方法:收集寻常型银屑病患者血热证、血瘀证和健康人的血清各3例,采用抗体蛋白芯片检测和分析不同证候间的差异蛋白.结果:筛选出寻常银屑病血热和血瘀证差异蛋白48种,健康对照组与血热证、血瘀证之间的差异蛋白分别为30种、20种,逻辑分析得出代表血热证证候特异性差异蛋白4种:B7-1/CD80,PDGF-AB,MIP-1b,FGF-9,血瘀证证候特异性差异蛋白6种:Smad 1,GRO-a,NCAM-1/CD56,IL-23 R,IL-23,TMEFF1/Tomoregulin-1.结论:银屑病血热证、血瘀证存在着血清蛋白表达的差异,可能与发病机制和不同证型的物质基础有关.

目的 观察苋榆洗液湿敷治疗急性湿疹的临床疗效.方法 按随机数字表法将40例急性湿疹患者分为治疗组和对照组各20例.2组均给予氯雷他定片口服,同时对照组给予硼酸溶液湿敷治疗,治疗组给予苋榆洗液湿敷治疗.治疗1周后观察2组湿疹面积严重程度评分(EASI)、瘙痒程度(VAS)评分及临床疗效.结果 治疗1周后,治疗组患者EASI和VAS评分均明显低于对照组,差异有统计学意义(P＜0.01);对照组治疗愈显率55％,低于治疗组的100％,差异有统计学意义(P＜0.05).结论 苋榆洗液湿敷治疗急性湿疹具有清热祛湿、凉血愈显消肿、解毒止痒的功效.在降低EASI评分和VAS评分,改善患者临床症状方面,治疗效果优于对照组.

目的 运用中医传承辅助平台,探讨斑秃的证治规律.方法 以“斑秃…“鬼剃头”“中医”“中药”等为关键词检索中国知网(CNKI)、维普数据库(VIP)、万方数据知识服务平台(Wanfang data)及中国生物医学数据库(CBM)中有关斑秃治疗的文献,检索时间:1988年2月1日-2019年2月28日,均采用2人独立背靠背的检索方式.根据纳入及排除标准,搜集治疗斑秃方剂,运用中医传承辅助平台,基于关联规则算法和复杂系统熵聚类,进行数据挖掘分析.结果 共纳入文献54篇.肝肾不足、气滞血瘀及气血两虚为斑秃最常见证型;当归、川芎、熟地黄、女贞子、何首乌等为斑秃最常用药物;对药物间关联规则进行挖掘,得出18个核心药物组合及5个新方.结论 斑秃内治时多在滋补肝肾的基础上加以行气、活血、祛风.

目的:观察凉血五花汤治疗面部皮炎的临床效果,及其对白介素4、白介素13、CD4、CD8、经皮水分丢失值的影响.方法:中药组采用凉血五花汤加减联合外用氧化锌软膏治疗两周,对照组采用盐酸西替利嗪口服联合外用氧化锌软膏.分别于初诊和第二周进行皮损形态及瘙痒积分标准判定.中药组进一步进行皮肤屏障功能检测、T细胞亚群、IL-4、IL-13血清学检测.结果:48例患者皮损积分明显下降(P＜0.05),对照组总有效率67％,中药组总有效率79％,经皮水分丢失明显下降(P＜0.05),CD3+CD4+、CD3+CD8+治疗后稍升高无统计学意义(P＞0.05),IL-4、IL-13治疗后稍下降无统计学意义(P＞0.05),治疗前CD4与IL-4、IL-13有直线相关性(P＜0.05).结论:凉血五花汤加减联合氧化锌软膏外用治疗面部过敏性皮炎患者,具有显著临床疗效,可以降低经皮水分丢失值,改善皮肤屏障功能,可能使CD4升高或IL-4、IL-13降低,从而破坏CD4与IL-4、IL-13的平衡关系.

文章收集、整理和总结了金起凤教授辨治寻常型银屑病的临证经验.金起凤教授洞察病机癓结,提出“血热毒盛”为银屑病的病机核心,而血热可致瘀化燥,因此,金起凤教授认为寻常型银屑病的主要病机是“血热毒盛兼气血瘀滞”, “血热毒盛”贯穿疾病始终.金起凤教授将寻常型银屑病分为血热、血燥、湿热3种证型,创立“消银解毒汤”系列方剂,内外合参治疗寻常型银屑病.用药独具匠心,擅用水牛角、玳瑁、金银花、蚤休等凉血解毒之品,擅用虫类药治疗皮肤顽症,临证灵活施方药,临床疗效显著.

目的:运用中医传承辅助平台V2.5,分析当代医家治疗银屑病血瘀证用药规律.方法:以"银屑病"OR"白疕"为主题词,"血瘀"OR"活血化瘀"为自由词,采用主题词与自由词结合的方式检索中国知网(CNKI)、维普全文数据库(VIP)及万方数据知识服务平台,根据纳入及排除标准,搜集治疗寻常型银屑病血瘀证的方剂,运用中医传承辅助平台进行数据挖掘分析.结果:共纳入文献35篇,红花、丹参、桃仁等为寻常型银屑病血瘀证最常用药物,并对药物间关联规则进行挖掘,得出10个核心药物组合及5个新方.结论:寻常型银屑病血瘀证的中医治疗以活血化瘀为主要治则;运用中医传承辅助平台挖掘寻常型银屑病血瘀证用药规律,不仅能客观反映临床用药规律,亦可为相关科研提供参考.

总结金起凤教授应用清化和胃托毒法治疗有头疽的经验.金起凤教授中医外科思想源于清代嘉定黄墙朱氏外科流派,除其先业师朱咏豳外,亦受张山雷先生所著《疡科纲要》影响,擅长内治与外治结合治疗皮肤科重症.有头疽相当于西医的“痈”,是指相邻毛囊及其周围组织同时发生的急性化脓性炎症,可伴有全身症状,易内陷生变,金起凤教授认为本病的病机为脏腑内蕴毒热,痰湿随热上壅,中焦气机失常,气血凝滞.临证循内科之理以治外疡,治以清化和胃托毒法,临床随证而施,结合外治,疗效显著.

Objective: To investigate the distribution and evolution of composite constitution in patients with chronic urticaria. Methods: To analyze the composite constitution of 199 patients with chronic urticaria by using "Traditional Chinese Medicine Inheritance Assistant Software v2.5". Results: The majority patients of chronic urticaria have 2～4 kinds of biased composite constitutions, and the "Yang deficiencyQi deficiency constitution" is the main type, while other biased constitution can further increase the probability of developing into composite Yang deficiency or Qi deficiency. Conclusion: The type of composite constitution in patients with chronic urticaria are complex and changeable, there are internal relations among the physical constitutions, which influence and promote each other. The role of "Yang-deficiency" and "Qi-deficiency" in the pathogenesis of chronic urticaria should be payed more attention.

The famous traditional Chinese medicine doctor ZHU Zhan-yu created a prescription called Guomin Decoction.This recipe is consist of four Chinese herbal medicines:Starwort Root,dark plum,schisandra chinensis and Chinese parsnip root.It makes large effect on a variety of allergic disease,such as allergic asthma,allergic dermatitis,irritable bowel syndrome and so on.Modem pharmacology has proved the drug composition of this prescription has obvious anti-allergic effects,which can inhibit mast cell degranulate,block histamine receptors and reduce vascular permeability.The aim of this review is to explore the curative effect of Guomin Decoction on all kinds of allergic diseases by elaborating the modern pharmacological research and clinical application of Guomin Decoction,and to open up new ideas for the prevention and treatment of allergic diseases.

目的 观察自拟和血除湿汤治疗血虚风燥型慢性湿疹的临床疗效及探讨其可能的作用机制.方法 将60例血虚风燥型慢性湿疹患者随机分为中药组(自拟和血除湿汤)和西药组(西替利嗪),18例健康体检者为正常对照组.治疗前后对湿疹面积及严重度指数评分(eczema area and severity index,EASI)、皮肤病生活质量指数量表(dermatology life quality index,DLQI)及瘙痒程度进行评分,并用酶联免疫吸附法测定外周血清中细胞因子白介素-4(interleukin-4,IL-4)、干扰素-γ(interferon-γ,INF-γ)表达水平.结果 治疗前,两组患者的EASI、DLQI及瘙痒程度评分比较差异均无统计学意义(P>0.05);治疗4周后,中药组EASI、DLQI及瘙痒程度评分均明显低于西药组(P<0.05);中药组总有效率为70％,明显高于西药组的40％(P<0.05).治疗前,两组患者的血清IL-4、IFN-γ水平比较差异均无统计学意义(P>0.05);两组患者与健康对照组比较,IL-4水平均明显升高,IFN-γ水平均明显降低(P<0.05).治疗4周后,两组患者IL-4水平均下降,IFN-γ水平均升高(P<0.05);且中药组IL-4水平明显低于西药组,中药组IFN-γ水平明显高于西药组(均P<0.05).结论 自拟和血除湿汤治疗血虚风燥型慢性湿疹,可明显改善患者症状、体征及生活质量,提高临床疗效,其作用机制可能与降低IL-4水平、促进IFN-γ分泌以使Th1/Th2细胞分化趋于平衡有关.

Objective:To investigate the constitution distribution and potential tendency of patients with chronic urticaria.Methods:According to Constitution in Chinese Medicine Questionnaire and criterion by Professor WANG Qi,the transformation scores of constitution were calculated,then the data were analyzed using EXCEL,SPSS 21.0 software.Results:The ‘tendency of special constitution’ was the main direction evolution of basically normal constitution,the single allergic constitution and single yang-deficiency constitution were the main types of single biased constitution,with the tendency of special constitution,tendency of qi-deficiency constitution and tendency of yin-deficiency constitution as the main direction,the yang-deficiency constitution was the main basic constitution,and ‘yang-qi deficiency constitution’,‘yang deficiency-special constitution’ and ‘yang deficiency-qi stagnation constitution’ as the main composite constitution.Conclusion:Warming yang,anti-allergic,invigorating vital energy and regulating qi-flowing drugs should be paid attention in the treatment of chronic urticaria,and according to the other composite constitution with yang deficiency constitution,appropriate drugs should be chosen to regulate different constitution,and thus it could improve curative effect of treatment.

Objective To evaluate systemically the clinical efficacy of cooling blood and detoxification method for the treatment of psoriasis vulgaris.Methods Through searching China National Knowledge Infrastructure(1956-2016),VIP(1989-2016),WANFANG DATA (1990-2016),PubMed,EMBASE and Medline,all randomized controlled trials about using cooling blood and detoxification method for the treatment of psoriasis vulgaris were collected,and the quality of studies were evaluated by two researchers by RevMan5.3.Results A total of 9 randomized controlled trials were included.Meta analysis showed the clinical effectiveness of cooling blood and detoxification method for the treatment of psoriasis vulgaris was obviously different from other methods [RR =1.20,95％ CI (1.13,1.28)].Conclusion Cooling blood and detoxification method for the treatment of psoriasis vulgaris is better than other methods for psoriasis vulgaris.However,because of the low quality of included studies in methodology,it is difficult to prove that the clinical effect of cooling blood and detoxification method for the treatment of psoriasis vulgaris is better than other methods.Multicentered of randomized double-blind controlled trials with large samples are still needed to provide high quality clinical evidence.

在临床医院皮肤性病专业的工作模式中,青年医务工作者有着双重身份,既是青年医师,同时也是青年教师.建立一支结构合理、素质良好的青年医师和青年教师队伍,不仅关系到当前高等教育大发展时期高等中医药院校的教学科研工作,而且影响着临床教学医院的可持续发展.目前我院皮肤性病专业的现状是,青年医师和青年教师主要来自专业型研究生,缺乏常见皮肤性病的诊疗经验,导致他们在教学中理论部分与临床部分脱节.