中药药浴联合他克莫司治疗儿童中、重度特应性皮炎的疗效及对血清LTB4、LTC4的影响

目的 探讨中药药浴联合他克莫司治疗儿童中、重度特应性皮炎(AD)的疗效及对血清炎症介质的影响。 方法 选取中、重度AD患儿102例，随机分为A组、B组、C组，每组各34例。A组使用0.05%地奈德乳膏，B组使用0.03%他克莫司软膏涂抹患处皮损，C组采用中药药浴联合他克莫司软膏外涂治疗。3组均治疗至皮损“消除”后1周或治疗达3周。于治疗前、治疗1周、治疗2周、治疗3周/结束，进行湿疹面积及严重度指数(EASI)评分；于治疗前、治疗3周/结束时检测血清LTB₄、LTC₄，采用皮肤病学生活质量指数(DLQI)进行生活质量评分；治疗3周/结束后进行临床疗效评定，比较治疗期间的药物不良反应；随访3个月了解AD复发情况。 结果 A、B、C组治疗1周、治疗2周、治疗3周/结束EASI评分均较治疗前降低(P＜0.05或P＜0.01)；C组EASI评分均低于A、B组(P＜0.05或P＜0.01)；治疗3周/结束后，A、B、C组有效率分别为65.63%、63.64%、87.10%，C组有效率均高于A、B组(P＜0.05)；治疗3周/结束后，B、C组血清LTB₄、LTC₄均降低(P＜0.05或P＜0.01)；依A、B、C组的顺序，血清LTB₄、LTC₄及DLQI评分均依次降低(P＜0.05)。A、B、C组不良反应发生率分别为40.63%、36.36%、12.90%，A、B组均高于C组(P＜0.05)；随访3个月，A、B、C组复发率分别为34.38%、9.09%、3.23%，A组复发率均高于B、C组(P＜0.05或P＜0.01)。 结论 中药药浴联合他克莫司治疗儿童中、重度AD具有较好的疗效，有效消除了皮损症状，降低了血清LTB₄、LTC₄的水平，提高了相关生活质量，且具有较低的不良反应发生率和复发率，优于糖皮质激素、他克莫司软膏单纯外涂治疗的效果。 

Curative effect of TCM medicated bath combined with tacrolimus on moderate to severe atopic dermatitis in children and influence on serum LTB4 on LTC4

Objective To explore the curative effect of medicated bath of TCM combined with tacrolimus in the treatment of children moderate to severe atopic dermatitis(AD) and their influence on the serum inflammatory mediator. Methods Total 102 children with moderate to severe AD were selected and randomly divided into group A,B and C with 34 cases in each group.The patients in group A were given 0.05% desonide ointment,group B were given 0.03% tacrolimus ointment,and group C were given medicated both of TCM and tacrolimus.The treatment in three groups was all lasted until 1 week after skin lesion elimination or for 3 weeks.EASI were evaluated before the treatment,1 week,2 weeks and 3 weeks after the treatment/treatment finished.Serum LTB₄ and LTC₄,and DLQI were detected before the treatment,3 weeks after the treatment/treatment finished.The curative effects were evaluated 3 weeks after treatment/treatment finished.The adverse reactions wererecorded and follow-up for 3 months to record the recurrence. Results Comparing with the conditions before the treatment,three groups’ EASI scores were all decreased 1 week after the treatment,2 weeks after the treatment,and 3 weeks after the treatment/treatment finished(P＜0.05 or P＜0.01),and EASI score in group C was lower than those in both group A and B(P＜0.05 or P＜0.01).The effective rate in Group A,B and C was 65.63%,63.64% and 87.10%,respectively,and the effective rate in group C was higher than those in both group A and B(P＜0.05).The serum LTB₄ and LTC₄ in group B and C were both decreased 3 weeks after treatment/treatment finished(P＜0.05 or P＜0.01).By the order of group A,B and C,serum LTB₄ and LTC₄ and DLQI scores were all decreased successively(P＜0.05).The incidence of adverse reaction in group A,B and C was 40.63%,36.36%,12.90%,respectively,and the rate both in group A and B were higher than that in group C(P＜0.05).In 3 months following-up,the recurrence rate in group A,B and C was 34.38%,9.09%,3.23%,respectively,and the recurrence rate group A was higher than that in both group B and C(P＜0.01). Conclusion The medicated bath of TCM combined with tacrolimus have a good curative effect on moderate to severe AD in children,it can effectively eliminates the skin lesion,decrease serum LTB₄ and LTC₄ level,improve life quality,also has lower side effects and recurrence rate,and it is superior to simple glucocorticoid or tacrolimus in curative effect.