【Abstract】Objective
To observe the clinical efficacy and the effect on the quality of life of chronic idiopathic urticaria treated with solid-epithelium dispelling and antipruritic soup combined with stavastine hydrochloride tablets. Methods Eighty patients with chronic idiopathic urticaria who were eligible for inclusion were randomly divided into two groups according to the order of consultation: 40 cases in the control group were given oral administration of stavastine hydrochloride tablets; 40 cases in the treatment group were given oral administration of the Chinese herbal soup Good Watch Dispel Wind and Relieve Itch on top of the control group. The quality of life survey was conducted using the Dermatological Disease Quality of Life Index (DLQI) scale before and after treatment in both groups, and the comprehensive clinical efficacy of the two groups was compared after 1 month of medication. Results After 1 month of treatment, the effective rate was 87.5% in the treatment group and 67.5% in the control group, with statistically significant differences (P < 0.05); the total score of the quality of life index decreased in both groups after treatment compared with that before treatment (P < 0.05), but the decrease was significant in the treatment group. Conclusion The efficacy of solid table dispelling wind and relieving itch soup combined with stavastatin hydrochloride tablets in the treatment of chronic idiopathic urticaria is significant and better than stavastatin hydrochloride tablets alone, and it can improve the quality of life level of patients.
Key words】Chronic idiopathic urticaria; Anti-wind and anti-itch soup; Stastine hydrochloride tablets
Chronic idiopathic urticaria (CIU) is one of the most common clinical allergic diseases in dermatology, with complex etiology, recurrent attacks and intractable. In order to find an effective treatment plan, our dermatology outpatient clinic treated 40 cases of chronic idiopathic urticaria with the combination of solid-form wind dispelling and anti-itch soup and stavastatin hydrochloride tablets from August 2011 to February 2013, and achieved satisfactory results.
Data and methods
1.1 Diagnostic criteria [1] (1) sudden appearance of wind clusters of different sizes and shapes on the skin with clear borders; (2) the rash is fluctuating, with indefinite occurrence and intense itching, leaving no trace after retreating; (3) some cases may have abdominal pain and diarrhea, or fever and arthralgia. Severe cases may have respiratory difficulty or even cause asphyxia; (4) positive skin scratch test; (5) the duration of the disease is more than 3 months.
1.2 Inclusion criteria (1) clinical diagnosis was consistent with chronic idiopathic urticaria, with transient wind masses and itching as the main clinical manifestation, age ≥ 18 years; (2) no glucocorticoid or immunosuppressant had been used within 1 month before treatment, and no Chinese medicine or antihistamine had been taken within 1 week; (3) the subject or guardian had signed the informed consent; (4) Chinese medicine identification belonged to lung qi deficiency, wind-cold external attack evidence, clinical manifestations: wind The clinical manifestations: recurrent episodes of wind-cold attack, pale red or pale wind masses, heavy on exposed areas, aggravated by fatigue or wind or cold, relieved by warmth, pale tongue, thin white fur, floating and tight or slow pulse.
1.3 Exclusion criteria
(1) Patients with serious primary diseases such as cardiovascular, cerebrovascular, hepatic, renal and hematopoietic systems and psychiatric disorders; (2) women who were breastfeeding and pregnant; (3) those with recent co-infections; (4) patients who refused to sign the informed consent or had poor compliance.
1.4 General information
Eighty patients were diagnosed with chronic idiopathic urticaria from the outpatient clinic of the Department of Dermatology, Liuan Hospital of Traditional Chinese Medicine, Anhui Province, and were randomly divided into a treatment group and a control group according to the order of consultation. There were 40 cases in the treatment group, including 26 males and 14 females; ages ranged from 18 to 63 years, mean age (33.1±16.8), duration of disease ranged from 3 months to 10 years, mean duration of disease (1.37±0.42) years; 40 cases in the control group, including 23 males and 17 females; ages ranged from 18 to 65 years, mean age (34.1±16.2), duration of disease ranged from 3 months to 11 years The mean duration of disease was (1.20±0.47) years. The general data of gender, age and disease duration of the two groups were statistically treated without significant differences and were comparable (P0.05).
1.5 Treatment methods
In the control group, the following formula was added to the control group: Astragalus membranaceus 20g, Bifeng 10g, Atractylodes macrocephala 10g, Jingzhu 10g, Gui Zhi 10g, Bai Shao 10g, Jujube 3 pieces, Ginger Bark 10g, Tribulus terrestris 10g. The herbal soup was decocted by automatic decoction machine for 150 mL, 2 times/d. Both groups were treated with the herbal medicine for 1 month. During the treatment period, the patients stopped using other oral and topical drugs and paid attention to their diet, avoiding fishy and spicy foods such as beef and mutton, fish and shrimp, crab, tobacco and alcohol.
1.6 Efficacy assessment [1] Clinical symptoms, including the size, number, congestion and itchiness of the wind masses, were recorded on the day of consultation and 1 month after medication. Patients’ pruritus, number of wind masses and congestion were recorded according to the 4-point scoring method of symptoms and signs 0-3, and the total score was calculated by adding the three items. 0 was classified as no pruritus, no wind masses and no redness; 1 was classified as mild pruritus, no irritation, 1-10 wind masses and mild congestion; 2 was classified as moderate pruritus, still tolerable, 11-20 wind masses and obvious congestion; and 2 was classified as moderate pruritus. -20, congestion is obvious; 3 is classified as severe itching, unbearable, with more than 20 wind masses and very obvious congestion. The symptom score decrease index (SSRI) was calculated according to the following formula: SSRI = (pre-treatment symptom score a post-treatment symptom score) ÷ pre-treatment symptom score × 100%. Cured was SSRI≥90%; effective was 60%≤SSRI<90%; effective was 20%≤SSRI<60%; ineffective was SSRI<20%. Effective rate=[(cured+effective+effective)/total number of cases]×100％.
1.7 Quality of life evaluation [2] The DLQI scale test method, which is commonly used internationally, was used. There are 10 questions in the whole questionnaire: physiology, psychology, daily activities, dressing, social recreation, exercise, work and study, family, sex life, and treatment. Each question was scored on a 4-point scale: 0 for none, 1 for a little, 2 for relatively obvious, and 3 for very obvious. The total score was 0 to 30. The doctor explained the purpose and significance of the survey and the precautions for completing the questionnaire to the patients, and the patients completed the questionnaire independently, and the evaluation time was for the past 1 month. After 1 month of treatment, the DLQI test was performed again.
1.8 Statistical methods
SPSS16.0 statistical software was used for statistical analysis. The measurement data were expressed as `x±s with t-test or corrected t-test, and the count data were tested by χ2 test, and P < 0.05 indicated that the difference was statistically significant.
Results
2.1
Comparison of clinical efficacy between the two groups After 1 month of relevant drug treatment in the two groups, 15 cases were cured, 11 cases were effective, 9 cases were effective, and 5 cases were invalid in the treatment group; the effective rate was 65.0% and the efficiency was 87.5%; 9 cases were cured, 6 cases were effective, 12 cases were effective, and 13 cases were invalid in the control group; the effective rate was 37.5% and the efficiency was 67.5%; the difference between the efficiency of the two groups was statistically significant (χ2= 4.588, P < 0.05). See Table 2-1.
Table 2-1 Comparison of clinical efficacy between the two groups Number of cases (%)
Group
n
Cured
Apparent effect
Effective
Ineffective
Effective rate (%)
Treatment group
Control group
40
40
15
9
11
6
9
12
5
13
87.5
67.5
2.2 Comparison of DLQI scores between the two groups
The total scores of the 10 questions in the DLQI questionnaire were accumulated before and after treatment for both groups, see Table 2-2. The total scores were (13.96±6.32) and (14.13±6.67) for the treatment group and the control group before treatment, and (6.75±2.32) and (9.61±2. 79) for the treatment group, respectively. The difference between the two groups before and after treatment was not statistically significant (t=0.138, P0.05), and the difference between the two groups after treatment was also statistically significant (t=4985, P<0.05).
Table 2-2 Comparison of DLQI scores between the two groups (`x±s)
Group
n (number of cases)
Total cumulative DLQI score (points)
Before treatment After treatment
Treatment group
40
13.9±6.32
6.75±2.32
Control group
40
14.1±6.67
9.61±2.79
Discussion
Chronic idiopathic urticaria is a common allergic skin disease whose pathophysiological mechanism has not been completely understood and whose etiology is complex, with 3/4 of the patients unable to find the exact cause. Western medicine believes that the pathological changes are mainly dermal capillary dilatation and limited edema, with collagen bundles as well as individual fibers separated by edema, and perivascular infiltration with neutrophilic leukocytes, lymphocytes and a few eosinophils. The release of histamine can cause capillary dilation, increased vascular permeability, and smooth muscle spasm, resulting in the development of pemphigus [3].
In addition, wind is the longest of all diseases, its nature is light and easy to be good at several changes, and it is most likely to be accompanied by other pathologies (such as dampness, heat, etc.), resulting in this disease. Therefore, the treatment mostly adopts the principle of benefitting the qi and consolidating the surface, dispelling wind and relieving itch, and harmonizing Ying and Wei. The formula includes Astragalus membranaceus, Rhizoma Atractylodis Macrocephalae and Fructus Anemarrhenae to strengthen the surface of the body and protect it from wind, and Thornbush, Cinnamomum cassiae, Paeonia lactiflora and Jujube to harmonize the Ying and Wei and disperse wind and cold, in which Thornbush and Fructus Anemarrhenae dispel wind and relieve itch without leaving evil behind, Tribulus terrestris, Ocimum sanctum and Cicada molasses search wind and evil, extinguish wind and relieve itch, and licorice harmonizes all medicines. The whole formula can benefit the qi and consolidate the surface, dispel wind and relieve itch, and harmonize the camp and the body.
As a third-generation antihistamine, sestamibi not only inhibits the release of various allergic inflammatory chemical mediators, but also has been shown in the literature [4, 5] that it has strong antihistamine effects with minimal sedative effects and effects on other central nervous system, fast onset of action, and no cardiac side effects, with a wide range of safety. It can also be used for other acute and chronic allergic reactions.
The results of the present study showed that the combination of the combination of the treatment of Chronic Idiopathic Urticaria with Stelastine Hydrochloride can achieve satisfactory efficacy, which is better than the use of Stelastine Hydrochloride alone, and significantly improve the quality of life of patients, which is worthy of clinical reference.
References
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[3] Meng Shuang, Li Tienan. Clinical observation of 100 cases of chronic idiopathic urticaria treated with a combination of Chinese and Western medicine. Chinese Journal of Integrative Dermatology and Venereology, 2007,6(4):244-244.
[4] Hu S G, Wang F, Sun B. The antihistamine effect of stavastatin hydrochloride. Pharmacodynamic study of the antihistamine effect of stavastine hydrochloride. Anhui Medicine, 2005, 9(6):417-419.
[5] Li Ren, Tang Guang. Stelastine hydrochloride. Chinese Journal of New Drugs, 2006, 15(14):1219-1220.