【目的】 探究黄连解毒汤合犀角地黄汤加减方治疗寻常型银屑病血热证患者的疗效及其对Th1/Th2平衡的影响。【方法】 选 取2022年1月至2023年6月期间河南中医药大学第一附属医院皮肤科收治的130例寻常型银屑病血热证患者，采用随机数字 表法将患者随机分为观察组和对照组，每组各65例。对照组给予常规西药治疗，观察组在对照组的基础上给予黄连解毒汤 合犀角地黄汤加减方内服治疗，连续治疗4周并随访1年。观察2组患者治疗前后皮损面积及严重程度指数（PASI）和皮肤病生 活质量指数（DLQI）评分、外周血Th1/Th2平衡指标及血清Th1/Th2相关因子[干扰素γ（INF-γ）、白细胞介素2（IL-2）及白细胞介 素4（IL-4）]的变化情况，评估2组患者的临床疗效和治疗期间的不良反应情况，统计2组患者1年内的复发情况。【结果】（1）疗 效方面，治疗4周后，观察组的总有效率为90.77%（59/65），对照组为76.92%（50/65），组间比较，观察组的疗效明显优于对 照组（P < 0.05）。（2）相关量表评分方面，治疗后，2组患者的PASI评分及DLQI评分均较治疗前降低（P < 0.05），且观察组对 PASI评分及DLQI评分的降低幅度均明显优于对照组（P < 0.01）。（3）Th1/Th2相关因子方面，治疗后，2组患者的血清 INF-γ、 IL-2水平均较治疗前降低（P < 0.05），血清 IL-4水平均较治疗前升高（P < 0.05），且观察组对血清 INF-γ、IL-2水平的降低 幅度及对血清IL-4水平的升高幅度均明显优于对照组（P < 0.05或P < 0.01）。（4）Th1/Th2平衡指标方面，治疗后，2组患者的 外周血Th1、Th2细胞水平及Th1/Th2值均较治疗前降低（P < 0.05），且观察组对外周血Th1、Th2细胞水平及Th1/Th2值的降 低幅度均明显优于对照组（P < 0.01）。（5）复发情况方面，观察组和对照组复发率分别为20.69%（12/58）、38.33%（23/60），复 发时间分别为（8.49 ± 1.43）、（5.36 ± 0.95）个月；组间比较，观察组1年复发率较对照组明显降低（P < 0.05），复发时间较对 照组明显延长（P < 0.05）。（6）不良反应方面，观察组和对照组药物不良反应发生率分别为10.77%（7/65）、12.31%（8/65），组 间比较，差异无统计学意义（P > 0.05）。【结论】 黄连解毒汤合犀角地黄汤加减方能够显著提高寻常型银屑病血热证患者的临 床疗效，改善Th1/Th2平衡及病情严重程度，延缓病情复发，降低复发率，且具有较高的安全性。

Objective To investigate the efficacy of modified use of Huanglian Jiedu Decoction plus Xijiao Dihuang Decoction in the treatment of patients with psoriasis vulgaris of blood-heat syndrome and to observe its effect on Th1/Th2 balance in the patients. Methods The investigation was carried out in a total of 130 patients with psoriasis vulgaris of blood-heat syndrome，who were admitted to the dermatology department of the First Affiliated Hospital of Henan University of Chinese Medicine between January 2022 and June 2023. The patients were randomly divided into an observation group and a control group by the random number table method，with 65 patients in each group. The control group was treated with conventional western medicine，while the observation group was treated with modification of Huanglian Jiedu Decoction plus Xijiao Dihuang Decoction on the basis of treatment for the control group. Both groups were treated for four consecutive weeks and were followed up for one year. The changes in the scores of Psoriasis Area and Severity Index（PASI）and Dermatology Life Quality Index（DLQI），levels of peripheral blood Th1/Th2 balance indicators，and levels of peripheral Th1/Th2-related factors such as γ-interferon （INF-γ），interleukin 2（IL-2），and interleukin 4（IL-4）in the two groups of patients before and after treatment were observed. Moreover，the clinical efficacy and adverse reactions during treatment were evaluated，and the recurrent cases within one year in the two groups were counted. Results（1）After four weeks of treatment，the total effective rate of the observation group was 90.77%（59/65），and that of the control group was 76.92%（50/65）. The intergroup comparison showed that the clinical efficacy of the observation group was significantly superior to that of the control group（P < 0.05）.（2）After treatment，the scores of PASI and DLQI in the two groups of patients were decreased when compared with those before treatment（P < 0.05），and the decrease of PASI and DLQI scores in the observation group was significantly superior to that in the control group（P < 0.01）.（3）After treatment，the serum levels of Th1/Th2-related factors such as INF-γ and IL-2 in the two groups of patients were decreased when compared with those before treatment（P < 0.05），and IL-4 level was increased when compared with that before treatment（P < 0.05），and the decrease of serum INF-γ and IL-2 levels and the increase of serum IL-4 level in the observation group were significantly superior to those in the control group（P < 0.05 or P < 0.01）.（4）After treatment，the peripheral blood levels of Th1/Th2 balance indicators of Th1，Th2 and Th1/Th2 in the two groups of patients were decreased when compared with those before treatment（P < 0.05），and the decrease of peripheral blood Th1，Th2 and Th1/Th2 levels in the observation group was significantly superior to that in the control group （P < 0.01）.（5）The recurrence rate of the observation group was 20.69%（12/58）and that of the control group was 38.33%（23 / 60）， and the recurrence time in the observation group was（8.49 ± 1.43）months and that of the control group was（5.36±0.95）months. The intergroup comparison showed that the one-year recurrence rate of the observation group was significantly decreased compared with that of the control group （P < 0.05）， and the recurrence time was significantly prolonged compared with that of the control group（P < 0.05）.（6）The medicineinduced adverse reaction rate in the observation group was 10.77%（7/65）and that in the control group was 12.31% （8 / 65）， and the intergroup comparison showed that the difference was not statistically significant（P > 0.05）. Conclusion Modified use of Huanglian Jiedu Decoction plus Xijiao Dihuang Decoction is effective on enhancing the clinical efficacy of patients with psoriasis vulgaris of blood-heat syndrome，and on improving the balance of Th1 / Th2 and the severity of the disease， delaying the recurrence of psoriasis vulgaris， and reducing the recurrence rate，with high safety.

R275.9

河南省自然科学基金青年项目 （编号：222300420225）；河南省中医药科学研究专项（编号：20-21ZY2006）；河南省卫生健康 委员会国家中医临床研究基地科研专项（编号：2019JDZX2020）