【目的】 观察连蓉膏封包疗法对血热型寻常型银屑病不同部位皮肤屏障功能的改善情况，探讨其可能的作用机制并指 导不同病变部位治疗方案的选择。【方法】 纳入2023年3月至2024年5月在广州中医药大学附属宝安中医院皮肤科就诊并确 诊为血热型寻常型银屑病的患者40例，按随机数字表法将患者随机分为观察组和对照组，每组各20例；同时，收集同期在 本院体检的健康人群20例为健康组。观察组与对照组均给予犀角地黄汤合黄连解毒汤加减的中药汤剂内服，对照组同时给 予皮损处外涂卡泊三醇软膏治疗，观察组在对照组的基础上配合连蓉膏封包疗法治疗，2组疗程均为4周。以健康组为参照， 对比观察组和对照组在治疗前及治疗4周后不同部位的皮肤屏障功能指标变化情况，并比较观察组和对照组治疗前后银屑病 皮损面积和严重程度指数（PASI）评分、瘙痒程度视觉模拟量表（VAS）评分和皮肤病生活质量量表（DLQI）评分的改善情况。 【结果】（1）治疗前，观察组和对照组头颈部的经表皮水分丢失值（TEWL）水平与健康组无明显差异（P＞0.05），躯干、上肢、 下肢较健康组高（P＜0.05），各部位的角质层含水量、头颈部皮脂含量较健康组低（P＜0.05）。治疗后，观察组与对照组各部 位的TEWL水平均较治疗前明显降低（P＜0.05），躯干及上肢部位观察组、对照组、健康组之间无明显差异（P＞0.05），下肢 部位观察组与健康组之间无明显差异（P＞0.05），但对照组较健康组仍明显升高（P＜0.05）；观察组各部位的角质层含水量较 治疗前及对照组治疗后均明显升高（P＜0.05），但仍低于健康组水平（P＜0.05）；观察组和对照组的头颈部皮脂含量在治疗前 后始终低于健康组（P＜0.05）；观察组和对照组不同部位的 pH 值在治疗前后及其与健康组之间差异均无统计学意义（P＞ 0.05）。（2）观察组和对照组的PASI评分、DLQI评分和瘙痒程度VAS评分均较治疗前明显降低（P＜0.05），且观察组的降低幅 度均明显优于对照组（P＜0.05）。【结论】 血热型寻常型银屑病患者不同部位皮肤屏障功能指标变化不同，头颈部TEWL变化 不明显，各部位角质层含水量均有较明显变化，而各部位pH值变化不明显；连蓉膏封包疗法能有效改善血热型寻常型银屑 病的临床症状及皮肤屏障功能指标并且以头颈部和上肢的效果最佳，而恢复皮损处角质层含水量及TEWL从而修复皮肤屏障 功能可能是其作用机制之一。

Objective To investigate the potential mechanism of Lianrong Ointment dressing-packag therapy and guide treatment selection for different lesion sites by observing its effects on skin barrier function at various body sites of patients with blood-heat type of psoriasis vulgaris. Methods Forty patients diagnosed with blood-heat type of psoriasis vulgaris in the Dermatology Department of Bao’an Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Chinese Medicine between March 2023 and May 2024 were enrolled and randomly divided into an observation group （n=20） and a control group （n=20） using a random number table. Additionally， 20 healthy individuals undergoing physical examinations during the same period were recruited as a healthy group. Both the observation and control groups received modified Xijiao Dihuang Decoction combined with Huanglian Jiedu Decoction. The control group additionally received topical calcipotriol ointment，while the observation group received Lianrong Ointment dressing-package therapy in addition to the control group’s treatment. The treatment course for both groups was 4 weeks. Using the healthy group as a reference， changes in skin barrier function indicators at different body sites were compared between the observation and control groups before and after 4 weeks of treatment. Improvements in Psoriasis Area and Severity Index （PASI） scores，Visual Analogue Scale （VAS） scores for pruritus severity，and Dermatology Life Quality Index （DLQI） scores were also compared between the two treatment groups. Results （1） Before treatment，transepidermal water loss （TEWL） values in the head and neck regions of the observation group and control group showed no significant difference compared to the healthy group （P＞0.05），while TEWL level in the trunk，upper limbs，and lower limbs was significantly higher than those in the healthy group （P＜0.05）. Stratum corneum hydration and sebum content in the head and neck regions of the two treatment groups were significantly lower than those in the healthy group （P＜0.05）. After treatment， TEWL levels at all body sites significantly decreased in both the observation and control groups compared to pretreatment levels （P＜0.05）. No significant differences in TEWL were observed among the observation group， control group， and healthy group in the trunk and upper limbs （P＞0.05）. In the lower limbs， no significant difference was found between the observation group and the healthy group （P＞0.05），but TEWL in the control group remained significantly higher than that in the healthy group （P＜0.05）. Stratum corneum hydration at all body sites in the observation group significantly increased compared to pre-treatment levels and the control group posttreatment levels （P＜0.05），though it remained lower than that in the healthy group （P＜0.05）. Sebum content in the head and neck regions of both the observation group and control group remained significantly lower than that in the healthy group before and after treatment （P＜0.05）. No statistically significant differences in pH values were observed among different body sites within or between groups before and after treatment，or when compared to the healthy group （P＞0.05）.（2） PASI scores，DLQI scores，and pruritus VAS scores significantly decreased after treatment in both the observation and control groups compared to pre-treatment levels （P＜0.05）， with the observation group demonstrating significantly greater reductions than the control group （P＜0.05）. Conclusion Skin barrier function indicators vary in different body sites of patients with blood-heat typed psoriasis vulgaris. TEWL changes in the head and neck are not significant， while stratum corneum hydration changes are more pronounced across all sites，and pH values remain relatively stable. Lianrong Ointment dressing-packag therapy effectively improves clinical symptoms and skin barrier function indicators，with optimal effects observed in the head，neck，and upper limbs. The restoration of stratum corneum hydration and TEWL at lesion sites，thereby repairing the skin barrier，may be one of its mechanisms of action.

R275.9

国家自然科学基金青年基金项目（编号：82405559）；广东省中医药局中医药科研项目（编号：20231293）；深圳市“医疗卫生三名 工程”项目（编号：SZZYSM202106008）