Abstract:

Objective To study the regulation of Chinese herbal medicine compound Qingdai capsule combined with methotrexate（MTX） on the immune balance of helper T cell（Th）1 and Th2 in patients with psoriasis,and to evaluate the efficacy of combined therapy. Methods A total of 50 patients with plaque psoriasis with a psoriasis area and severity index（PASI）>10 were enrolled. The study lasted for 8 weeks,of which 25 patients received weekly MTX treatment,and the other 25 patients received daily oral compound Qingdai capsule combined with weekly MTX treatment. Blood samples were collected before treatment（baseline） and after 8 weeks of treatment. Peripheral blood mononuclear cell（PBMC） was isolated,and real-time polymerase chain reaction（PCR） was used to analyze Th1 transcription factor T-bet,cytokine interleukin（IL）-12 and interferon-gamma（IFN-γ）. In addition,the Th2 transcription factor GATA-3 and cytokine IL-4 were also determined. Clinical performance was assessed by PASI. Results At the 8th week of treatment,12 patients in compound Qingdai capsule combined with MTX group achieved PASI-75（defined as at least 75% reduction in PASI）,and 8 patients in single MTX group achieved PASI-75. There was statistical significance in clinical manifestation between the 2 groups（P<0.05）. The Th1-related cytokines were down-regulated,and the Th2-related cytokines were up-regulated in compound Qingdai capsule combined with MTX group（P<0.05）. Furthermore,with PASI-75 as the threshold,in compound Qingdai capsule combined with MTX group,the IFN-γ expression of PASI-75 was lower than that in single MTX group（P<0.05）. Compound Qingdai capsule combined with MTX group reached PASI-75,and GATA-3 and IL-4 levels were higher than those in single MTX group（P<0.05）. Conclusions Compound Qingdai capsule combined with MTX has better therapeutic effect on psoriasis. The reason may be that combination treatment has strong immune regulatory effect on Th1 and Th2.

Key words: Cytokine, Gene expression, Compound Qingdai capsule, Methotrexate, Psoriasis