本文關鍵詞： 重型斑禿 富血小板血漿 糖皮質激素 六味地黃湯　出處：《廣州中醫(yī)藥大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:觀察富血小板血漿(platelet-rich plasma PRP)聯(lián)合中西藥治療重型斑禿(肝腎不足型)的臨床療效及安全性觀察。方法:采用隨機對照研究方法,將符合條件的13例中醫(yī)辨證肝腎不足型的重型斑禿患者分為對照組(6例)和治療組(7例),對照組:內服中藥(六味地黃湯加減,每天1劑)和小劑量糖皮質激素(甲潑尼龍片0.25mg/kg,每天1次,清晨頓服;此后根據(jù)實際情況減量至停藥),鹽酸雷尼替丁膠囊(150mg,每天2次),碳酸鈣D3片(600mg,每天1次)。治療組:在對照組治療方法基礎上行PRP注射。用水光注射儀將PRP局部注射至脫發(fā)區(qū)域,每月1次,連續(xù)3次為一個療程。同時患者在治療前后行血液分析,肝腎功能,尿組合,大便檢查,感染四項安全性檢查;填寫基本信息表,生活質量調查表及知情同意書。觀察者填寫不良反應觀察表,安全性檢查表,及重型斑禿臨床觀察表。治療0周,4周,8周,12周用數(shù)碼相機記錄脫發(fā)區(qū)域的毛發(fā)情況,根據(jù)治療前后脫發(fā)面積,拉發(fā)實驗,毛發(fā)再生情況進行臨床療效觀察。結果:1.治療組和對照組的患者在年齡、性別、病程方面,分別進行統(tǒng)計學分析,P0.05差異均無統(tǒng)計學意義,具有可比性;兩組患者在治療前后,肝腎功能、血分析、尿組合、大便檢查均無明顯異常;兩組患者不良反應,均無統(tǒng)計學意義,PRP注射聯(lián)合中西藥治療重型斑禿具有安全性。2.治療后,兩組在脫發(fā)面積、毛發(fā)再生方面,經(jīng)統(tǒng)計學分析,P值均P0.05,差異有統(tǒng)計學意義,治療組在減小脫發(fā)面積,提高毛發(fā)再生情況均優(yōu)于對照組。拉發(fā)實驗,P0.05,差異無統(tǒng)計學意義,治療組在改善拉發(fā)試驗優(yōu)勢不明顯,兩組改善程度無明顯差異。兩組皮損總積分比較,治療后組間和組內比較,P值均P0.05,兩種治療方法均能改善皮損總情況,治療組改善皮損評分優(yōu)于對照組。3.治療組與對照組臨床總有效率比較,對照組66.66%,治療組85.71%,統(tǒng)計學分析,P0.05,臨床顯效率比較,對照組33.33%,治療組57.14%,P0.05,兩組療效差異均無統(tǒng)計學意義,治療組與對照組相比,臨床療效優(yōu)勢不明顯。結論:富血小板血漿聯(lián)合內服小劑量糖皮質激素和六味地黃湯加減治療與單純內服小劑量糖皮質激素和六味地黃湯加減治療相比,臨床療效無明顯優(yōu)勢,但在減小脫發(fā)面積,改善毛發(fā)再生情況方面有明顯優(yōu)勢,且兩種治療方法均能改善皮損總狀況且治療安全,具有臨床治療意義。
[Abstract]:Objective: to observe the clinical efficacy and safety of platelet-rich plasma plasma combined with western medicine in the treatment of severe alopecia areata. Thirteen cases of severe alopecia areata with syndrome differentiation of liver and kidney were divided into control group (n = 6) and treatment group (n = 7). One dose per day and one dose of glucocorticoid (methylprednisolone 0.25mg / kg, once a day, early in the morning); Then according to the actual situation, the dosage of ranitidine hydrochloride was 150 mg, twice a day, calcium carbonate D3 tablet 600 mg, once a day. The treatment group was given PRP injection on the basis of the treatment method of the control group, and the PRP was injected locally into the alopecia area with the water photoinjector. At the same time, the patients were given blood analysis, liver and kidney function, urine combination, stool examination, infection four safety tests before and after treatment, filling out basic information form, Quality of life questionnaire and informed consent form. Observers filled out adverse reaction observation forms, safety check forms, and clinical observation forms for severe alopecia areata. Hair in the hair loss area was recorded by digital camera at 0 weeks, 4 weeks, 8 weeks and 12 weeks after treatment. According to the area of hair loss, hair pulling experiment and hair regeneration before and after treatment, the clinical curative effect was observed. Results there was no significant difference in age, sex and course of disease between the treatment group and the control group (P0.05). Two groups of patients before and after treatment, liver and kidney function, blood analysis, urine combination, stool examination were not significantly abnormal, the two groups of adverse reactions, There was no statistical significance in the treatment of severe alopecia areata with PRP injection and western medicine. 2. After treatment, there was significant difference in hair loss area and hair regeneration between the two groups (P 0.05), and the treatment group was reducing the alopecia area. The improvement of hair regeneration in the treatment group was better than that in the control group, the difference was not statistically significant (P 0.05), the advantage of the treatment group was not obvious in the improvement of hair pulling test, and there was no significant difference in the improvement degree between the two groups. After treatment, the P values of the two groups were all P 0.05, both of which could improve the overall condition of skin lesions, and the improvement score of skin lesions in the treatment group was better than that in the control group .3.The total effective rate of the treatment group was higher than that of the control group, and the total effective rate of the treatment group was higher than that of the control group. The control group (66.66), the treatment group (85.71), the clinical efficacy rate was compared, the control group was 33.33, the treatment group was 57.14 and P0.05, there was no significant difference between the treatment group and the control group. Conclusion: platelet rich plasma combined with low-dose glucocorticoid and Liuweidihuang decoction has no obvious advantage in clinical effect compared with that of low-dose glucocorticoid and Liuweidihuang decoction alone. But there are obvious advantages in reducing the area of hair loss and improving hair regeneration. Both methods can improve the overall condition of skin lesions and the treatment is safe, which has clinical significance.
【學位授予單位】：廣州中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R758.71

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