發(fā)布時間：2018-03-17 13:04

  本文選題：銀屑病　切入點(diǎn)：皮膚屏障　出處：《安徽醫(yī)科大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：研究背景與目的皮膚是人體最大的器官,是機(jī)體的天然屏障,具有體溫調(diào)節(jié)、感覺、吸收、分泌及排泄、反饋等多種生理功能,其中屏障功能意義重大。銀屑病患者的屏障功能根據(jù)不同程度的皮損表現(xiàn)受到不同程度的損傷。尋常型銀屑病患者的皮損主要是以浸潤性紅斑,上附銀白色鱗屑為主要表現(xiàn),可伴有薄膜現(xiàn)象和點(diǎn)狀出血,Auspitz征(+),部分患者皮損因瘙癢而搔抓刺激作用下在紅斑鱗屑基礎(chǔ)上可見抓痕、血痂、滲出,鱗屑顏色也由銀白色轉(zhuǎn)為淡黃至深褐色,即伴有濕疹樣臨床表現(xiàn)。本次臨床研究重點(diǎn)是對尋常型銀屑病患者的皮膚屏障及其皮損出現(xiàn)濕疹樣改變情況展開調(diào)查及分析,了解尋常型銀屑病患者皮膚屏障功能情況,探討尋常型銀屑病患者皮損區(qū)與非皮損區(qū)、患者與正常人皮膚屏障功能相關(guān)指標(biāo)之間的差異；另外,對銀屑病患者皮損處出現(xiàn)濕疹樣改變的情況進(jìn)行調(diào)查、分析,探討尋常型銀屑病患者皮損出現(xiàn)濕疹樣改變的發(fā)生率及相關(guān)影響因素。方法與結(jié)果1.尋常型銀屑病患者皮膚屏障功能的臨床分析使用皮膚屏障功能測試儀測定尋常型銀屑病患者皮損區(qū)、非皮損區(qū)、健康志愿者的皮膚角質(zhì)層含水量、PH值及經(jīng)皮水分流失量(TEWL)；分別采用壓板法、分光光度法測定尋常型銀屑病患者的血清NO、VitE水平。探討尋常型銀屑病患者皮損區(qū)與非皮損區(qū)、患者與正常人皮膚屏障功能相關(guān)指標(biāo)之間的差異。結(jié)果發(fā)現(xiàn)尋常型銀屑病患者皮損區(qū)PH值為(5.69±0.61)高于非皮損區(qū)PH值和健康對照組PH值；皮損區(qū)含水量為(17.90±6.75)低于非皮損區(qū)及健康對照組；皮損區(qū)TEWL為(18.58±11.55)g/m2h,高于非皮損區(qū)和健康對照組。非皮損區(qū)與健康對照組的PH值、角質(zhì)層含水量及TEWL值無統(tǒng)計(jì)學(xué)差異。銀屑病患者皮損區(qū)進(jìn)展期含水量(18.28±7.51)高于靜止期,有統(tǒng)計(jì)學(xué)差異；消退期含水量(21.64±5.28)高于靜止期,有統(tǒng)計(jì)學(xué)差異；消退期含水量高于進(jìn)展期,無統(tǒng)計(jì)學(xué)差異；進(jìn)展期TEWL值(22.74±13.16)g/m2h高于消退期,有統(tǒng)計(jì)學(xué)差異；進(jìn)展期TEWL值高于靜止期,無統(tǒng)計(jì)學(xué)差異；靜止期TEWL值高于消退期,無統(tǒng)計(jì)學(xué)差異；進(jìn)行期、靜止期、消退期皮損區(qū)的PH值間比較,無統(tǒng)計(jì)學(xué)差異。尋常型銀屑病患者血清維生素E含量7.27±0.96ug/ml低于健康對照組,銀屑病組血清NO含量5.29±1.91umol/L高于健康對照組。2.尋常型銀屑病患者皮損濕疹樣改變的臨床分析制訂病例調(diào)查表記錄患者信息和病情變化情況,利用圖像采集設(shè)備記錄皮損圖像信息,應(yīng)用SPSS16.0軟件和Excel軟件進(jìn)行數(shù)據(jù)分析。結(jié)果發(fā)現(xiàn)241例尋常型銀屑病患者中男性137例,女性104例；出現(xiàn)濕疹樣改變的患者122例,發(fā)生率為50.6%；出現(xiàn)濕疹樣改變與未出現(xiàn)濕疹樣改變的患者在皮膚類型、瘙癢評分及疾病分期方面差異具有統(tǒng)計(jì)學(xué)意義；在性別、年齡、家族史、病程及皮損形態(tài)上差異無統(tǒng)計(jì)學(xué)意義。結(jié)論1.尋常型銀屑病患者皮損區(qū)與非皮損區(qū)及健康組比較,皮膚屏障功能指標(biāo)異常,表現(xiàn)在皮膚表面PH值升高、角質(zhì)層含水量下降、TEWL值升高、血清VitE下降、血清NO升高,恢復(fù)銀屑病患者的皮膚屏障功能應(yīng)當(dāng)作為銀屑病治療的重要內(nèi)容。2.尋常型銀屑病患者在自覺瘙癢感強(qiáng)烈、皮膚干燥或處于進(jìn)展期時,皮損易出現(xiàn)濕疹樣改變,在治療早期應(yīng)當(dāng)重視口服止癢藥物及外用保濕劑,聯(lián)合治療,提高療效,促進(jìn)皮損消退。
[Abstract]:Research background and purpose of the skin is the largest organ in the body, is the natural barrier of the body, with thermoregulation, feeling, absorption, secretion and excretion, the physiological functions of feedback, one of the major barrier function significance. In patients with psoriasis skin barrier function according to different degree of damage by varying degrees of damage. The skin lesions of patients with psoriasis vulgaris is mainly to the infiltration of erythema, with silvery scales as the main performance, can be accompanied by film phenomenon and punctate bleeding, Auspitz syndrome (+) lesions, itching and scratching due to stimulation in red spot scales based on visible scratches, blood scab, exudation of some patients with scales color from white to silver light yellow to dark brown, with eczema like clinical manifestations. The clinical study is focused on the skin barrier and skin lesions of patients with psoriasis vulgaris eczema like change situation investigation and analysis, seeking to understand Often type psoriasis skin barrier function, to explore the lesions of patients with psoriasis vulgaris and non lesional skin, the differences between the related index of skin barrier function in patients and normal persons; in addition, the skin lesions of patients with psoriasis appear eczematous changes of the investigation, analysis, explore the skin lesions of patients with psoriasis vulgaris eczema like change incidence and the correlative factors. Methods and results: clinical analysis of 1. skin barrier function in patients with psoriasis vulgaris using skin barrier function tester lesions of patients with psoriasis vulgaris, non lesional skin, the stratum corneum of the skin of healthy volunteers moisture, pH and percutaneous water loss (TEWL) were used to plate method;, spectrophotometric method for the determination of serum NO, VitE levels in patients with psoriasis vulgaris. To investigate the lesions of patients with psoriasis vulgaris and non lesional skin, patients and normal people The difference between the related index of skin barrier function. The results showed that the pH value of the lesions of patients with psoriasis vulgaris for (5.69 + 0.61) higher than that of non lesional skin pH and healthy controls pH; lesions of water (17.90 + 6.75) is lower than that of non lesional and normal control group; the lesions of TEWL (18.58 + 11.55) g/m2h that is higher than that of non lesional and non lesional skin. The healthy control group and healthy control group the pH of stratum corneum water content and TEWL value had no significant difference. During the progression of psoriatic lesions containing water (18.28 + 7.51) higher than the resting stage, there were significant differences; paracmasis moisture (21.64 + 5.28) higher than the stationary phase, there were significant differences; paracmasis moisture content higher than the advanced stage, there was no significant difference in TEWL value; (22.74 + 13.16) g/m2h higher than the recession, there is significant difference; advanced TEWL value is higher than the resting stage, there was no significant difference in resting stage; high TEWL value In a recession, no significant difference; period, quiescent, dissipated period compared the pH value of the lesions, with no significant difference. The content of E in patients with psoriasis vulgaris serum vitamin 0.96ug/ml was 7.27 lower than that of the control group, levels of serum NO and clinical analysis of 5.29 psoriasis + 1.91umol/L Gao Yujian Kang group.2. of psoriasis vulgaris eczema for cases like change was used to record the patient information and condition changes, the use of image acquisition equipment lesions recorded image information, the application of SPSS16.0 software and Excel software to analyze the data. The results showed that 241 cases of patients with psoriasis vulgaris in male 137 cases, female 104 cases; 122 cases of eczema like changes of patients, the incidence of 50.6%; eczema like change and no change in patients with eczematous skin type, pruritus score and disease staging showed a statistically significant difference; In gender, age, family history, no significant difference on the duration and lesion morphology. Compared with non lesional skin lesions and healthy group 1. conclusions in patients with psoriasis vulgaris, abnormal skin barrier function, increased on the surface of the skin pH value, the stratum corneum water content decreased, TEWL value increased, decreased serum VitE, serum NO increased, an important content of.2. in patients with psoriasis vulgaris to restore skin barrier function in patients with psoriasis should be used as the treatment of psoriasis in a strong sense of itching, dry skin or in the advanced stage, skin prone to eczema like changes in the early stage of treatment should pay attention to oral antipruritic drugs and topical moisturizing agent, combined treatment, improve the curative effect, promote lesions fade.

【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R758.63

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