本文選題：銀屑病　切入點(diǎn)：阿維A　出處：《湖北中醫(yī)藥大學(xué)》2010年碩士論文　論文類型：學(xué)位論文

【摘要】： 目的：本研究旨在通過臨床觀察來比較阿維A、中藥復(fù)方及兩種藥物聯(lián)合應(yīng)用這三種治療方法治療銀屑病的臨床療效；從而對(duì)比分析評(píng)價(jià)三種治療方法的治療作用；在此基礎(chǔ)上探討中西藥聯(lián)合治療銀屑病的作用機(jī)制,為阿維A酸類藥物與中藥聯(lián)合應(yīng)用能更有效治療銀屑病提供臨床依據(jù)；為進(jìn)一步研究阿維A酸類藥物療效、如何降低其毒副作用提供有效思路。 方法：分析鄖陽醫(yī)學(xué)院附屬太和醫(yī)院皮膚性病科于2008年9月-2009年2月,2009年9月-2010年2月門診及住院經(jīng)臨床確診為銀屑病患者254例,采用隨機(jī)數(shù)字表法分為三個(gè)治療組。三組患者在平均年齡、病程、治療前PASI評(píng)分均無統(tǒng)計(jì)學(xué)意義(P0.05),具有可比性。阿維A治療組100例患者口服阿維A膠囊,中藥復(fù)方治療組80例患者口服中藥復(fù)方煎劑。阿維A聯(lián)合中藥復(fù)方治療組74例患者口服阿維A膠囊同時(shí)口服中藥復(fù)方煎劑。三組患者均同時(shí)靜脈輸注復(fù)方甘草酸苷注射液、外用鈣泊三醇軟膏。療程均為六周,每周隨訪一次,并且在治療1個(gè)療程后采用國際通用的銀屑病皮損嚴(yán)重程度評(píng)分(PASI)法判定臨床療效,并觀察不良反應(yīng),結(jié)果采用多個(gè)組間樣本兩兩比較的X2檢驗(yàn),使用SPSS13.0統(tǒng)計(jì)軟件進(jìn)行統(tǒng)計(jì)學(xué)處理,以P0.05(a=0.05)、P0.017(a′=0.017)為差異具有統(tǒng)計(jì)學(xué)意義,對(duì)各組間的療效進(jìn)行統(tǒng)計(jì)學(xué)分析。 結(jié)果：阿維A治療組、中藥復(fù)方治療組、阿維A聯(lián)合中藥復(fù)方治療組的總有效率為57.09%,各治療組有效率分別是51.00%、43.75%和79.73%；阿維A治療組和阿維A聯(lián)合中藥復(fù)方治療組的有效率高于中藥復(fù)方治療組,三種治療方法的有效率差別有統(tǒng)計(jì)學(xué)意義(P0.05),說明三種療法的療效有差別。通過兩兩組間比較阿維A治療組和中藥復(fù)方治療組的有效率,發(fā)現(xiàn)差別沒有統(tǒng)計(jì)學(xué)意義(P0.017)。進(jìn)一步將阿維A聯(lián)合中藥復(fù)方治療組分別與阿維A治療組、中藥復(fù)方治療組的有效率進(jìn)行兩兩比較時(shí),發(fā)現(xiàn)他們兩兩之間的有效率差別有統(tǒng)計(jì)學(xué)意義(P0.017)。但臨床觀察中發(fā)現(xiàn)阿維A治療組中有2例血鉀降低,通過補(bǔ)鉀后恢復(fù)；13例患者出現(xiàn)輕度血脂升高,5例患者出現(xiàn)轉(zhuǎn)氨酶升高,44例患者治療過程中出現(xiàn)不同程度的皮膚干燥、口角炎、口干、皮膚變脆變薄等毒副反應(yīng),療程結(jié)束后停藥并經(jīng)適當(dāng)治療后恢復(fù),未影響治療。中藥復(fù)方治療組有2例患者出現(xiàn)腹瀉,減少中藥劑量后恢復(fù),未影響治療。阿維A聯(lián)合中藥復(fù)方治療組未見明顯不良反應(yīng)。三組患者均未發(fā)生系統(tǒng)不良反應(yīng)。 結(jié)論：阿維A膠囊、中藥復(fù)方、阿維A膠囊聯(lián)合中藥復(fù)方治療銀屑病均有較好療效,其中阿維A膠囊聯(lián)合中藥復(fù)方的療效明顯優(yōu)于阿維A膠囊和中藥復(fù)方,阿維A膠囊與中藥復(fù)方間的療效無顯著性差異。中藥復(fù)方可有效降低阿維A膠囊的毒副作用。
[Abstract]:Objective: the purpose of this study was to compare the clinical efficacy of Avera, Chinese medicine compound and two drugs in the treatment of psoriasis by clinical observation, and to compare and evaluate the therapeutic effects of the three methods. On this basis, the mechanism of combination of Chinese and western medicine in the treatment of psoriasis was discussed, which provided the clinical basis for the combination of aretinoic acid and traditional Chinese medicine in the treatment of psoriasis, and provided the clinical basis for further study of the curative effect of aretinoic acid. How to reduce its toxicity and side effects to provide effective ideas. Methods: 254 patients with psoriasis were analyzed from September 2008 to February 2009, from September 2009 to February 2010, from the Department of Dermatology and venereal Diseases of Taihe Hospital affiliated to Yunyang Medical College. Three treatment groups were randomly divided into three groups: the average age, course of disease and PASI score before treatment were not statistically significant (P 0.05), which were comparable. 80 patients in the traditional Chinese medicine compound treatment group and 74 patients in the Avera combined Chinese medicine compound treatment group were given oral Avera capsule and Chinese medicine compound decoction simultaneously. All the three groups were given intravenous infusion of compound glycyrrhizin injection at the same time. The course of treatment was 6 weeks, followed up once a week, and after one course of treatment, the clinical efficacy was evaluated by the international PASI method, and the adverse reactions were observed. Results the X2 test was used to compare the samples of different groups, and the statistical analysis was carried out by SPSS13.0 software. The difference was statistically significant between the two groups (P 0.05, P 0.017, P 0.017, P 0.017), and the curative effect of each group was analyzed statistically. Results: Avera treatment group, traditional Chinese medicine compound treatment group, The total effective rate of Avera combined with traditional Chinese medicine compound treatment group was 57.09, the effective rate of each treatment group was 51.00 and 43.75% and 79.73% respectively, the effective rate of Avera treatment group and Avera combined Chinese medicine compound treatment group was higher than that of traditional Chinese medicine compound treatment group, the effective rate of each treatment group was 51.00% and 79.73%, respectively. The difference of the effective rate of the three treatment methods is statistically significant (P 0.05), which shows that there are differences in the efficacy of the three treatments. The effective rate of Avera treatment group and traditional Chinese medicine compound treatment group was compared by comparing the two groups. It was found that the difference was not statistically significant (P 0.017). Further, the effective rate of Avera combined with traditional Chinese medicine compound treatment group was compared with that of Avera treatment group and traditional Chinese medicine compound treatment group. It was found that there was a statistically significant difference in the effective rate between them (P 0.017). But in the clinical observation, there were two cases of hypokalemia in the Avera treatment group. After potassium supplementation, 13 patients with mild hyperlipidemia and 5 patients with elevated aminotransferase were found to have some toxic side effects, such as dry skin, mouth horn inflammation, dry mouth, brittle skin thinning and so on, in the course of treatment, 44 patients had different degrees of skin dryness, mouth horn inflammation, dry mouth, skin brittle thinning and so on. After the course of treatment, two patients in the treatment group developed diarrhea and recovered after reducing the dosage of traditional Chinese medicine. There were no obvious adverse reactions in the treatment group. No systemic adverse reactions were found in the three groups. Conclusion: Avea capsule, traditional Chinese medicine compound and Avera capsule combined with traditional Chinese medicine have better curative effect on psoriasis, and Avea capsule combined with traditional Chinese medicine compound has better curative effect than Avea capsule and traditional Chinese medicine compound. There was no significant difference in curative effect between Avera capsule and traditional Chinese medicine compound, which could effectively reduce the toxicity and side effect of Avera capsule.
【學(xué)位授予單位】：湖北中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2010
【分類號(hào)】：R758.63

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