本文選題：甲分離　切入點：維胺酯　出處：《泰山醫(yī)學院》2014年碩士論文

【摘要】：背景甲分離(onycholysis)也被稱為甲剝離,是指甲板從甲床自發(fā)性的分離,為最常見的甲病癥狀之一。隨著社會的不斷發(fā)展,人民生活水平有了明顯的提高,甲病受到了人們更多的關注,因甲分離而來就診的患者有了明顯的增多。該病發(fā)病機制尚不清楚,臨床上也缺少有效的治療手段。維胺酯作為第一代的維A酸類的藥物,除了具有促進上皮細胞的正常性分化、促進上皮細胞的正常角化的作用外,還具有抑制細菌、低抗炎癥和免疫性的調節(jié)的作用;甲由基質角化而來,甲下角化過度為甲分離的常見誘因,分離后常繼發(fā)的甲下細菌或真菌感染和物理或化學的損傷往往會影響分離的愈合甚至會加重原有的分離。結合維胺酯的藥物作用原理,其調節(jié)角化作用對甲分離應該有治療作用。導師10多年前便注意到這一特點,并開展了應用維胺酯調節(jié)角化作用來治療甲分離臨床觀察,并取得了滿意的療效。目的對維胺酯治療甲分離的療效及安全性進行評估,掌握該治療的適應癥,分析甲分離的發(fā)病機理。方法查閱相關文獻并進行總結分析。設計統(tǒng)一的甲分離治療觀察表,對2011年9月-2013年12月間聊城市第二人民醫(yī)院皮膚科門診甲剝離患者進行觀察記錄,觀察內容主要包括:患者姓名、性別、年齡、職業(yè)、可能誘因、受累及病甲數(shù)、伴發(fā)的其他癥狀、實驗室檢查、有無其他的并發(fā)疾病、治療情況及每療程治療后皮損的變化情況等。共順利完成觀察76例患者、153個指甲的甲分離治療情況。具體治療方法為:對符合納入標準又沒有用藥禁忌癥的患者給予維胺酯口服,按1~2.0mg/kg/天計算,成人每次25~50mg,每日服2~3次。持續(xù)的治療一個月為一個完整的療程,共計觀察三個完整的療程。結果甲分離發(fā)病年齡從17歲到68歲,平均發(fā)病年齡42.82±11.34歲,其中發(fā)病年齡分布在40-49歲年齡段的有28人,占總數(shù)的36.84%,在30-59歲年齡段的共有61人,占總數(shù)的80.26%。男性18人,占23.68%;女性58人,占76.32%,共治療的指甲數(shù)為153個,出現(xiàn)甲分離最多的是右手大拇指,共出現(xiàn)甲分離45個,占總數(shù)的29.41%,其次為左手的大拇指為27個,占總數(shù)的17.65%,出現(xiàn)甲分離最少的是左手的小指,占總數(shù)的3.92%。面積下降指數(shù)計算公式:(治療前總面積-治療后總面積)/治療前總面積。治療前所有甲分離指甲的總面積為8580平方毫米,平均甲分離面積為56.08平方毫米,治療一個月以后總面積下降為6678平方毫米,下降指數(shù)為0.22;治療兩個月后甲分離總面積下降為5379平方毫米,下降指數(shù)為0.19;治療三個月以后甲分離總面積下降為4412平方毫米,下降指數(shù)為0.18。治療前總積分為283分,滿分為459分,每個甲分離指甲平均評分為1.85,甲分離治療一個月后總積分下降指數(shù)為0.22,治療兩個月后總積分下降指數(shù)為0.19,治療三個月后總積分下降指數(shù)為0.18。經(jīng)過三個月的治療后共有64個指甲的甲分離獲得痊愈。在為期三個月的觀察治療期間共有13例患者出現(xiàn)了輕微的不良反應,占總數(shù)的17%,其中7例為皮膚粘膜干燥伴有脫屑,4例只有口唇干燥、輕微皸裂,無皮膚干燥的表現(xiàn),還有兩例出現(xiàn)了眼睛的干燥。因為反應的程度比較輕,都沒有影響正常的治療與觀察,并且所有的不良反應均在停藥后得到徹底的緩解。結論:甲分離發(fā)病與多種內外因素有關,內因有多種系統(tǒng)性疾病、系統(tǒng)性用藥等,外因則有急慢性的物理及化學的損傷,更多的則是在易感的基礎上多種因素共同導致。目前已知的預防和治療甲分離的措施:鼓勵高蛋白飲食改善全身營養(yǎng)狀態(tài);保持甲分離處的清潔干燥,避免進一步的物理及化學損傷;家庭主婦要多用手套和洗衣機,手工業(yè)者和農民要多借助于使用工具,以減少慢性物理損傷,避免指甲和有害物質接觸;有原發(fā)疾病導致的要積極治療原發(fā)疾病;在使用光敏性藥物時注意皮膚和指甲的防光;在使用化療藥物前用冷凍手套降低手足部位的循環(huán)和代謝。維胺酯對于無明顯禁忌癥的甲分離患者有明顯的治療作用,而且沒有明顯的副作用。部分患者對維胺酯的治療不敏感,可能原因:還有其他潛在因素在加重甲分離,如機體營養(yǎng)不良導致的指甲營養(yǎng)不良、局部的細菌及真菌感染等因素、機體或局部的變態(tài)反應性因素及甲床或甲母細胞損傷程度較重。
[Abstract]:The background of a separation (onycholysis) is also known as a spin off, separated from the nail bed nail plate is spontaneous, as one of the most common symptoms of a disease. With the continuous development of society, people's living standard has been greatly improved, a disease has been paid more attention to, due to a separation and treatment of patients have been significantly increased. The pathogenesis of this disease is not clear, there is a lack of effective clinical treatment. Viaminati vitamin A acid as a drug of first generation, but with the promotion of epithelial cells of normal sexual differentiation, promote normal keratinized epithelial cells of the role, but also inhibit bacteria, anti inflammation and low the immune regulatory role; a matrix diagonalization and subungual hyperkeratosis is a common cause of separation, after the separation of Chang Jifa under a bacterial or fungal infection and physical or chemical injury often affect the separation of healing even To increase the original separation. Combining with the drug action principle of VC, the regulation of diversification role should have therapeutic effect on a separation. Mentor 10 years ago he noticed this, and carry out the application of Viaminati regulating keratosis to clinical observation on the treatment of a separation, and achieved satisfactory results. To evaluate the efficacy and safety of objective to treat the separation of Viaminati, master the treatment indications, the pathogenesis of a separation. Methods literatures were reviewed and analyzed. The design of unified treatment of a separate observation table, was recorded on September 2011 -2013 in December in Liaocheng Second People's Hospital Outpatient Department of Dermatology onycholysis patients, observe the main contents include the patient's name, gender, age, occupation, and may cause a number of involvement and disease, with other symptoms, the laboratory examination, there is no other concurrent disease, treatment And after each course of treatment of skin lesions and other changes were successfully completed. Of the 76 patients, 153 nail treatment. The specific treatment methods: no medication contraindications to met the inclusion criteria were given oral viaminate, according to 1~2.0mg/kg/ days, adult each time 25~50mg, daily for 2~3 times continuously. One month of treatment for a complete course of treatment, a total observation of three complete treatment. Results a separation from age 17 to 68 years old, the average age of 42.82 + 11.34 years old, the age distribution in 40-49 at the age of 28, accounting for 36.84% of the total, in 30-59 years of age a total of 61 people, accounted for 80.26%. of the total number of 18 men, women accounted for 23.68%; 58 people, accounting for 76.32%, the number of nails were treated for 153, there is a maximum separation of the right thumb, there were a separation of 45, accounting for 29.41% of the total, followed by the left hand thumb Refers to 27, accounting for 17.65% of the total, there is at least a separation of the little finger of his left hand, formula of the total area of 3.92%. decline index: (total area of the total area before treatment after treatment before treatment) / total area. The total area of all treatment before a separation nail is 8580 mm, the average a separation the area is 56.08 mm for a month after the total area reduced to 6678 square millimeter, drop index was 0.22; after two months of treatment with a separation of the total area decreased to 5379 square mm, drop index is 0.19; three months after treatment the total area under a separation is reduced to 4412 mm, drop index was 0.18. before treatment the total score was 283 points, out of 459 points, each a separation of the nail an average score of 1.85, a separate one month after treatment decreased total score index was 0.22, two months after treatment the total score decreased index was 0.19, three months after treatment the total points Drop index for 0.18. after three months of treatment were separated 64 nail healed. There were observed during the treatment period of three months 13 patients had mild adverse reactions, accounting for 17% of the total, including 7 cases of skin and mucosa with dry desquamation, only 4 cases of dry lips. Slightly chapped, dry skin without performance, there are two cases appeared eye dry. Because of the mild reaction, did not affect the normal treatment and observation, and the adverse reactions were thoroughly relieved after drug withdrawal. Conclusion: a separation is associated with a variety of internal and external factors, internal factors have a variety of system disease, systemic medication, external factors are urgent chronic physical and chemical damage, the more it is based on the susceptible factors of common cause. Now known as the prevention and treatment of a separation measures: to encourage a high protein diet change Good nutritional status of the body; maintain a separation of the clean and dry, avoid physical and chemical damage further; housewives to use gloves and washing machine, craftsmen and farmers to rely on the use of tools to reduce chronic physical damage, avoid contact nails and harmful substances; primary disease leads to active treatment of primary disease; in the use of photosensitive drugs when attention to anti light skin and nails; in the use of chemotherapy drugs before freezing reduce circulation and metabolism and glove parts. Viaminate has therapeutic effect is significant for a separation of patients with no contraindications, and no obvious side effects. The reason is not sensitive to treatment. On the part of patients may Viaminati: there are other potential factors in aggravating a separation, such as malnutrition caused by nail dystrophy, bacterial and fungal infections and other local factors, machine body or local variable The state of reactivity and the degree of damage to the nail bed or methoa were heavy.

【學位授予單位】：泰山醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R758.72

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