本文選題：白癜風(fēng) + 復(fù)方卡力孜然酊��； 參考：《大連醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:白癜風(fēng)是一種常見的皮膚黏膜色素脫失性疾病,是皮膚科常見疾病之一,病因復(fù)雜,發(fā)病機(jī)制尚不清楚。在我國(guó)人群中患病率為0.1%~2.7%。好發(fā)于暴露及摩擦部位,影響患者的美觀和人際交往,給患者帶來較大的心理障礙。白癜風(fēng)的治療比較困難,隨著醫(yī)學(xué)的逐漸發(fā)展,其治療方法也在日益增多。近年來,光療法和光化學(xué)療法逐漸興起,PUVA是其中應(yīng)用較多的一種療法,它是補(bǔ)骨脂素與長(zhǎng)波紫外線UVA的聯(lián)合應(yīng)用,其療效雖已經(jīng)獲得臨床認(rèn)可,但其帶來的不良反應(yīng)也不容忽視。UVA1(340~400 nm)是長(zhǎng)波紫外線UVA的一個(gè)波段,其皮膚穿透能力更強(qiáng)。本研究中通過對(duì)穩(wěn)定期白癜風(fēng)患者三種不同治療方法的觀察,探討UVA1聯(lián)合外用復(fù)方卡力孜然酊治療穩(wěn)定期白癜風(fēng)的療效,為臨床治療白癜風(fēng)提供新的方案。方法:本研究收集2016年09月份~2016年12月大連醫(yī)科大學(xué)附屬第二醫(yī)院皮膚科門診符合納入標(biāo)準(zhǔn)和排除標(biāo)準(zhǔn)的白癜風(fēng)患者,篩選26例進(jìn)行研究。治療過程中有2例退出,故共入選24例,其中男性12例,女性12例。年齡14~57歲,病程6個(gè)月~23年。共包括靶皮損72片,皮損分布于面部、頸部、胸部、腹部、背部、臀部、腰部、手足部、四肢部等等,符合自身對(duì)照試驗(yàn)要求。將24例白癜風(fēng)患者鄰近或?qū)ΨQ部位的3處白斑,隨機(jī)分為復(fù)方卡力孜然酊組、UVA1組和聯(lián)合組,采取自身對(duì)照的研究方法進(jìn)行治療,觀察白癜風(fēng)皮損復(fù)色狀況。復(fù)方卡力孜然酊外用每日3~4次,UVA1照射每周2次。在治療8周、12周后,根據(jù)白癜風(fēng)的療效判定標(biāo)準(zhǔn)進(jìn)行評(píng)估,分為痊愈、顯效、好轉(zhuǎn)、無效。將皮損統(tǒng)計(jì)后,計(jì)算總有效率,對(duì)三個(gè)組的療效進(jìn)行對(duì)比。并在治療12周后,將聯(lián)合組內(nèi)不同部位的皮損進(jìn)行統(tǒng)計(jì),對(duì)療效進(jìn)行比較。結(jié)果:1.臨床療效對(duì)比:在治療8周后,復(fù)方卡力孜然酊組的總有效率為33.33%;UVA1組總有效率為37.50%,聯(lián)合組的總有效率為58.33%。經(jīng)統(tǒng)計(jì)學(xué)檢驗(yàn),三組間療效差異無統(tǒng)計(jì)學(xué)意義(P0.05)。治療12周后,復(fù)方卡力孜然酊組的總有效率為50.00%;UVA1組的總有效率為54.17%,聯(lián)合組的總有效率為79.17%。經(jīng)統(tǒng)計(jì)學(xué)檢驗(yàn),復(fù)方卡力孜然酊組與UVA1組療效差異無統(tǒng)計(jì)學(xué)意義(P0.05),聯(lián)合組的療效高于復(fù)方卡力孜然酊組及UVA1組,差異有統(tǒng)計(jì)學(xué)意義(P0..05)。2.聯(lián)合組不同部位的療效對(duì)比:在治療12周后,面頸部的療效顯著高于四肢部和手足部,差異有統(tǒng)計(jì)學(xué)意義(P0.05),軀干部的療效高于手足部,差異有統(tǒng)計(jì)學(xué)意義(P0.05),其余各部位之間療效差異無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:UVA1聯(lián)合復(fù)方卡力孜然酊治療白癜風(fēng)的療效明顯優(yōu)于復(fù)方卡力孜然酊、UVA1的單獨(dú)應(yīng)用,療效顯著,而且不良反應(yīng)少,應(yīng)用安全,其療效差異與部位有關(guān),是臨床上治療穩(wěn)定期白癜風(fēng)的一種新選擇,值得進(jìn)一步推廣和研究。
[Abstract]:Objective: vitiligo is a common skin and mucosal pigment loss disease, is one of the common dermatologic diseases, the etiology is complex, the pathogenesis is not clear. The prevalence rate in Chinese population was 0.1% and 2.7%. It affects the beauty and interpersonal communication of the patients, and brings great psychological obstacles to the patients. Vitiligo treatment is more difficult, with the development of medicine, its treatment methods are increasing. In recent years, phototherapy and photochemotherapy are becoming more and more widely used as a combination of psoralen and ultraviolet UVA. However, the adverse reactions can not be ignored. UVA1 340Nm) is a band of long wavelength ultraviolet (UVA), and its skin penetration is stronger. In this study, we observed three different treatment methods of stable vitiligo patients, and discussed the efficacy of UVA1 combined with compound Kalizilan tincture in the treatment of stable vitiligo, and provided a new scheme for clinical treatment of vitiligo. Methods: from September 2016 to December 2016, 26 patients with vitiligo were selected from Department of Dermatology, second affiliated Hospital of Dalian Medical University. In the course of treatment, 2 cases quit, so 24 cases were enrolled, including 12 cases of male and 12 cases of female. The disease course ranged from 6 months to 23 years. A total of 72 target lesions were found in the face, neck, chest, abdomen, back, buttocks, waist, hands and feet, limbs and so on. Two hundred and twenty-four patients with vitiligo were randomly divided into two groups: UVA1 group and UVA1 group. Compound kalicumin tincture was irradiated with UVA1 4 times a day, twice a week. After 8 weeks and 12 weeks of treatment, vitiligo was evaluated according to the criteria of curative effect. The total effective rate was calculated and the curative effect of the three groups was compared. After 12 weeks of treatment, the skin lesions of different parts in the combined group were statistically analyzed and the curative effects were compared. The result is 1: 1. Comparison of clinical efficacy: after 8 weeks of treatment, the total effective rate of compound Kalidzilan tincture group was 33.33 and the total effective rate of UVA1 group was 37.50, and the total effective rate of combined group was 58.33. There was no significant difference in curative effect among the three groups by statistical test (P 0.05). After 12 weeks of treatment, the total effective rate of compound Carrizin tincture group was 50.00and the total effective rate of UVA1 group was 54.17, and the total effective rate of combined group was 79.17. By statistical test, there was no significant difference in curative effect between compound Kalidzilan tincture group and UVA1 group. The curative effect of combined group was higher than that of compound Kalidzilan tincture group and UVA1 group, and the difference was statistically significant. After 12 weeks of treatment, the curative effect of face and neck was significantly higher than that of limbs and hands and feet, the difference was statistically significant (P 0.05), and the curative effect of trunk was higher than that of hand and foot. The difference was statistically significant (P 0.05), but there was no significant difference between the other parts (P 0.05). Conclusion the curative effect of the treatment of vitiligo is obviously better than that of UVA1 combined with compound Kalidzilan tincture. The curative effect is remarkable, the adverse reaction is less, and the application is safe. The difference of curative effect is related to the part of vitiligo. It is a new choice in the treatment of stable vitiligo.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R758.41

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