【摘要】：背景:特應(yīng)性皮炎是一種與遺傳因素相關(guān)的慢性、炎癥性皮膚病,特征為難耐的瘙癢感和反復(fù)發(fā)作的濕疹樣病變。雖然它往往于嬰兒期發(fā)病,發(fā)病率約為34%,也常常見于成年期起病。AD是一種非致命性,但對患者及親屬產(chǎn)生相當(dāng)大心理負(fù)擔(dān)的皮膚病,并且有增加患者哮喘、過敏性鼻炎和其他免疫介導(dǎo)的炎癥性疾病的風(fēng)險,甚至引起精神健康障礙。外用皮質(zhì)類固醇類藥物治療仍然是急性發(fā)作治療的一線用藥,隨著研究的推進(jìn),我們需要一種安全有效的治療手段,近年來非激素類外用免疫調(diào)節(jié)劑如他克莫司成為了炎癥性皮膚病的新型治療方法。目前公認(rèn)的AD是一種具有多種臨床表現(xiàn)的終身性疾病,主要的病因為表皮屏障功能的缺陷,現(xiàn)今的預(yù)防及治療主要在表皮屏障功能的恢復(fù),最好的治療手段為潤膚劑的使用。綜上所述,我們進(jìn)行了兩種藥物聯(lián)合治療的臨床研究。目的:評價他克莫司軟膏聯(lián)合柔潤保濕霜治療成人AD的療效。實驗方法:選取2015年1月至2016年12月來我科門診就診的成人AD患者,隨機將其分為對照組和治療組,每組34人,兩組在年齡、性別、病程等資料方面比較,差異無統(tǒng)計學(xué)意義(P0.05)。治療組患者早、晚間給予0.1%或0.03%他克莫司軟膏涂于患處并輕揉,30min后將薇諾娜柔潤保濕霜涂于患處。對照組早晚間在患處僅外用他克莫司軟膏,兩組均治療3周。分別在患者初次(基線)和治療后1、2、3周分析總體改善率、濕疹面積和嚴(yán)重度指數(shù)(EASI)評分、受累體表面積百分?jǐn)?shù)(BSA%)、醫(yī)生的總體評估(PGE),同時應(yīng)用視覺模擬尺(VAS)對瘙癢程度進(jìn)行評估。結(jié)果:治療結(jié)束時,治療組與對照組治療第1、2、3周的有效率分別為29.41%(10/34)、58.82%(20/34)、85.29%(29/34)和20.59%(7/34)、44.12%(15/34)、64.71%(22/34)。PGE評分第1、2、3周分別達(dá)到32.35%(11/34)、64.71%(22/34)、88.24%(30/34)和20.59%(7/34)、47.06%(16/34)、70.59%(24/34),EASI經(jīng)治療3周后治療組和對照組評分分別由21.24和20.91減為為5.59和7.88。BSA%經(jīng)治療3周后治療組和對照組分別由32.29%和32.82%減為9.47%和15.11%。療程結(jié)束時,治療組治療成功率高達(dá)85.29%,其中有35.29%的患者達(dá)到痊愈,所觀察的兩組病例中未發(fā)現(xiàn)變差的病例。通過VAS對患者瘙癢程度進(jìn)行評估,顯示治療3周后治療組和對照組的評分分別由5.29和5.03下降為2.03和3.94。兩組使用他克莫司的藥物相關(guān)性不良反應(yīng)發(fā)生率分別為8.82%和20.59%,主要表現(xiàn)為皮膚灼熱、瘙癢加重或刺痛等局部刺激反應(yīng),多為輕到中度,無需特殊處置和停用藥物,可逐漸自行緩解。結(jié)論:他克莫司聯(lián)合薇諾娜柔潤保濕霜治療AD患者,兩者發(fā)揮協(xié)同作用,療效明確,優(yōu)于單用他克莫司治療AD患者,不良反應(yīng)少。隨治療時間延長,治療效果隨之增加。
[Abstract]:Background: atopic dermatitis is a chronic inflammatory dermatosis associated with genetic factors characterized by intolerable itching and recurrent eczema-like lesions. Although it often occurs in infancy, with an incidence rate of about 34 and is often found in adult onset. AD is a non-fatal skin disease that imposes a considerable psychological burden on patients and relatives, and increases asthma in patients. Allergic rhinitis and other immune-mediated inflammatory diseases may even cause mental health disorders. Topical corticosteroid therapy is still the first line of treatment for acute seizures, and with the advance of research, we need a safe and effective treatment. In recent years, non-hormone topical immunomodulators such as tacrolimus have become a new treatment for inflammatory dermatosis. At present, AD is a life-long disease with many clinical manifestations. The main cause is the defect of epidermal barrier function. Nowadays, the prevention and treatment is mainly in the recovery of epidermal barrier function, the best treatment is the use of emollients. To sum up, we conducted a clinical study of two drug combinations. Objective: to evaluate the efficacy of tacrolimus ointment combined with Ruorun moisturizing cream in the treatment of adult AD. Methods: adult AD patients from January 2015 to December 2016 were randomly divided into control group and treatment group with 34 persons in each group. There was no significant difference in age, sex and course of disease between the two groups (P0.05). In the treatment group, 0.1% or 0.03% tacrolimus ointment was applied to the affected area in the morning and evening and gently rubbed for 30 minutes. The control group was treated with tacrolimus ointment for 3 weeks. The overall improvement rate, (EASI) score of eczema area and severity index, the percentage of affected body surface area (BSA%), the total evaluation of (PGE), and the degree of pruritus were evaluated by visual analog scale (VAS) at the first (baseline) and 1: 2 weeks after treatment. Results: at the end of the treatment, 娌葷枟緇勪笌瀵圭収緇勬不鐤楃1,2,3鍛ㄧ殑鏈夋晥鐜囧垎鍒負(fù)29.41%(10/34),58.82%(20/34),85.29%(29/34)鍜，

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