【摘要】：本論文主要包括文獻(xiàn)綜述、臨床調(diào)查研究和導(dǎo)師治療經(jīng)驗(yàn)三部分。 文獻(xiàn)綜述：從現(xiàn)代醫(yī)學(xué)和傳統(tǒng)醫(yī)學(xué)兩種角度闡述關(guān)于白癜風(fēng)病因及治療進(jìn)展的研究概況,包括國內(nèi)外西醫(yī)學(xué)對白癜風(fēng)發(fā)病機(jī)制的最新研究、近年來治療方面的研究進(jìn)展及臨床科研成果；中醫(yī)學(xué)對白癜風(fēng)病因病機(jī)的認(rèn)識、近現(xiàn)代大家的臨證經(jīng)驗(yàn)及經(jīng)方驗(yàn)藥和近年來中醫(yī)治療白癜風(fēng)的臨床療效觀察及實(shí)驗(yàn)研究。 臨床調(diào)查研究部分： 目的：通過對2011年6月一2011年12月期間門診就診于北京中醫(yī)醫(yī)院皮膚科的白癜風(fēng)患者進(jìn)行流行病學(xué)病因?qū)W調(diào)查,統(tǒng)計(jì)白癜風(fēng)一病的流行病學(xué)資料,主要包括性別、年齡、病程、發(fā)病季節(jié)、膚色、初發(fā)及目前皮損的部位及大小、臨床分型分布情況、家族史、伴發(fā)病史、常見病因、誘因及可能相關(guān)危險(xiǎn)因素、舌苔、脈象、中醫(yī)辨證分型等內(nèi)容,在此基礎(chǔ)上總結(jié)白癜風(fēng)的各年齡段、男女之間發(fā)病率有無差異；平均病程；皮損有無好發(fā)部位及季節(jié)性規(guī)律；臨床各種分型的發(fā)病比例；白癜風(fēng)與其他疾病的關(guān)系,有無家族遺傳傾向；臨床常見病因、誘發(fā)因素及可能相關(guān)危險(xiǎn)因素的探討；舌苔脈及中醫(yī)辨證分型的規(guī)律,為今后白癜風(fēng)病因及治療方面的科研提供一些研究依據(jù)和思路。 方法：制定“白癜風(fēng)的流行病學(xué)病因?qū)W調(diào)查表”,對符合納入標(biāo)準(zhǔn)的患者經(jīng)其知情同意后進(jìn)行病例采集,認(rèn)真填寫表格各項(xiàng)數(shù)據(jù),尊重患者隱私權(quán)。收集完所有病例之后,對數(shù)據(jù)進(jìn)行集中處理。所得數(shù)據(jù)均輸入Excel表格,用SPSS17.0軟件進(jìn)行統(tǒng)計(jì)學(xué)處理,并得出相應(yīng)結(jié)論。計(jì)數(shù)資料采用均值、標(biāo)準(zhǔn)差描述,計(jì)量資料用構(gòu)成比描述。 結(jié)果：共收集了104例白癜風(fēng)患者,女性75例,男性29例,女：男為2.6：1,女性白癜風(fēng)患病率高于男性。白癜風(fēng)首次發(fā)病可在任何年齡,從1歲到74歲不等,平均年齡32.17±17.29,72.1%的白癜風(fēng)患者集中在11-50歲,其中以21-30歲者所占比例最多,為19.2%；小于10歲及高于50歲組所占比例較少,均低12%；白癜風(fēng)各年齡段除11-20歲組外,均為女性發(fā)病率高于男性,尤以21-60歲階段表現(xiàn)突出,女性發(fā)病率均為男性3倍以上。平均病程4.12±5.96年,其中病程1年一3年者最多,占24.04%,病程1年者62例,占59.6%。104例白癜風(fēng)患者中膚色正常者80例,偏黑者19例,偏白者5例,本研究顯示黃種人中膚色偏黑者患病率高于偏白者。104例白癜風(fēng)患者中,有100例患者能回憶起初次發(fā)病或本次加重的季節(jié),初次發(fā)病或本次加重時(shí)間春季29例,夏季44例,秋季14例,冬季13例,春夏季節(jié)發(fā)病率明顯高于秋冬季節(jié)。目前皮損主要分布于面部、手部和頸部,且軀干部頭面頸部上肢下肢。初發(fā)皮損好發(fā)于面部、手部和腹部,且頭面頸部軀干部上肢下肢。104例白癜風(fēng)患者中,節(jié)段型4例,尋常型100例,其中以散在型和局限型為主；處于進(jìn)展期的21例,以散在型和肢端型為主,穩(wěn)定期的83例,以散在型和局限型為主；完全性白斑91例,不完全性白斑13例。皮損嚴(yán)重程度以輕度和中度為主。本研究中有12.5%的白癜風(fēng)患者有家族史,家族成員中共有16例患本病,其中Ⅰ級親屬5例,占31.3%,Ⅱ級親屬8例,占50%,Ⅲ級親屬3例,占18.7%,Ⅲ級親屬患病率低于Ⅰ、Ⅱ級。在眾多相關(guān)病因中,精神心理因素所占比例最大,有72.12%的白癜風(fēng)患者在起病之前、疾病發(fā)展階段或者復(fù)發(fā)階段曾有過精神創(chuàng)傷、生活工作壓力過大、用腦過度、緊張焦慮等狀況出現(xiàn)。免疫方面,約有22.12%的白癜風(fēng)患者伴發(fā)甲狀腺疾病、類風(fēng)濕、肝炎、哮喘、斑禿、濕疹、糖尿病、慢性鼻炎、慢性胃炎等自身免疫性或與免疫相關(guān)的疾��；33.65%的白癜風(fēng)患者中出現(xiàn)同形反應(yīng)。較多攝入維生素C,較多接觸電腦、電視以及某些化學(xué)物質(zhì),微量元素缺乏等都是本病的相關(guān)危險(xiǎn)因素。104例白癜風(fēng)患者中,氣滯血瘀型18例,肝腎陰虛型48例,其他證型38例。舌暗紅(50.0%),苔薄白(54.8%),脈沉(47.1%)及沉弦(35.0%)所占比例最多。 導(dǎo)師治療經(jīng)驗(yàn)：針對白癜風(fēng)的多種致病因素,單一治療方法難以取得理想效果,導(dǎo)師采用綜合療法取得了較好的臨床療效,包括辨證論治中藥內(nèi)服,藥湯外敷以引氣血,飲食療法,心理疏導(dǎo),鞏固性治療。
[Abstract]:This paper mainly includes three parts: literature review, clinical investigation and tutor treatment experience.
Literature review: from two angles of modern medicine and traditional medicine, this paper expounds the general situation of the research on the etiology and treatment progress of vitiligo, including the latest research on the pathogenesis of vitiligo at home and abroad, the progress in the treatment of treatment and the achievements of clinical research in recent years, the understanding of the pathogenesis of vitiligo in traditional Chinese medicine, and the recent modern people Clinical experience and experience in the treatment of vitiligo in recent years.
Clinical research research part:
Objective: through the epidemiological investigation of vitiligo patients in Department of Dermatology of Beijing Chinese Medicine Hospital during the period of December 2011 June 2011, the epidemiological data of vitiligo, including sex, age, course of disease, disease season, skin color, location and size of skin lesions, and the distribution of clinical types, were mainly included. Conditions, family history, associated history, common cause, inducement and possible related risk factors, tongue coating, pulse image, TCM syndrome differentiation, and so on. On this basis, we summarize the age of vitiligo, the incidence of men and women has no difference, the average course of disease, the skin lesions have no good hair position and seasonal regularity; the incidence of various types of clinical types; The relationship between vitiligo and other diseases, the familial hereditary tendency, the clinical common cause, the inducing factor and the possible related risk factors, the tongue coating pulse and the pattern of TCM syndrome differentiation, provide some research basis and thought for the research of the etiology and treatment of vitiligo in the future.
Methods: formulating the epidemiological etiological questionnaire for vitiligo, collecting the cases after their informed consent, carefully filling out the data of the form and respecting the patient's right to privacy. After collecting all the cases, the data were concentrated. All the data were entered into the Excel form and used in the SPSS17.0 software. Statistics were processed, and corresponding conclusions were obtained. Counting data were described by mean, standard deviation, and measured data were described by constituent ratio.
Results: a total of 104 patients with vitiligo were collected, 75 women, 29 male and female: male was 2.6:1. The incidence of vitiligo in women was higher than that of men. The first onset of vitiligo was at any age, ranging from 1 to 74 years old. The average age of 32.17 + 17.29,72.1% of vitiligo was 11-50 years old, with the largest proportion of 21-30 years old, 19.2%. The proportion of the group less than 10 years old and the 50 year old group was less than 12%. The incidence of female vitiligo in all ages except 11-20 years old was higher than that of men, especially in the stage of 21-60 years, the incidence of women was 3 times more than that of men. The average course of disease was 4.12 + 5.96 years, of which the course of disease was 1 years and 3 years, accounting for 24.04%, 62 cases of 1 years in the course of illness accounted for 59. In.6%.104 patients with vitiligo, there were 80 cases of normal skin color, 19 cases of blacken and 5 cases of whiteness. This study showed that the prevalence rate of black people in the yellow race was higher than that of vitiligo patients in.104 cases, and 100 patients could recall the first onset or this aggravation season, 29 cases in the first onset or this aggravation time, 44 in summer and 14 in the autumn. The incidence of 13 cases in winter was obviously higher than that of autumn and winter in the spring and summer season. At present, the lesions mainly distributed in the face, hand and neck, and the upper limbs of the head and neck of the body. The primary skin lesions were in the face, the hand and the abdomen, and the upper limbs of the head and neck trunk of the upper limbs were.104 cases of white purpura, 4 cases of segmental type and 100 cases of common type. In the 21 cases of progressive period, 21 cases were mainly scattered and acromegaly, 83 cases in the stable period, mainly scattered and localized, 91 cases of complete leukoplakia and 13 cases of incomplete leukoplakia. The severity of skin lesions was mild and moderate. In this study, 12.5% of the patients with white purpura had family history, and the family members had 16 cases. Among them, there were 5, 31.3%, 8, 50%, 3, 18.7%, and class III of relatives lower than I, class II. Among the many related causes, psycho psychological factors accounted for the largest proportion, and 72.12% of vitiligo patients had had mental trauma before the onset of disease or in the relapse stage. There are about 22.12% of vitiligo patients with thyroid diseases, rheumatoid, hepatitis, asthma, alopecia, eczema, diabetes, chronic rhinitis, chronic gastritis and other autoimmune or immune related diseases, and 33.65% of vitiligo patients have homomorphic reactions. Intake of vitamin C, more exposure to computers, television and some chemicals, and the lack of trace elements were all associated risk factors for the disease in.104 patients with vitiligo, 18 cases of qi stagnation and blood stasis, 48 cases of yin deficiency of liver and kidney, 38 cases of other syndrome types, tongue dark red (50%), moss white (54.8%), pulse sinks (47.1%) and sunk chord (35%).
Tutor treatment experience: in view of the various pathogenic factors of vitiligo, the single treatment method is difficult to achieve the ideal effect, the tutor adopts comprehensive therapy to achieve better clinical effect, including syndrome differentiation and treatment of Chinese medicine, medicine soup external application to lead Qi and blood, diet therapy, psychological counseling, sera fixation.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R758.41

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