【摘要】：研究背景 特應性皮炎（atopic dermatitis,AD）是一種慢性、復發(fā)性皮膚疾病，以皮膚干燥、瘙癢和炎癥為主要特征。其發(fā)病機制尚不完全清楚，與遺傳、環(huán)境、免疫等因素相關(guān)。近年的研究發(fā)現(xiàn)，皮膚屏障結(jié)構(gòu)和功能異�？赡苁翘貞云ぱ装l(fā)病的首要機制。AD的臨床表現(xiàn)多種多樣，除有紅斑、丘疹、滲出、表皮剝脫和苔蘚樣變等多種表現(xiàn)外，約有80%的AD患者有不同程度的干皮癥，表現(xiàn)為皮膚干燥和脫屑，尤其在秋冬季節(jié)，AD皮損也往往在此季節(jié)加重。因此，恢復皮膚屏障功能、緩解皮膚干燥、脫屑以及瘙癢是治療AD和預防AD再次發(fā)作的重要措施。采用具有修復皮膚屏障作用的保濕潤膚劑作為基礎(chǔ)治療措施已成為AD治療的共識。目前，國外有研究表明外用糖皮質(zhì)激素聯(lián)合保濕潤膚劑能有效降低AD復發(fā)率并延長其緩解期。本研究采用隨機、平行對照方法，觀察單獨外用糖皮質(zhì)激素與外用糖皮質(zhì)激素聯(lián)合保濕潤膚劑治療AD的療效，并對其安全性進行評估。 目的 評價保濕潤膚劑輔助治療兒童輕~中度特應性皮炎臨床療效和安全性，保濕潤膚劑延緩兒童輕~中度特應性皮炎復發(fā)的情況。 方法 采用隨機、平行對照實驗。本研究共納入2~12歲輕~中度AD患兒30例，均滿足Hanifin-Rajka標準。其中男14例，女16例，平均年齡為4.95±2.80歲。隨機分為試驗組及對照組，試驗組予以糖皮質(zhì)激素聯(lián)合保濕潤膚劑外用治療，對照組僅予以糖皮質(zhì)激素外用治療。分別于治療的第14天、第28天、第56天進行隨訪。治療前及每次隨訪時對患兒疾病嚴重程度SCORAD（Scoring of Atopic Dermatitis）及客觀體征紅斑、丘疹/水腫、滲出/結(jié)痂、表皮剝脫/抓痕、苔蘚化、皮膚干燥及主觀癥狀瘙癢、睡眠障礙進行評分，并就每項評分比較試驗組及對照組的差異。 結(jié)果 30例納入研究的AD患兒均完成隨訪。 1.SCORAD值：首診當天，試驗組與對照組疾病嚴重程度SCORAD值無統(tǒng)計學差異（39.4±7.781、38.0±9.016，P＞0.05）。第14、28天隨訪時，試驗組與對照組SCORAD值亦無統(tǒng)計學差異。而在第56天，試驗組SCORAD值較對照組明顯降低（3.933±5.885、12.133±9.855，P＜0.05）。 2.有效率和復發(fā)率：試驗組在治療第14天有效率與對照組相當（66.7%、46.7%，P＞0.05），而在第28、56天有效率均高于對照組（第28天：100%、66.7%，P＜0.05；第56天：93.3%、53.3%，P＜0.05）。試驗組在治療第56天復發(fā)率明顯低于對照組（6.6%、46.7%，P＜0.05）。 3.客觀體征：首診當天，試驗組與對照組的客觀體征評分均無統(tǒng)計學差異（P＞0.05），而試驗組的紅斑評分在第56天較對照組明顯降低（0.13±0.352、0.53±0.640，P＜0.05），干燥評分在第28、56天較對照組明顯降低（第28天：0.133±0.352、0.6±0.507，P＜0.05；第56天：0.067±0.258、0.467±0.518，P＜0.05）。整個隨訪過程中，丘疹/水腫、滲出/結(jié)痂、表皮剝脫/抓痕、苔蘚化的評分在試驗組及對照組之間均無統(tǒng)計學差異（P＞0.05）。 4.主觀癥狀：首診當天，，試驗組與對照組的瘙癢及睡眠障礙評分均無統(tǒng)計學差異（P＞0.05），而試驗組的瘙癢評分在第56天較對照組有明顯降低（1.333±1.447、2.533±1.685，P＜0.05），整個隨訪過程中，睡眠障礙的評分在試驗組及對照組之間無統(tǒng)計學差異（P＞0.05）。 5.整個試驗過程中無不良反應事件發(fā)生。 結(jié)論 糖皮質(zhì)激素聯(lián)合保濕潤膚劑外用治療輕~中度特應性皮炎可以提高治療的有效率，較長時間規(guī)則使用潤膚劑有助于減輕疾病嚴重程度并改善患兒皮膚的紅斑、干燥、瘙癢，同時可以降低特應性皮炎的復發(fā)率。
[Abstract]:Research background
Atopic dermatitis (AD) is a chronic, recurrent skin disease characterized by dry skin, pruritus and inflammation. The pathogenesis of AD is not fully understood, and is related to genetic, environmental and immune factors. In addition to erythema, papules, exudation, exfoliation and lichenoid degeneration, about 80% of AD patients have different degrees of xerodermia, characterized by dry skin and scaling, especially in autumn and winter, AD skin lesions are often aggravated in this season. Therefore, restore the skin barrier function, alleviate skin dryness, scaling to And itching is an important measure to treat AD and prevent the recurrence of AD. It has become a common understanding to use moisturizing and emollient with skin barrier repairing function as the basic treatment for AD. At present, foreign studies have shown that topical glucocorticoid combined with moisturizing and emollient can effectively reduce the recurrence rate of AD and prolong the remission period. A randomized, parallel controlled trial was conducted to evaluate the efficacy and safety of glucocorticoid combined with moisturizing emollient in the treatment of AD.
objective
To evaluate the efficacy and safety of moisturizing and emollient in adjuvant treatment of mild to moderate atopic dermatitis in children, and to delay the recurrence of mild to moderate atopic dermatitis in children.
Method
Thirty children aged 2 to 12 years with mild to moderate AD were enrolled in this study. They all met the Hanifin-Rajka criteria. There were 14 males and 16 females with an average age of 4.95 (+ 2.80 years). They were randomly divided into experimental group and control group. The experimental group was treated with glucocorticoid combined with moisturizing and emollient, while the control group was treated only with glucocorticoid. The severity of SCORAD (Scoring of Atopic Dermatitis) and the objective signs of erythema, papules/edema, exudation/scab, exfoliation/scratch, lichening, dry skin and subjective symptoms, pruritus, sleep disorders were scored before and during each follow-up. The differences between the experimental group and the control group were compared with each score.
Result
30 children with AD who were included in the study were followed up.
1. SCORAD value: On the first day of diagnosis, there was no significant difference in SCORAD value between the experimental group and the control group (39.4 7.781, 38.0 9.016, P > 0.05). At the 14th and 28th day of follow-up, there was no significant difference in SCORAD value between the experimental group and the control group.
2. Effective rate and recurrence rate: The effective rate of the experimental group was similar to that of the control group on the 14th day (66.7%, 46.7%, P > 0.05), but higher than that of the control group on the 28th and 56th day (100%, 66.7%, P < 0.05; 93.3%, 53.3%, P < 0.05) on the 56th day. The recurrence rate of the experimental group was significantly lower than that of the control group on the 56th day (6.6%, 46.7%, P < 0.05).
3. Objective Signs: On the first day of diagnosis, there was no significant difference between the experimental group and the control group (P > 0.05), but the erythema score of the experimental group was significantly lower than that of the control group on the 56th day (0.13.352, 0.53.640, P < 0.05), and the dry score was significantly lower than that of the control group on the 28th and 56th day (0.133.352, 0.6 65507, P < 0.05). During the whole follow-up period, papules/edema, exudation/scab, epidermal exfoliation/scratch, and mossy scores were not significantly different between the experimental group and the control group (P > 0.05).
4. Subjective symptoms: On the first day of diagnosis, there was no significant difference in the itching and sleep disorder scores between the experimental group and the control group (P > 0.05), while the itching score of the experimental group on the 56th day was significantly lower than that of the control group (1.333 (+ 1.447), 2.533 (+ 1.685), P < 0.05). Academic differences (P > 0.05).
5. no adverse events occurred during the whole experiment.
conclusion
Glucocorticoid combined with moisturizing emollients can improve the efficacy of topical treatment of mild to moderate atopic dermatitis. Regular use of emollients for a long time can help to reduce the severity of the disease and improve the erythema, dryness, itching of the skin, and reduce the recurrence rate of atopic dermatitis.
【學位授予單位】：重慶醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R758.3

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