【摘要】：目的： 1.得膚寶外用治療白癜風(fēng),與對照組達(dá)力士、二丙酸倍他米松臨床療效比較；通過共聚焦激光掃描顯微鏡監(jiān)測3組療效,判斷白斑皮損治療后基底層色素恢復(fù)程度及表皮其它變化。 2.利用CLSM對臨床中常見的6種白斑性皮膚病的掃描圖像特征初步探索。為臨床白斑性皮膚病提供初步的診斷依據(jù)。 方法： 1.36例白癜風(fēng)患者白斑皮損隨機(jī)分為3組分別給予得膚寶、達(dá)力士、二丙酸倍他米松,于3-6月治療期后,根據(jù)白癜風(fēng)常規(guī)臨床療效判定標(biāo)準(zhǔn),對3組藥物治療前后療效的評價。利用CLSM分別監(jiān)測3組皮損隨訪間期及治療后基底層色素變化程度及表皮變化,評價3組實(shí)際色素程度恢復(fù)的差異及其它變化,從而發(fā)現(xiàn)白癜風(fēng)臨床與CLSM掃描病情恢復(fù)的差異。 2.利用CLSM分別觀察132例白斑患者的皮損,記錄基底層色素等級,及真表皮結(jié)構(gòu)特點(diǎn),初步判定貧血痣、白癜風(fēng)、無色素痣、炎癥后色素減退、花斑癬、白色糠疹的CLSM掃描圖像特征及圖像差異。 結(jié)果： 1. 3組臨床療效比較：3、6月治療期后,得膚寶(A組)有效率均高于達(dá)力士(B組)、二丙酸倍他米松(C組),A組與B、C組相比有效率也具有統(tǒng)計學(xué)差異。而B組和C組有效率無明顯統(tǒng)計學(xué)差異。6月治療期后3組白癜風(fēng)皮損不同部位臨床有效率差別無統(tǒng)計學(xué)意義。A組治療白癜風(fēng)進(jìn)展期和穩(wěn)定期有效率有統(tǒng)計學(xué)差異,而B、C組無明顯差異。3組不良反應(yīng)無統(tǒng)計學(xué)差異。CLSM監(jiān)測治療后3組色素恢復(fù)等級、樹枝狀黑色素細(xì)胞存在與否、以及細(xì)胞水腫存在與否均有明顯統(tǒng)計學(xué)差異。 2.6種白斑性皮膚病CLSM掃描圖像特征：貧血痣基底層色素?zé)o明顯減少；其余5類白斑性皮膚病均表現(xiàn)為色素不同程度減少,但其色素分布和色素減少程度各不相同。 結(jié)論： 1.得膚寶外用治療白癜風(fēng)臨床療效明顯優(yōu)于達(dá)力士和二丙酸倍他米松,CLSM觀察得膚寶對于基底層色素恢復(fù)、樹枝狀黑色素細(xì)胞的生成等明顯優(yōu)于其它兩組。 2.CLSM可用于初步分析和評價各型白斑性皮膚病的色素分布和脫失程度。
[Abstract]:Objective: 1. The clinical efficacy of Difubao in the treatment of vitiligo was compared with that of Dalix and betamethasone in control group, and the confocal laser scanning microscope was used to monitor the efficacy of the three groups. To judge the recovery degree of basal layer pigment and other changes of epidermis after the treatment of leukoplakia. 2. The scanning image features of 6 kinds of leukoplakia dermatoses were preliminarily explored by CLSM. To provide a preliminary diagnostic basis for clinical leukoplakia dermatosis. Methods: 1.Thirty six patients with vitiligo were randomly divided into 3 groups: Dafubo, Dalex and betamethasone dipropionate. To evaluate the curative effect of 3 groups before and after drug treatment. The changes of basal layer pigments and epidermis were monitored by CLSM during the follow-up period of skin lesions and after treatment, and the difference and other changes in the recovery of actual pigments in the three groups were evaluated. It was found that the difference between clinical and CLSM scan in patients with vitiligo was 2. 2. CLSM was used to observe the skin lesions of 132 patients with leukoplakia, to record the pigment grade of basal layer and the structure of true epidermis, and to determine the anaemic nevus, vitiligo, non-pigmented nevus, postinflammatory hypopigmentation, tinea versicolor. Features and differences of CLSM scan images of white pityriasis. Results: 1. The effective rate of dipropionate in group A was higher than that in group B, and the effective rate of betamethasone dipropionate in group A was significantly higher than that in group B after 6 months of treatment. The effective rate of betamethasone dipropionate in group A was also significantly higher than that in group B. But there was no significant difference in the effective rate between group B and group C. there was no significant difference in the clinical effective rate of different parts of vitiligo skin lesions in three groups after 6 months of treatment. The effective rate of group A in the progressive and stable stage of vitiligo was significantly different. However, there was no significant difference in adverse reactions between group 3 and group C. CLSM was used to monitor the grade of pigment recovery and the existence of dendritic melanocytes in the three groups after treatment. There were significant differences in the presence or absence of cell edema. The features of CLSM images of 2. 6 kinds of leukoplakia dermatoses were as follows: the pigments of basal layer of anaemic nevus did not decrease obviously, and the other 5 kinds of leukoplakia dermatoses showed decreased pigments in varying degrees. But its pigment distribution and pigment decrease degree are different. Conclusion: 1. The clinical efficacy of defubao in the treatment of vitiligo was significantly better than that of dalexin and betamethasone dipropionate CLSM in the restoration of basal layer pigment. The formation of dendritic melanocytes was superior to that of the other two groups, and 2.CLSM could be used to analyze and evaluate the distribution and loss of pigment in various types of leukoplakia skin diseases.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2011
【分類號】：R758.41

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