【摘要】：目的 根據(jù)Pillsbury分類法在Ⅱ-Ⅳ度的痤瘡患者,經(jīng)光動(dòng)力治療后,隨機(jī)分為兩組,將一組患者治療后用中藥外洗而另一組無(wú)中藥外洗,觀察臨床療效及不良反應(yīng),通過(guò)兩組對(duì)比證實(shí)中藥外用對(duì)光動(dòng)力療法治療中重度痤瘡后具有輔助治療作用,并能減少不良反應(yīng)的持續(xù)時(shí)間,從而為臨床尋找安全有效的中西醫(yī)結(jié)合療法治療中重度痤瘡提供理論依據(jù)。 臨床觀察 1.所有病例來(lái)源為2011年6月至2011年12月武漢市一醫(yī)院皮膚科門診41名患者。所有病例均符合診斷標(biāo)準(zhǔn)及排除標(biāo)準(zhǔn)。按就診順序隨機(jī)分為兩組：中藥聯(lián)合光動(dòng)力治療組22人,光動(dòng)力治療組19人。其中中藥聯(lián)合光動(dòng)力治療組中Ⅱ度6例,Ⅲ度7例,Ⅳ度9例；光動(dòng)力治療組中Ⅱ度7例,Ⅲ度5例,Ⅳ度7例。兩組患者在年齡、性別、病程、治療前評(píng)分等方面均無(wú)統(tǒng)計(jì)學(xué)顯著性差異(P0.05),具有可比性。 2.中藥聯(lián)合光動(dòng)力治療組經(jīng)光動(dòng)力治療后使用中藥外洗面部,1日2次。光動(dòng)力治療組僅接受光動(dòng)力治療。光動(dòng)力療法每2周治療1次,治療結(jié)束后每月隨訪1次,共隨訪3個(gè)月。 3.外用中藥外洗組方為薏苡仁10g、黃芩10g、金銀花10g、側(cè)柏葉10g或中藥配方顆粒：薏苡仁2包、黃芩2包、金銀花2包、側(cè)柏葉2包,每次治療后將中藥加水濃煎或開水沖化,水溫適宜時(shí)清洗患處,每次清洗10分鐘,每日早晚各1次。 4.兩組均采用評(píng)分法,分別于治療前、每次治療后及隨訪時(shí)根據(jù)病情變化評(píng)分后判定療效。在治療期間觀察療效及不良反應(yīng)。 5.使用統(tǒng)計(jì)軟件spssl2.0進(jìn)行數(shù)據(jù)處理,病情評(píng)分結(jié)果采用t檢驗(yàn),總有效率采用X2檢驗(yàn)。 結(jié)果 1.療效評(píng)定 (1)兩組在光動(dòng)力治療前無(wú)明顯差異(X2=0.15,P0.1)。經(jīng)1次治療后(X2=1.31,P0.1),2次治療后(X2=0.21,P0.1)和3次治療后(X2=2.10,P0.1)的痤瘡皮損面積和嚴(yán)重程度指數(shù)評(píng)分均未出現(xiàn)顯著的差異； (2)在4次治療后,使用中藥外洗的患者組痤瘡皮損面積和嚴(yán)重程度指數(shù)評(píng)分明顯低于不使用中藥外洗的患者組(X2=3.15,P0.05)； (3)中藥外洗聯(lián)合光動(dòng)力治療痤瘡患者2周后總有效率9.1%,4周后為45.5%,6周后為66.7%,8周后上升至100%；光動(dòng)力組的總有效率在第2、4、6、8周時(shí)分別為15.8%、31.6%、41.7%和91.7%。中藥聯(lián)合光動(dòng)力組的療效要優(yōu)于光動(dòng)力組,但兩組無(wú)顯著性差異(P0.05)。 2.不良反應(yīng)評(píng)定 (1)中藥聯(lián)合光動(dòng)力組患者出現(xiàn)紅斑(84.5%)、腫脹疼痛(53.5%)、脫屑(78.9%)、反應(yīng)性痤瘡(69.0%)、色素沉著(11.3%)、面部瘙癢(7.0%)等癥狀；光動(dòng)力組患者出現(xiàn)紅斑(95.2%)、腫脹疼痛(69.4%)、脫屑(91.9%)、反應(yīng)性痤瘡(75.8%)、色素沉著(30.6%)、面部瘙癢(9.7%)等癥狀。兩組不良反應(yīng)中紅斑、腫脹疼痛、脫屑、反應(yīng)性痤瘡、面部瘙癢發(fā)生率比較無(wú)顯著性差異(P0.05)。但是色素沉著的發(fā)生率在兩組之間有顯著性差異(P0.05)。 (2)不良反應(yīng)中,出現(xiàn)紅斑后持續(xù)的時(shí)間：兩組之間有顯著差異(X2=4.27,P0.05)；出現(xiàn)腫脹疼痛后持續(xù)的時(shí)間：兩組之間有非常顯著差異(X2=9.54,P0.01)；出現(xiàn)脫屑后持續(xù)的時(shí)間：兩組之間有顯著差異(X2=4.37,P0.05)；出現(xiàn)反應(yīng)性痤瘡后持續(xù)的時(shí)間：兩組之間有非常顯著差異(X2=8.13,P0.01)；出現(xiàn)色沉后持續(xù)的時(shí)間：兩組之間有非常顯著差異(X2=9.69,P0.01)；出現(xiàn)面部瘙癢后持續(xù)的時(shí)間：兩組之間無(wú)顯著差異(X2=1.27,P0.1)。 結(jié)論 ①用中藥外洗聯(lián)合光動(dòng)力治療痤瘡,治療1至3次后能較好的緩解臨床不適癥狀。 ②治療4次后兩組痤瘡皮損面積和嚴(yán)重程度指數(shù)評(píng)分中藥外洗聯(lián)合光動(dòng)力治療組優(yōu)于光動(dòng)力治療組(P0.05),說(shuō)明治療4次后中藥外洗方能夠較快減少面部痤瘡皮損面積和減輕嚴(yán)重程度。 ③治療總有效率,中藥外洗聯(lián)合光動(dòng)力治療組和光動(dòng)力治療組兩者無(wú)明顯差異(P0.05)。 ④治療中,出現(xiàn)的不良反應(yīng)發(fā)生率中藥外洗聯(lián)合光動(dòng)力治療組均小于光動(dòng)力治療組,兩組不良反應(yīng)中紅斑、腫脹疼痛、脫屑、反應(yīng)性痤瘡、面部瘙癢發(fā)生率比較無(wú)顯著性差異(P0.05),但是色素沉著的發(fā)生率在兩組之間有顯著性差異(P0.05)。不良反應(yīng)如紅斑、腫脹疼痛、脫屑、反應(yīng)性痤瘡、色沉的持續(xù)時(shí)間,中藥外洗聯(lián)合光動(dòng)力治療組少于光動(dòng)力治療組(P0.05),說(shuō)明中藥外洗方在減少不良反應(yīng)發(fā)生率上無(wú)明顯作用,但能有效的減少大多不良反應(yīng)出現(xiàn)后持續(xù)的時(shí)間。
[Abstract]:objective
According to Pillsbury classification, acne patients with grade II-IV were randomly divided into two groups after photodynamic therapy. One group was treated with traditional Chinese medicine and the other group was not treated with traditional Chinese medicine. And can reduce the duration of adverse reactions, so as to find a safe and effective combination of traditional Chinese and Western medicine in the clinical treatment of moderate and severe acne provides a theoretical basis.
Clinical observation
1. All the cases were from 41 outpatients of Dermatology Department of Wuhan First Hospital from June 2011 to December 2011. All the cases met the diagnostic criteria and exclusion criteria. They were randomly divided into two groups according to the order of visiting: 22 cases in Chinese medicine combined with photodynamic therapy group and 19 cases in photodynamic therapy group. In the photodynamic therapy group, there were 7 cases of grade II, 5 cases of grade III and 7 cases of grade IV. There was no significant difference in age, sex, course of disease and score before treatment between the two groups (P 0.05).
2. Chinese herbal medicine combined with photodynamic therapy group was used to wash face twice a day after photodynamic therapy. Photodynamic therapy group only received photodynamic therapy.
3. External use of Chinese herbal medicine washing group for coix seed 10g, Scutellaria baicalensis 10g, honeysuckle 10g, Platycladus orientalis leaf 10g or Chinese herbal formula granules: Coix seed 2 packs, baicalein 2 packs, honeysuckle 2 packs, Platycladus oris leaves 2 packs, after each treatment of Chinese herbal medicine will be decocted or boiled water flushing, water temperature appropriate time to clean the affected area, each time 10 minutes, morning and evening once a day.
4. The two groups were assessed by scoring method before treatment, after each treatment and at follow-up according to the changes in the state of the disease.
5. Data were processed by statistical software spssl 2.0. The result of disease score was tested by t test, and the total effective rate was tested by X2 test.
Result
1. curative effect assessment
(1) There was no significant difference between the two groups before photodynamic therapy (X2 = 0.15, P 0.1). After one treatment (X2 = 1.31, P 0.1), two treatments (X2 = 0.21, P 0.1) and three treatments (X2 = 2.10, P 0.1), there was no significant difference in acne lesion area and severity index scores.
(2) After 4 times of treatment, the acne lesion area and severity index score of the patients who used Chinese herbal wash were significantly lower than those who did not use Chinese herbal wash (X2 = 3.15, P 0.05).
(3) The total effective rate was 9.1% after 2 weeks, 45.5% after 4 weeks, 66.7% after 6 weeks and 100% after 8 weeks. The total effective rate of photodynamic group was 15.8%, 31.6%, 41.7% and 91.7% at 2, 4, 6 and 8 weeks, respectively.
2. ADR evaluation
(1) Erythema (84.5%), swelling and pain (53.5%), desquamation (78.9%), reactive acne (69.0%), pigmentation (11.3%), facial itching (7.0%) and other symptoms were found in the Chinese medicine combined with photodynamic therapy group; erythema (95.2%), swelling and pain (69.4%), desquamation (91.9%), reactive acne (75.8%), pigmentation (30.6%) and facial pruritus (9.7%) were found in the photodynamic therapy group. There was no significant difference in the incidence of erythema, swelling and pain, scaling, reactive acne and facial pruritus between the two groups (P 0.05). However, there was a significant difference in the incidence of pigmentation between the two groups (P 0.05).
(2) In adverse reactions, the duration of erythema onset was significantly different between the two groups (X2 = 4.27, P 0.05); the duration of swelling and pain onset was significantly different between the two groups (X2 = 9.54, P 0.01); the duration of desquamation onset was significantly different between the two groups (X2 = 4.37, P 0.05); Time: There was a very significant difference between the two groups (X2 = 8.13, P 0.01); duration after the occurrence of color sedimentation: there was a very significant difference between the two groups (X2 = 9.69, P 0.01); duration after the occurrence of facial pruritus: there was no significant difference between the two groups (X2 = 1.27, P 0.1).
conclusion
(1) using traditional Chinese medicine combined with photodynamic therapy to treat acne can relieve the clinical symptoms better after 1 to 3 times.
(2) The score of acne lesion area and severity index of the two groups after 4 times of treatment was better than that of the photodynamic therapy group (P 0.05). It showed that after 4 times of treatment, the area of facial acne lesion and the severity of acne could be reduced quickly.
There was no significant difference in the total effective rate between the two groups (P 0.05).
(4) In the treatment, the incidence of adverse reactions was lower in the treatment group than in the photodynamic treatment group. There was no significant difference in the incidence of erythema, swelling and pain, scaling, reactive acne and facial itching between the two groups (P 0.05), but the incidence of pigmentation was significantly different between the two groups (P 0.05). Adverse reactions such as erythema, swelling and pain, peeling, reactive acne, color sedimentation duration, Chinese herbal wash combined with photodynamic treatment group was less than photodynamic treatment group (P 0.05), indicating that Chinese herbal wash has no obvious effect in reducing the incidence of adverse reactions, but can effectively reduce the duration of most adverse reactions.
【學(xué)位授予單位】：湖北中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R758.733

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