【摘要】：目的:本文通過對(duì)治療前后各項(xiàng)觀測(cè)指標(biāo)的客觀評(píng)價(jià),研究蕁麻湯聯(lián)合依巴斯汀治療血虛風(fēng)燥型蕁麻疹的臨床療效,初步探討中西醫(yī)結(jié)合治療慢性蕁麻疹的特點(diǎn)和優(yōu)勢(shì)。方法:病例選取2015年9月—2016年9月就診于遼寧中醫(yī)藥大學(xué)附屬醫(yī)院皮膚科門診患者,經(jīng)中醫(yī)辨證診為蕁麻疹血虛風(fēng)燥證,符合納入標(biāo)準(zhǔn)者共計(jì)64例。隨機(jī)分為治療組(蕁麻湯聯(lián)合依巴斯汀組)和對(duì)照組(依巴斯汀組)各32例,療程8周。根據(jù)發(fā)病因素和臨床癥狀制定“蕁麻疹臨床資料調(diào)查表”,通過患者各項(xiàng)癥狀的評(píng)分變化,運(yùn)用統(tǒng)計(jì)學(xué)方法對(duì)風(fēng)團(tuán)數(shù)目、風(fēng)團(tuán)大小、瘙癢程度等積分下降指數(shù)以及發(fā)病因素、不良反應(yīng)、復(fù)發(fā)率等情況進(jìn)行分析。通過觀察實(shí)驗(yàn)室指標(biāo)分析慢性蕁麻疹的發(fā)病與免疫功能的相關(guān)性。結(jié)果:1.兩組臨床療效比較,經(jīng)秩和檢驗(yàn)P㩳0.05,治療組(總有效率90.3%)與對(duì)照組(總有效率73.3%)治療前后組內(nèi)和組間均存在顯著性差異。2.治療8周后兩組癥狀總積分較治療前均有下降,組內(nèi)比較存在明顯差異(P㩳0.05),組間比較無顯著性差異。3.治療8周后兩組間的風(fēng)團(tuán)數(shù)目、瘙癢程度、發(fā)作頻率及皮膚劃痕征四項(xiàng)觀察指標(biāo),治療組明顯優(yōu)于對(duì)照組,均有顯著性差異(P㩳0.05),其他客觀癥狀組間比較無明顯差異。4.停藥4周后隨訪,發(fā)現(xiàn)治療組復(fù)發(fā)率17.4%,對(duì)照組53.3%,兩組比較具有顯著性差異(P㩳0.05)。5.兩組臨床資料統(tǒng)計(jì)顯示,蕁麻疹男女性患者分別占比34.4%和65.5%(約1:2),18-35歲年齡段患者占比41.0%,夜間為起病及加重者占比52.4%,因食物和環(huán)境因素發(fā)病者占總例數(shù)的70.5%,91.8%患者就診前曾服用抗組胺藥物。6.實(shí)驗(yàn)室指標(biāo):IgE、IgA、IgG、IgM陽(yáng)性率分別為50.8%、42.6%、26.2%、29.5%。7.不良反應(yīng)發(fā)生率:兩組比較無顯著性差異(P0.05)。結(jié)論:1.蕁麻湯聯(lián)合依巴斯汀治療血虛風(fēng)燥型蕁麻疹的療效優(yōu)于單獨(dú)應(yīng)用后者,且顯著減輕風(fēng)團(tuán)數(shù)目、發(fā)作頻率、瘙癢及皮膚劃痕征癥狀,且不良反應(yīng)輕微,復(fù)發(fā)率低,值得臨床推廣應(yīng)用。2.蕁麻疹好發(fā)人群的年齡、性別、時(shí)間分別集中于中青年女性和夜間,以食物和環(huán)境為主要誘發(fā)因素。3.免疫球蛋白(血清總IgE、IgA、IgG、IgM)對(duì)慢性蕁麻疹的發(fā)病可能存在一定相關(guān)性。
[Abstract]:Objective: to study the clinical efficacy of urticaria decoction combined with ebastin in the treatment of chronic urticaria before and after treatment, and to explore the characteristics and advantages of combination of traditional Chinese and western medicine in the treatment of chronic urticaria. Methods: cases were selected from September 2015 to September 2016 in the outpatient department of dermatology of affiliated Hospital of Liaoning University of traditional Chinese Medicine, and 64 cases were diagnosed as urticaria blood deficiency wind dryness syndrome according to TCM syndrome differentiation. They were randomly divided into two groups: the treatment group (n = 32) and the control group (n = 32). The course of treatment was 8 weeks. According to the factors and clinical symptoms of urticaria, the clinical data questionnaire of urticaria was established. The number of wind masses, the size of wind masses, the degree of itching and the incidence factors were measured by statistical method, through the changes of the scores of each symptom of the patients. Adverse reactions, recurrence rate and so on were analyzed. The correlation between the pathogenesis of chronic urticaria and immune function was analyzed by observing laboratory indexes. Results: 1. The comparison of clinical efficacy between the two groups showed that there was a significant difference between the treatment group (90.3%) and the control group (73.3%) before and after treatment by rank sum test P < 0.05. There was a significant difference between the two groups before and after treatment. 2. After 8 weeks of treatment, the total score of symptoms in the two groups decreased compared with that before treatment, and there was a significant difference between the two groups (P < 0.05), and there was no significant difference between the two groups. After 8 weeks of treatment, the number of wind masses, the degree of pruritus, the frequency of attack and the skin scratch sign between the two groups were significantly higher than those in the control group (P < 0.05), and there was a significant difference between the two groups (P < 0.05). There was no significant difference between other objective symptoms. 4. 4 weeks after withdrawal, the recurrence rate was 17.4% in the treatment group and 53.3% in the control group. There was a significant difference between the two groups (P < 0.05). The clinical data of the two groups showed that male and female patients with urticaria accounted for 34.4% and 65.5% (about 1:2), 18-year-old 35-year-old patients accounted for 41.0%, and night-time onset and aggravation accounted for 52.4%. Food and environmental factors accounted for 70.5% of the total, 91.8% of the patients had taken antihistamines before treatment. 6. Laboratory indexes: the positive rates of IgE,IgA,IgG,IgM were 50.8%, 42.6%, 26.2%, 29.5% respectively. Incidence of adverse reactions: there was no significant difference between the two groups (P0.05). Conclusions: 1. Urticaria decoction combined with ebastin in the treatment of blood-deficiency wind-dryness type urticaria was better than the latter alone, and significantly reduced the number of wind masses, frequency of attacks, itching and skin scratches symptoms, with mild adverse reactions, low recurrence rate. Worthy of clinical popularization and application. 2. Age, sex and time of urticaria-prone population were concentrated in young and middle-aged women and nighttime, respectively, and food and environment were the main inducing factors. Immunoglobulin (serum total IgE,IgA,IgG,IgM) may be associated with the pathogenesis of chronic urticaria.
【學(xué)位授予單位】：遼寧中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R758.24

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