發(fā)布時(shí)間：2018-01-19 19:11

  本文關(guān)鍵詞： 色素性紫癜性皮病 血熱 血瘀 虛 中醫(yī)辨證　出處：《北京中醫(yī)藥大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：色素性紫癜性皮病(Pigmentary purpuric dermatosis, PPD)是一組紫癜性皮膚病,主要包括進(jìn)行性色素性紫癜皮病(progressive pigmented purpuric dermatosis)、色素性紫癜性苔蘚樣皮病(pigmented purpuric lichenoid dermatosis)以及毛細(xì)血管擴(kuò)張性環(huán)狀紫癜(purpura annularis telangiectosis)。臨床一般無自覺癥狀,部分患者伴瘙癢,皮損以下肢多發(fā)性細(xì)小紫癜樣皮疹及色素沉著為典型特點(diǎn),本病可發(fā)生于任何年齡段。這些疾病關(guān)系密切,臨床形態(tài)及組織病理相似,大部分病例為慢性經(jīng)過,皮損常持續(xù)存在,可自行消退,但常復(fù)發(fā)。臨床觀察發(fā)現(xiàn),近年來PPD發(fā)病率有所升高,就診患者增多,因其皮損多發(fā)于下肢等暴露部位,皮損消退緩慢,反復(fù)發(fā)作,部分患者可伴皮膚明顯癢痛及下肢腫脹,影響患者身心健康及生活質(zhì)量。本病臨床診斷相對(duì)容易,但尚無特效治療方法,其病因及治療仍存在爭議。中醫(yī)辨證治療PPD存在一定優(yōu)勢。 目的：通過對(duì)就診的PPD患者進(jìn)行臨床信息采集,分析總結(jié)其發(fā)病的男女比例,職業(yè)類型,發(fā)病誘因,病程分布情況,初發(fā)年齡,初發(fā)部位,疾病分型分期與PPD發(fā)病的相關(guān)性,對(duì)納入研究的PPD患者進(jìn)行中醫(yī)辨證治療,探討中醫(yī)辨證治療PPD的臨床療效。 方法：通過文獻(xiàn)查閱,制定PPD臨床資料表,采用臨床觀察的方法,對(duì)符合PPD納入標(biāo)準(zhǔn)及排除標(biāo)準(zhǔn)的24例患者進(jìn)行病例收集,所有入組患者均采用中醫(yī)辨證治療,觀察3個(gè)療程(以4周為1個(gè)療程)。收集、整理相關(guān)信息并錄入Excel,用Excel、 SPSS19.0軟件進(jìn)行數(shù)據(jù)分析。 結(jié)果：納入的PPD男性9例,女性15例,男女比例為3:5。1.初發(fā)年齡從24歲至78歲不等,平均初發(fā)年齡為52.667±13.419,其中：20-29歲1例,30-39歲2例,40-49歲6例,50-59歲9例,60-69歲2例,70-79歲4例。男性平均初發(fā)年齡：56.222±14.298,女性平均初發(fā)年齡：50.533±12.883。2.24例PPD患者病程從1月至9年不等,平均病程為20.958±24.275月,男性平均病程：9.667±10.368月,女性平均病程：27.733±27.848月,其中就診患者病程在1年之內(nèi)者15例,占62.50%。3.24例PPD患者中文職人員13例,占51.47%；退休人員3例,占12.50%;司機(jī)、售貨員、廚師各2例,各占8.33%；農(nóng)民及保姆各1例,各占4.17%。從事長期坐立及站立工作的患者,多發(fā)本病。4.有明確誘因者3例,蚊蟲叮咬后1例,磕傷后1例,口服溫?zé)嵝再|(zhì)中藥1例�；A(chǔ)疾�。合轮o脈曲張6例,原發(fā)性高血壓6例,糖尿病4例,冠心病2例,甲亢1例,銀屑病1例,慢性支氣管炎1例,貧血1例。其中1例患者有家族史。5.患者皮損初發(fā)部位存在差異,其中上肢1例,占4.17%；膝蓋周圍2例,占8.33%；足踝部6例,占25.00%；小腿部15例,占62.50%。發(fā)病部位：小腿足踝膝蓋上肢,可見PPD好發(fā)于下肢部位。6.24例PPD患者中,7例為進(jìn)行性色素性紫癜性皮病患者,其中5例為急性期,2例為慢性期；17例色素性紫癜性苔蘚樣皮病患者中,6例為急性期,11例為慢性期。7.PPD中醫(yī)證型分布：血熱妄行10例,占41.67%；血瘀阻絡(luò)9例,占37.50%；氣血虧虛5例,占20.83%,血熱妄行證血瘀阻絡(luò)證氣血虧虛證。8.24例PPD患者經(jīng)中醫(yī)辨證治療3個(gè)療程,痊愈5例,占20.83%;顯效12例,占50%；有效4例,占16.67%；無效3例,占12.50%；總顯愈率70.83%,總有效率87.50%。其中,血熱妄行證顯愈率70.00%,有效率90.00%；血瘀阻絡(luò)證顯愈77.78%,有效率88.89%；氣血虧虛證顯愈率60.00%,有效率80.00%;總有效率：血熱妄行證血瘀阻絡(luò)證氣血虧虛證。 結(jié)論：PPD好發(fā)于中老年；PPD起病隱匿；因工作需要長期坐位或站立者本病多發(fā)；PPD初發(fā)部位以下肢為主,尤以小腿及足踝部為著。PPD證型分布以血熱妄行最多(41.67%),血瘀阻絡(luò)次之(37.50%),總有效率：血熱妄行證血瘀阻絡(luò)證氣血虧虛證；中醫(yī)中藥辨證治療PPD顯愈率70.83%,總有效率87.50%,療效顯著,副作用小,臨床值得推廣。
[Abstract]:Pigmented purpuric purpura ( PPD ) is a group of purpuric dermatosis , mainly including progressive purpuric purpura , pigmented purpuric purpura oid and capillary dilatational ring purpura . Clinical observation shows that the incidence of PPD in the lower extremities is similar , and most of the cases are chronic , the lesions often persist . Most of the cases are chronic , the lesions often persist , and some patients have obvious itch pain and swelling of the lower limbs . The clinical diagnosis of the disease is relatively easy . However , there is still a dispute between the etiology and treatment of the patients . Objective : To collect and analyze the clinical information of PPD patients and summarize the relationship between the incidence of the disease , the type of occupation , the cause of disease , the distribution of disease course , the primary age , the primary site , the stage of disease typing and PPD , the PPD patients who were included in the study were treated with TCM syndrome differentiation , and the clinical curative effect of PPD in TCM syndrome differentiation was discussed . Methods : According to the clinical data of PPD , the PPD clinical data table was established , and 24 patients who met PPD in standard and exclusion criteria were collected . All enrolled patients were treated with TCM syndrome differentiation , 3 courses of treatment were observed ( 4 weeks as one treatment course ) . Data were collected , collated and entered into Excel , and the data were analyzed by Excel and SPSS 10.0 software . Results : There were 9 cases of PPD male , 15 female and 3 : 5.1 for male and female . The average age was 52.667 鹵 13.419 . Among them , there were 1 case , 30 - 39 years old , 2 cases 40 - 49 years old , 1 case aged between 50 - 59 years old , 1 case aged 60 - 69 years old and 70 - 79 years old . Among them , there were 6 cases of primary hypertension , 6 cases of primary hypertension , 4 cases of diabetes , 2 cases of coronary heart disease , 1 case of hyperthyroidism , 1 case of psoriasis and 1 case of chronic bronchitis . There were 1 case of anemia . Among them , 1 patient had family history . 5 . There was a difference in the primary lesion of skin lesion of the patients . Among them , 6 cases were acute phase , 2 cases were chronic phase , 7 cases were progressive pigmented purpura patients . The effective rate is 88.89 % ; the apparent recovery rate of qi and blood deficiency syndrome is 60.00 % , the effective rate is 80.00 % ; the total effective rate is : the blood heat and blood stasis obstructing the blood stasis obstructing the syndrome of qi and blood deficiency syndrome . Conclusion : PPD is good for middle - aged and old - aged people ; PPD is hidden in the disease . The PPD syndrome is mainly composed of lower limbs and lower limbs , especially the lower limbs and ankle parts . PPD syndrome differentiation is the most important ( 37.50 % ) . The total effective rate is 87.50 % , the curative effect is obvious , the side effect is small , and the clinical value is worthy of popularization .

【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R275.9

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