本文選題：銀屑病 + 尋常型�。� 參考：《成都中醫(yī)藥大學(xué)》2013年碩士論文

【摘要】：目的：通過火針與卡泊三醇軟膏治療尋常型銀屑病的療效比較,明確火針治療尋常型銀屑病的療效。運(yùn)用咪喹莫特誘導(dǎo)的銀屑病動物模型,觀察火針治療銀屑病對皮損的病理改變,為火針治療銀屑病提供實(shí)驗依據(jù)。 方法：本研究分為臨床和實(shí)驗研究兩部分。 1.臨床研究：納入62例患者,隨機(jī)分為治療組31例,對照組31例。治療組采用火針點(diǎn)刺皮損,2周為1個療程,共治療3個療程。對照組采用卡泊三醇軟膏(達(dá)力士)外搽,每日2次,2周為一個療程,共治療3個療程。分別在治療前、治療第2、4、6周進(jìn)行PASI及瘙癢評分,并記錄不良反應(yīng),隨訪2個月。 2.實(shí)驗研究：將昆明小鼠24只背部去毛約2×2cm2裸露皮膚后單籠飼養(yǎng)。隨機(jī)分為空白對照組,模型組,空白治療組,模型治療組。模型組和模型治療組于背部涂抹咪喹莫特(Imiquimod,IQM)30mg,每日1次,連續(xù)8天。空白組與空白治療組于背部同等部位等量涂抹凡士林,每日1次,連續(xù)8天。空白治療組和模型治療組給予火針點(diǎn)刺背部皮損間隔距離0.2cm,每隔2日一次,8天后處死小鼠取背部皮損經(jīng)蘇木精-伊紅(hematoxylin and eosin,HE)染色。光鏡下進(jìn)行皮損區(qū)域組織病理觀察,分析火針對銀屑病樣皮損的改變。 結(jié)果：1、治療組和對照組總有效率分別為83.9%和80.6%,兩組療效差異無統(tǒng)計學(xué)意義(P0.05)。兩組在各觀察時間點(diǎn)上的PASI評分,差異均無統(tǒng)計學(xué)意義(P0.05)。瘙癢評分在治療2、4、6周均呈下降趨勢,治療組均優(yōu)于對照組差異有統(tǒng)計學(xué)意義(P0.05)。隨訪2個月,兩組患者未見復(fù)發(fā)加重,治療過程中無嚴(yán)重不良反應(yīng)。 2、經(jīng)咪喹莫特乳膏造模后肉眼及鏡下均表現(xiàn)出銀屑病樣皮損,鏡下觀察表皮典型角化過度、角化不全、棘層增厚、炎性浸潤等病理表現(xiàn)；模型治療組皮損紅斑、鱗屑、浸潤程度較模型組減輕,鏡下觀察角化不全、炎性浸潤均減輕,棘層厚度較模型組變薄。 結(jié)論：1.火針治療有效,對瘙癢癥狀的改善優(yōu)于卡泊三醇。 2.同時火針能部分逆轉(zhuǎn)咪喹莫特誘導(dǎo)小鼠銀屑病模型的病理改變,其機(jī)制有待進(jìn)一步研究。
[Abstract]:Objective: to compare the efficacy of fire acupuncture and carpotriol ointment in the treatment of psoriasis vulgaris. The animal model of psoriasis induced by Imiquimod was used to observe the pathological changes of psoriasis treated by fire acupuncture. Methods: this study is divided into two parts: clinical and experimental research. 1. Clinical study: 62 patients were randomly divided into treatment group (n = 31) and control group (n = 31). The treatment group was treated with fire acupuncture for 2 weeks and 3 courses of treatment. The control group was treated with carpotriol ointment (Dalius) twice a day for 2 weeks for 3 courses of treatment. PASI and pruritus scores were evaluated before and 4 weeks after treatment, and adverse reactions were recorded and followed up for 2 months. Experimental study: 24 Kunming mice were exposed to naked skin for 2 脳 2cm2 on their back. They were randomly divided into blank control group, model group, blank treatment group and model treatment group. The model group and the model treatment group were smeared with Imiquimodod IQM 30 mg on the back once a day for 8 days. The same amount of vaseline was applied to the back of the blank group and the blank treatment group, once a day for 8 days. The rats in blank treatment group and model group were treated with fire acupuncture for 0.2cm. The mice were killed for 8 days after every 2 days. The lesions were stained by hematoxylin and eosin hehe (hematoxylin and eosin hehe). The pathological changes of psoriatic lesions were analyzed under light microscope. Results the total effective rates of the treatment group and the control group were 83.9% and 80.6%, respectively. There was no significant difference in the curative effect between the two groups (P 0.05). There was no significant difference in PASI score between the two groups at each observation time point (P 0.05). The score of pruritus showed a decreasing trend at 6 weeks after treatment, and the treatment group was better than the control group (P 0.05). After 2 months follow-up, no recurrence and aggravation were found in the two groups, and no serious adverse reactions were observed during the treatment. 2. Psoriatic lesions were observed in the naked eye and under microscope after imiquimod cream, and the typical keratosis of the epidermis was observed under the microscope. The pathological manifestations of keratosis, thickening of spinous layer and inflammatory infiltration were observed in the model group, and the degree of erythema, scale and infiltration in the model group was less than that in the model group, the keratosis was not complete and inflammatory infiltration was alleviated under microscope, and the thickness of the spinous layer was thinner than that in the model group. Conclusion 1. Fire acupuncture treatment is effective, the improvement of pruritus symptoms is better than carpotriol. 2. At the same time, fire acupuncture can partially reverse the pathological changes of mice psoriasis model induced by Imiquimod, and its mechanism needs further study.
【學(xué)位授予單位】：成都中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R246.7

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