【摘要】：目的:通過(guò)對(duì)玫瑰痤瘡患者的臨床資料及中醫(yī)證候資料進(jìn)行分析,探討玫瑰痤瘡的臨床特點(diǎn)、危險(xiǎn)因素、中醫(yī)病因病機(jī)及證型分布特點(diǎn),以提高對(duì)該疾病的整體認(rèn)識(shí),為中醫(yī)辨證施治提供新的思路,為臨床規(guī)范化研究提供客觀依據(jù)。方法:本研究采用專人一對(duì)一問(wèn)卷調(diào)查的方式,181例患者均來(lái)自2016年4月-2017年1月就診于江蘇省中醫(yī)院皮膚科的玫瑰痤瘡患者,符合本研究的納入標(biāo)準(zhǔn),不符合排除標(biāo)準(zhǔn),并以性別、年齡1:1設(shè)置對(duì)照組,將所有采集的信息錄入excel建立數(shù)據(jù)庫(kù),運(yùn)用SPSS20.0軟件進(jìn)行相關(guān)統(tǒng)計(jì)學(xué)分析。運(yùn)用單因素及多因素logistic回歸分析該病的危險(xiǎn)因素,系統(tǒng)聚類法及因子分析法歸納出該病的主要致病因素及證型分類。結(jié)果:1.一般情況:181例患者中,男33例,女148例,男女比1:4.48,平均年齡36.17±11.294歲,20-50歲為該病的高發(fā)年齡;病程3天-25年,平均2.49±3.57年,女性病程低于男性。2.診療現(xiàn)狀:150例有既往診療史的病人中,40例(22.1%)表示治療無(wú)效,11例(6.1%)表示治療后癥狀加重,可疑誤診率高達(dá)34%;既往診療過(guò)程中,系統(tǒng)治療以口服抗生素(64.7%)、中藥湯劑(56.9%)、抗組胺藥(19.9%)為主,局部治療以激素(44.9%)、鈣調(diào)磷酸酶抑制劑(33.7%)為主。3.臨床特點(diǎn):臨床分型以紅斑毛細(xì)血管擴(kuò)張型(ETR)及丘疹膿皰型(PPR)最為多見(jiàn),分別占57.5%及33.7%;以陣發(fā)性潮紅(88.4%)、持久性紅斑(86.2%)、毛細(xì)血管擴(kuò)張(82.3%)為常見(jiàn)皮損表現(xiàn),雙頰(83.4%)、鼻部(68.0%)、口周(66.3%)為最常累及部位,女性患者雙頰、口周、額部受累頻率明顯高于男性;干燥(68.4%)、瘙癢(66.7%)、灼熱(64.2%)為三大主要自覺(jué)癥狀;高溫高熱、食辛辣刺激食物、日曬、情緒波動(dòng)是該病最常見(jiàn)的誘發(fā)、加重因素。ETR在陣發(fā)性潮紅、面部皮膚干燥方面的嚴(yán)重程度高于PPR,PPR在持久性紅斑、丘疹膿皰、灼熱和/或刺痛感、腫脹、肥大增生性改變方面嚴(yán)重程度高于ETR。4.危險(xiǎn)因素:單因素logistic回歸分析顯示:嗜食辛辣刺激食物、消化系統(tǒng)不適癥狀、性格急躁易怒、防曬與玫瑰痤瘡發(fā)病相關(guān),P值均0.05,將這些因素進(jìn)行共線性診斷后納入多因素條件logistic回歸分析,得出嗜食辛辣刺激食物、性格急躁易怒是玫瑰痤瘡發(fā)病的危險(xiǎn)因素(OR1),防曬是發(fā)病的保護(hù)因素(OR1)。5.中醫(yī)病因病機(jī)及證型分布:運(yùn)用因子分析得出痰、濕、熱、瘀為該病的主要致病因素;聚類分析結(jié)果顯示:肺胃熱盛證、脾胃濕熱證、痰濕凝滯證、氣滯血瘀證、肝郁化火證是臨床常見(jiàn)證型。結(jié)論:玫瑰痤瘡好發(fā)于中年女性,常伴有面部不適癥狀,應(yīng)加強(qiáng)對(duì)該病的認(rèn)識(shí),臨床需與激素依賴性皮炎、過(guò)敏性皮炎、脂溢性皮炎等加以鑒別。嗜食辛辣刺激食物、性格急躁易怒為該病的危險(xiǎn)因素,防曬為該病的保護(hù)因素。痰、濕、熱、瘀為該病的主要病理因素,病位涉及肺、脾、肝,痰濕在發(fā)病過(guò)程中起到了重要的作用。
[Abstract]:Objective: to explore the clinical characteristics, risk factors, etiology and pathogenesis of roseacne and the distribution of syndromes by analyzing the clinical data and TCM syndromes of patients with roseacne, in order to improve the overall understanding of the disease. To provide new ideas for TCM syndrome differentiation and treatment, and to provide objective basis for clinical standardized research. Methods: in this study, 181 patients with roseacne from April 2016 to January 2017 in the Department of Dermatology of Jiangsu Provincial traditional Chinese Medicine Hospital were investigated by a one-to-one questionnaire, which met the inclusion criteria of this study and did not meet the exclusion criteria. The control group was set up at 1:1 by sex and age, and all the collected information was input into excel to establish the database, and the related statistical analysis was carried out by SPSS20.0 software. By using univariate and multivariate logistic regression analysis, the main pathogenic factors and syndromes classification of the disease were summarized by systematic clustering and factor analysis. The result is 1: 1. There were 33 males and 148 females with a male to female ratio of 1: 4.48, with an average age of 36.17 鹵11.294 years or 20-50 years old. The course of disease was from 3 days to 25 years with an average of 2.49 鹵3.57 years, and the course of disease of female was lower than that of male. Of the 150 patients with a history of previous diagnosis and treatment, 40 (22.1%) indicated that treatment was ineffective, 11 (6.1%) indicated that symptoms had worsened after treatment, and the rate of suspected misdiagnosis was as high as 34%; in the course of past diagnosis and treatment, Oral antibiotics (64.7%), traditional Chinese medicine decoction (56.9%), antihistamines (19.9%) were used as systemic therapy, hormone (44.9%) and calcium modulation phosphatase inhibitor (33.7%). Clinical features: erythema capillary dilated (ETR) and papular pustular (PPR) were the most common clinical types, accounting for 57.5% and 33.7%, respectively, with paroxysmal flashes (88.4%), persistent erythema (86.2%), capillary dilatation (82.3%). Buccal (83.4%), nasal (68.0%), perioral (66.3%) were the most frequently involved sites. The frequency of buccal, perioral and frontal involvement in female patients was significantly higher than that in men, while dryness (68.4%), pruritus (66.7%) and burning heat (64.2%) were the three major symptoms. Emotional fluctuation is the most common cause of the disease. The severity of ETR in paroxysmal flushing, facial dryness is higher than that of PPR,PPR in persistent erythema, papules, burning and / or tingling, swelling. The severity of hypertrophic changes is higher than that of ETR.4.. Risk factors: univariate logistic regression analysis showed that eating spicy food, digestive system discomfort, irritability, irritability and irritability, The relative P values of sunscreen and rose-acne were 0.05. After co-linear diagnosis, these factors were analyzed by multivariate conditional logistic regression analysis. Irritability and irritability are risk factors (OR1) and sunscreen is the protective factor (OR1). The main pathogenic factors of the disease were phlegm, dampness, heat and blood stasis. Cluster analysis showed that: lung and stomach heat syndrome, spleen and stomach dampness heat syndrome, phlegm dampness stagnation syndrome, qi stagnation and blood stasis syndrome, Liver depression and fire syndrome is a common clinical syndrome type. Conclusion: rose-acne is common in middle-aged women and often accompanied with facial symptoms. It is necessary to recognize the disease and differentiate it from hormone dependent dermatitis, allergic dermatitis and seborrheic dermatitis. Irritability and irritability were the risk factors of the disease, and sun protection was the protective factor. Phlegm, dampness, heat and blood stasis are the main pathological factors of the disease. The location of the disease involves the lung, spleen, liver and phlegm dampness, which plays an important role in the pathogenesis of the disease.
【學(xué)位授予單位】：南京中醫(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)】：R275.9

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