计算机图像分析法评价中波高能紫外线及联合中药抗白灵霜治疗白癜风疗效的临床研究

发布时间：2018-02-25 22:16

本文关键词： 中波高能紫外线抗白灵霜白癜风计算机图像分析系统　出处：《南京中医药大学》2011年硕士论文　论文类型：学位论文

【摘要】：目的：利用计算机图像分析法评价中波高能紫外线及联合中药抗白灵霜治疗白癜风的临床疗效和安全性。方法：将62例白癜风患者随机分为3组。抗白灵组(20例共36块皮损)予抗白灵霜外涂于靶皮损处,每日2次。高能紫外线组(20例共35块皮损)予中波高能紫外线治疗,每周2次。联合组(22例共32块皮损)予中波高能紫外线治疗,每周2次,联合中药抗白灵霜外涂靶皮损,每日2次。3个治疗组观察疗程均为8周,在治疗前、治疗2周后、4周后、6周后和8周后分别对观察的靶皮损进行拍照和描绘,并采用计算机图像分析系统计算皮损面积从而计算皮损复色程度进行疗效评价,同时观察皮肤不良反应。结果：治疗8周后,总有效率联合组为88.26%,优于抗白灵组26.04%及高能紫外线组61.54%(P均0.01)；高能紫外线组优于抗白灵组(P0.01)；治疗4周、6周、8周后三组靶皮损面积减小率比较,联合组优于抗白灵组及高能紫外线组,高能紫外线组优于抗白灵组(P均0.01)；比较痊愈或显效患者高能紫外线照射累积剂量,联合组明显低于高能紫外线组(P均0.01)；在不同性别、年龄、病程、部位、MED值、日光反应类型、分型、分期等因素影响下,三组间的靶皮损面积减小率比较,≥40岁的年龄区间患者高能紫外线组与联合组靶皮损面积减小率比较及皮肤日光反应类型III型患者抗白灵组的靶皮损面积减少率与高能紫外线组比较,均无显著统计学差异；其它各因素下的三组靶皮损面积减小率比较均具有统计学差异(P均0.05),联合组的靶皮损面积减小率均优于抗白灵组、高能紫外线组；高能紫外线组的靶皮损面积减小率均优于抗白灵组；对三个治疗组内各因素下的靶皮损面积减小率进行比较显示,联合组内手足部位靶皮损面积减小率较其它部位差,稳定期患者面积减小率优于进展期患者(P均0.05)。高能紫外线治疗的不良反应主要包括靶皮损部位可能红斑、水疱、干燥、脱屑,自觉症状为瘙痒或刺痛,无不能耐受不良反应而退出研究者,外用抗白灵霜未见明显不良反应。结论：中波高能紫外线作为一种治疗白癜风的新型局部靶向光疗手段,具有治疗能量高,疗效好,直接作用于白癜风皮损,对附近正常皮肤无照射,不良反应少及患者依从性好等优点。中药抗白灵霜治疗白癜风有一定的疗效,中波高能紫外线联合抗白灵霜治疗白癜风疗效明显优于单独应用中波高能紫外线或中药抗白灵霜,联合治疗还可减少紫外线的照射次数与累积剂量从而有可能减少了紫外线照射不良反应的发生。运用对靶皮损描绘结合计算机图像分析系统计算损其面积评价白癜风疗效的方法,简单实用,可靠性好,在一定程度上避免了主观疗效评价的误差,值得在白癜风临床研究中进一步改进并推广。
[Abstract]:Objective: to evaluate the clinical efficacy and safety of UVB and Kangbailing cream in the treatment of vitiligo by computer image analysis. Methods: Sixty-two patients with vitiligo were randomly divided into 3 groups: 20 patients with 36 lesions in the Kangbailing group were treated with anti-white cream at the target lesions twice a day, and 20 patients with 35 lesions in the high-energy ultraviolet group were treated with high-energy ultraviolet (UVB). The combined treatment group (22 cases with 32 lesions) was treated with high energy ultraviolet (UVB) twice a week, and combined with traditional Chinese medicine anti-Bailing cream for 2 times a day. The course of treatment was 8 weeks in all the three treatment groups. After 2 weeks, 4 weeks, 6 weeks and 8 weeks, the observed target lesions were photographed and depicted, and the area of lesions was calculated by computer image analysis system to evaluate the therapeutic effect. At the same time, the adverse reactions of skin were observed. Results: after 8 weeks of treatment, the total effective rate of the combined group was 88.26, which was better than that of the anti-Bailing group (26.04%) and the high-energy ultraviolet group (61.54) (P 0.01), the high energy ultraviolet group was superior to the anti-Bailing group (P 0.01), and the three groups' target lesion area decreased after 4 weeks, 6 weeks and 8 weeks. The combined group was superior to the Kangbailing group and the high-energy ultraviolet group, and the high-energy ultraviolet group was superior to the anti-Bailing group (P < 0.01), and the cumulative dose of high-energy ultraviolet radiation was significantly lower in the combined group than that in the high-energy ultraviolet group (P < 0.01), and was significantly lower in the combined group than that in the high-energy ultraviolet group (P < 0.01). Under the influence of age, course of disease, site MED value, type of sunlight reaction, type of classification, stage and so on, the reduction rate of target lesion area was compared among the three groups. There was no significant difference in the reduction rate of target lesion area between the high energy ultraviolet group and the combination group, and the decrease rate of the target lesion area in the III type patients with skin type III and those in the high energy ultraviolet group. The decrease rate of target lesion area in the three groups under other factors was statistically different (P < 0.05). The decrease rate of target lesion area in the combined group was better than that in the Kangbailing group and the high-energy ultraviolet group. The reduction rate of target lesion area in high energy ultraviolet group was better than that in Kangbailing group, and the decrease rate of target lesion area in each factor of three treatment groups was lower than that of other parts in the combined group. The area reduction rate of stable stage patients was better than that of advanced patients (P < 0.05). The adverse reactions of high energy ultraviolet ray therapy mainly included erythema, blisters, dryness, desquamation, and conscious symptoms of pruritus or pruritus. No adverse reactions were tolerated and no obvious adverse reactions were observed in the external application of Anti-Belling Cream. Conclusion: as a new method of local targeted phototherapy for vitiligo, UVB has high energy and good curative effect. It acts directly on the lesions of vitiligo and has no irradiation on the normal skin nearby. There were few adverse reactions and good compliance of patients with vitiligo. The curative effect of Chinese traditional medicine Kangbailing cream on vitiligo was better than that of medium wave high energy ultraviolet ray alone or traditional Chinese medicine anti-Bailing cream, and the curative effect of medium wave high energy ultraviolet combined with anti-Bai Ling cream on vitiligo was obviously superior to that of traditional Chinese medicine in the treatment of vitiligo. Combined therapy can also reduce the number of times of ultraviolet irradiation and the cumulative dose, which may reduce the occurrence of adverse reactions of ultraviolet radiation. The area of target lesions was calculated and evaluated by computer image analysis system. The method of curative effect of Schonlein purpura. It is simple and practical, good reliability, to some extent avoid the error of subjective evaluation of curative effect, it is worthy of further improvement and promotion in the clinical study of vitiligo.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R758.41

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