富血小板血浆联合中西药治疗重型斑秃（肝肾不足型）临床观察

发布时间：2018-03-01 08:54

本文关键词： 重型斑秃富血小板血浆糖皮质激素六味地黄汤　出处：《广州中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:观察富血小板血浆(platelet-rich plasma PRP)联合中西药治疗重型斑秃(肝肾不足型)的临床疗效及安全性观察。方法:采用随机对照研究方法,将符合条件的13例中医辨证肝肾不足型的重型斑秃患者分为对照组(6例)和治疗组(7例),对照组:内服中药(六味地黄汤加减,每天1剂)和小剂量糖皮质激素(甲泼尼龙片0.25mg/kg,每天1次,清晨顿服;此后根据实际情况减量至停药),盐酸雷尼替丁胶囊(150mg,每天2次),碳酸钙D3片(600mg,每天1次)。治疗组:在对照组治疗方法基础上行PRP注射。用水光注射仪将PRP局部注射至脱发区域,每月1次,连续3次为一个疗程。同时患者在治疗前后行血液分析,肝肾功能,尿组合,大便检查,感染四项安全性检查;填写基本信息表,生活质量调查表及知情同意书。观察者填写不良反应观察表,安全性检查表,及重型斑秃临床观察表。治疗0周,4周,8周,12周用数码相机记录脱发区域的毛发情况,根据治疗前后脱发面积,拉发实验,毛发再生情况进行临床疗效观察。结果:1.治疗组和对照组的患者在年龄、性别、病程方面,分别进行统计学分析,P0.05差异均无统计学意义,具有可比性;两组患者在治疗前后,肝肾功能、血分析、尿组合、大便检查均无明显异常;两组患者不良反应,均无统计学意义,PRP注射联合中西药治疗重型斑秃具有安全性。2.治疗后,两组在脱发面积、毛发再生方面,经统计学分析,P值均P0.05,差异有统计学意义,治疗组在减小脱发面积,提高毛发再生情况均优于对照组。拉发实验,P0.05,差异无统计学意义,治疗组在改善拉发试验优势不明显,两组改善程度无明显差异。两组皮损总积分比较,治疗后组间和组内比较,P值均P0.05,两种治疗方法均能改善皮损总情况,治疗组改善皮损评分优于对照组。3.治疗组与对照组临床总有效率比较,对照组66.66%,治疗组85.71%,统计学分析,P0.05,临床显效率比较,对照组33.33%,治疗组57.14%,P0.05,两组疗效差异均无统计学意义,治疗组与对照组相比,临床疗效优势不明显。结论:富血小板血浆联合内服小剂量糖皮质激素和六味地黄汤加减治疗与单纯内服小剂量糖皮质激素和六味地黄汤加减治疗相比,临床疗效无明显优势,但在减小脱发面积,改善毛发再生情况方面有明显优势,且两种治疗方法均能改善皮损总状况且治疗安全,具有临床治疗意义。
[Abstract]:Objective: to observe the clinical efficacy and safety of platelet-rich plasma plasma combined with western medicine in the treatment of severe alopecia areata. Thirteen cases of severe alopecia areata with syndrome differentiation of liver and kidney were divided into control group (n = 6) and treatment group (n = 7). One dose per day and one dose of glucocorticoid (methylprednisolone 0.25mg / kg, once a day, early in the morning); Then according to the actual situation, the dosage of ranitidine hydrochloride was 150 mg, twice a day, calcium carbonate D3 tablet 600 mg, once a day. The treatment group was given PRP injection on the basis of the treatment method of the control group, and the PRP was injected locally into the alopecia area with the water photoinjector. At the same time, the patients were given blood analysis, liver and kidney function, urine combination, stool examination, infection four safety tests before and after treatment, filling out basic information form, Quality of life questionnaire and informed consent form. Observers filled out adverse reaction observation forms, safety check forms, and clinical observation forms for severe alopecia areata. Hair in the hair loss area was recorded by digital camera at 0 weeks, 4 weeks, 8 weeks and 12 weeks after treatment. According to the area of hair loss, hair pulling experiment and hair regeneration before and after treatment, the clinical curative effect was observed. Results there was no significant difference in age, sex and course of disease between the treatment group and the control group (P0.05). Two groups of patients before and after treatment, liver and kidney function, blood analysis, urine combination, stool examination were not significantly abnormal, the two groups of adverse reactions, There was no statistical significance in the treatment of severe alopecia areata with PRP injection and western medicine. 2. After treatment, there was significant difference in hair loss area and hair regeneration between the two groups (P 0.05), and the treatment group was reducing the alopecia area. The improvement of hair regeneration in the treatment group was better than that in the control group, the difference was not statistically significant (P 0.05), the advantage of the treatment group was not obvious in the improvement of hair pulling test, and there was no significant difference in the improvement degree between the two groups. After treatment, the P values of the two groups were all P 0.05, both of which could improve the overall condition of skin lesions, and the improvement score of skin lesions in the treatment group was better than that in the control group .3.The total effective rate of the treatment group was higher than that of the control group, and the total effective rate of the treatment group was higher than that of the control group. The control group (66.66), the treatment group (85.71), the clinical efficacy rate was compared, the control group was 33.33, the treatment group was 57.14 and P0.05, there was no significant difference between the treatment group and the control group. Conclusion: platelet rich plasma combined with low-dose glucocorticoid and Liuweidihuang decoction has no obvious advantage in clinical effect compared with that of low-dose glucocorticoid and Liuweidihuang decoction alone. But there are obvious advantages in reducing the area of hair loss and improving hair regeneration. Both methods can improve the overall condition of skin lesions and the treatment is safe, which has clinical significance.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R758.71

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