寻常型银屑病皮肤屏障功能检测及湿疹样变相关因素临床探讨

发布时间：2018-03-17 13:04

本文选题：银屑病　切入点：皮肤屏障　出处：《安徽医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：研究背景与目的皮肤是人体最大的器官,是机体的天然屏障,具有体温调节、感觉、吸收、分泌及排泄、反馈等多种生理功能,其中屏障功能意义重大。银屑病患者的屏障功能根据不同程度的皮损表现受到不同程度的损伤。寻常型银屑病患者的皮损主要是以浸润性红斑,上附银白色鳞屑为主要表现,可伴有薄膜现象和点状出血,Auspitz征(+),部分患者皮损因瘙痒而搔抓刺激作用下在红斑鳞屑基础上可见抓痕、血痂、渗出,鳞屑颜色也由银白色转为淡黄至深褐色,即伴有湿疹样临床表现。本次临床研究重点是对寻常型银屑病患者的皮肤屏障及其皮损出现湿疹样改变情况展开调查及分析,了解寻常型银屑病患者皮肤屏障功能情况,探讨寻常型银屑病患者皮损区与非皮损区、患者与正常人皮肤屏障功能相关指标之间的差异；另外,对银屑病患者皮损处出现湿疹样改变的情况进行调查、分析,探讨寻常型银屑病患者皮损出现湿疹样改变的发生率及相关影响因素。方法与结果1.寻常型银屑病患者皮肤屏障功能的临床分析使用皮肤屏障功能测试仪测定寻常型银屑病患者皮损区、非皮损区、健康志愿者的皮肤角质层含水量、PH值及经皮水分流失量(TEWL)；分别采用压板法、分光光度法测定寻常型银屑病患者的血清NO、VitE水平。探讨寻常型银屑病患者皮损区与非皮损区、患者与正常人皮肤屏障功能相关指标之间的差异。结果发现寻常型银屑病患者皮损区PH值为(5.69±0.61)高于非皮损区PH值和健康对照组PH值；皮损区含水量为(17.90±6.75)低于非皮损区及健康对照组；皮损区TEWL为(18.58±11.55)g/m2h,高于非皮损区和健康对照组。非皮损区与健康对照组的PH值、角质层含水量及TEWL值无统计学差异。银屑病患者皮损区进展期含水量(18.28±7.51)高于静止期,有统计学差异；消退期含水量(21.64±5.28)高于静止期,有统计学差异；消退期含水量高于进展期,无统计学差异；进展期TEWL值(22.74±13.16)g/m2h高于消退期,有统计学差异；进展期TEWL值高于静止期,无统计学差异；静止期TEWL值高于消退期,无统计学差异；进行期、静止期、消退期皮损区的PH值间比较,无统计学差异。寻常型银屑病患者血清维生素E含量7.27±0.96ug/ml低于健康对照组,银屑病组血清NO含量5.29±1.91umol/L高于健康对照组。2.寻常型银屑病患者皮损湿疹样改变的临床分析制订病例调查表记录患者信息和病情变化情况,利用图像采集设备记录皮损图像信息,应用SPSS16.0软件和Excel软件进行数据分析。结果发现241例寻常型银屑病患者中男性137例,女性104例；出现湿疹样改变的患者122例,发生率为50.6%；出现湿疹样改变与未出现湿疹样改变的患者在皮肤类型、瘙痒评分及疾病分期方面差异具有统计学意义；在性别、年龄、家族史、病程及皮损形态上差异无统计学意义。结论1.寻常型银屑病患者皮损区与非皮损区及健康组比较,皮肤屏障功能指标异常,表现在皮肤表面PH值升高、角质层含水量下降、TEWL值升高、血清VitE下降、血清NO升高,恢复银屑病患者的皮肤屏障功能应当作为银屑病治疗的重要内容。2.寻常型银屑病患者在自觉瘙痒感强烈、皮肤干燥或处于进展期时,皮损易出现湿疹样改变,在治疗早期应当重视口服止痒药物及外用保湿剂,联合治疗,提高疗效,促进皮损消退。
[Abstract]:Research background and purpose of the skin is the largest organ in the body, is the natural barrier of the body, with thermoregulation, feeling, absorption, secretion and excretion, the physiological functions of feedback, one of the major barrier function significance. In patients with psoriasis skin barrier function according to different degree of damage by varying degrees of damage. The skin lesions of patients with psoriasis vulgaris is mainly to the infiltration of erythema, with silvery scales as the main performance, can be accompanied by film phenomenon and punctate bleeding, Auspitz syndrome (+) lesions, itching and scratching due to stimulation in red spot scales based on visible scratches, blood scab, exudation of some patients with scales color from white to silver light yellow to dark brown, with eczema like clinical manifestations. The clinical study is focused on the skin barrier and skin lesions of patients with psoriasis vulgaris eczema like change situation investigation and analysis, seeking to understand Often type psoriasis skin barrier function, to explore the lesions of patients with psoriasis vulgaris and non lesional skin, the differences between the related index of skin barrier function in patients and normal persons; in addition, the skin lesions of patients with psoriasis appear eczematous changes of the investigation, analysis, explore the skin lesions of patients with psoriasis vulgaris eczema like change incidence and the correlative factors. Methods and results: clinical analysis of 1. skin barrier function in patients with psoriasis vulgaris using skin barrier function tester lesions of patients with psoriasis vulgaris, non lesional skin, the stratum corneum of the skin of healthy volunteers moisture, pH and percutaneous water loss (TEWL) were used to plate method;, spectrophotometric method for the determination of serum NO, VitE levels in patients with psoriasis vulgaris. To investigate the lesions of patients with psoriasis vulgaris and non lesional skin, patients and normal people The difference between the related index of skin barrier function. The results showed that the pH value of the lesions of patients with psoriasis vulgaris for (5.69 + 0.61) higher than that of non lesional skin pH and healthy controls pH; lesions of water (17.90 + 6.75) is lower than that of non lesional and normal control group; the lesions of TEWL (18.58 + 11.55) g/m2h that is higher than that of non lesional and non lesional skin. The healthy control group and healthy control group the pH of stratum corneum water content and TEWL value had no significant difference. During the progression of psoriatic lesions containing water (18.28 + 7.51) higher than the resting stage, there were significant differences; paracmasis moisture (21.64 + 5.28) higher than the stationary phase, there were significant differences; paracmasis moisture content higher than the advanced stage, there was no significant difference in TEWL value; (22.74 + 13.16) g/m2h higher than the recession, there is significant difference; advanced TEWL value is higher than the resting stage, there was no significant difference in resting stage; high TEWL value In a recession, no significant difference; period, quiescent, dissipated period compared the pH value of the lesions, with no significant difference. The content of E in patients with psoriasis vulgaris serum vitamin 0.96ug/ml was 7.27 lower than that of the control group, levels of serum NO and clinical analysis of 5.29 psoriasis + 1.91umol/L Gao Yujian Kang group.2. of psoriasis vulgaris eczema for cases like change was used to record the patient information and condition changes, the use of image acquisition equipment lesions recorded image information, the application of SPSS16.0 software and Excel software to analyze the data. The results showed that 241 cases of patients with psoriasis vulgaris in male 137 cases, female 104 cases; 122 cases of eczema like changes of patients, the incidence of 50.6%; eczema like change and no change in patients with eczematous skin type, pruritus score and disease staging showed a statistically significant difference; In gender, age, family history, no significant difference on the duration and lesion morphology. Compared with non lesional skin lesions and healthy group 1. conclusions in patients with psoriasis vulgaris, abnormal skin barrier function, increased on the surface of the skin pH value, the stratum corneum water content decreased, TEWL value increased, decreased serum VitE, serum NO increased, an important content of.2. in patients with psoriasis vulgaris to restore skin barrier function in patients with psoriasis should be used as the treatment of psoriasis in a strong sense of itching, dry skin or in the advanced stage, skin prone to eczema like changes in the early stage of treatment should pay attention to oral antipruritic drugs and topical moisturizing agent, combined treatment, improve the curative effect, promote lesions fade.

【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R758.63

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