维胺酯角化调节作用与甲分离的临床研究

发布时间：2018-04-02 13:33

本文选题：甲分离　切入点：维胺酯　出处：《泰山医学院》2014年硕士论文

【摘要】：背景甲分离(onycholysis)也被称为甲剥离,是指甲板从甲床自发性的分离,为最常见的甲病症状之一。随着社会的不断发展,人民生活水平有了明显的提高,甲病受到了人们更多的关注,因甲分离而来就诊的患者有了明显的增多。该病发病机制尚不清楚,临床上也缺少有效的治疗手段。维胺酯作为第一代的维A酸类的药物,除了具有促进上皮细胞的正常性分化、促进上皮细胞的正常角化的作用外,还具有抑制细菌、低抗炎症和免疫性的调节的作用;甲由基质角化而来,甲下角化过度为甲分离的常见诱因,分离后常继发的甲下细菌或真菌感染和物理或化学的损伤往往会影响分离的愈合甚至会加重原有的分离。结合维胺酯的药物作用原理,其调节角化作用对甲分离应该有治疗作用。导师10多年前便注意到这一特点,并开展了应用维胺酯调节角化作用来治疗甲分离临床观察,并取得了满意的疗效。目的对维胺酯治疗甲分离的疗效及安全性进行评估,掌握该治疗的适应症,分析甲分离的发病机理。方法查阅相关文献并进行总结分析。设计统一的甲分离治疗观察表,对2011年9月-2013年12月间聊城市第二人民医院皮肤科门诊甲剥离患者进行观察记录,观察内容主要包括:患者姓名、性别、年龄、职业、可能诱因、受累及病甲数、伴发的其他症状、实验室检查、有无其他的并发疾病、治疗情况及每疗程治疗后皮损的变化情况等。共顺利完成观察76例患者、153个指甲的甲分离治疗情况。具体治疗方法为:对符合纳入标准又没有用药禁忌症的患者给予维胺酯口服,按1~2.0mg/kg/天计算,成人每次25~50mg,每日服2~3次。持续的治疗一个月为一个完整的疗程,共计观察三个完整的疗程。结果甲分离发病年龄从17岁到68岁,平均发病年龄42.82±11.34岁,其中发病年龄分布在40-49岁年龄段的有28人,占总数的36.84%,在30-59岁年龄段的共有61人,占总数的80.26%。男性18人,占23.68%;女性58人,占76.32%,共治疗的指甲数为153个,出现甲分离最多的是右手大拇指,共出现甲分离45个,占总数的29.41%,其次为左手的大拇指为27个,占总数的17.65%,出现甲分离最少的是左手的小指,占总数的3.92%。面积下降指数计算公式:(治疗前总面积-治疗后总面积)/治疗前总面积。治疗前所有甲分离指甲的总面积为8580平方毫米,平均甲分离面积为56.08平方毫米,治疗一个月以后总面积下降为6678平方毫米,下降指数为0.22;治疗两个月后甲分离总面积下降为5379平方毫米,下降指数为0.19;治疗三个月以后甲分离总面积下降为4412平方毫米,下降指数为0.18。治疗前总积分为283分,满分为459分,每个甲分离指甲平均评分为1.85,甲分离治疗一个月后总积分下降指数为0.22,治疗两个月后总积分下降指数为0.19,治疗三个月后总积分下降指数为0.18。经过三个月的治疗后共有64个指甲的甲分离获得痊愈。在为期三个月的观察治疗期间共有13例患者出现了轻微的不良反应,占总数的17%,其中7例为皮肤粘膜干燥伴有脱屑,4例只有口唇干燥、轻微皲裂,无皮肤干燥的表现,还有两例出现了眼睛的干燥。因为反应的程度比较轻,都没有影响正常的治疗与观察,并且所有的不良反应均在停药后得到彻底的缓解。结论:甲分离发病与多种内外因素有关,内因有多种系统性疾病、系统性用药等,外因则有急慢性的物理及化学的损伤,更多的则是在易感的基础上多种因素共同导致。目前已知的预防和治疗甲分离的措施:鼓励高蛋白饮食改善全身营养状态;保持甲分离处的清洁干燥,避免进一步的物理及化学损伤;家庭主妇要多用手套和洗衣机,手工业者和农民要多借助于使用工具,以减少慢性物理损伤,避免指甲和有害物质接触;有原发疾病导致的要积极治疗原发疾病;在使用光敏性药物时注意皮肤和指甲的防光;在使用化疗药物前用冷冻手套降低手足部位的循环和代谢。维胺酯对于无明显禁忌症的甲分离患者有明显的治疗作用,而且没有明显的副作用。部分患者对维胺酯的治疗不敏感,可能原因:还有其他潜在因素在加重甲分离,如机体营养不良导致的指甲营养不良、局部的细菌及真菌感染等因素、机体或局部的变态反应性因素及甲床或甲母细胞损伤程度较重。
[Abstract]:The background of a separation (onycholysis) is also known as a spin off, separated from the nail bed nail plate is spontaneous, as one of the most common symptoms of a disease. With the continuous development of society, people's living standard has been greatly improved, a disease has been paid more attention to, due to a separation and treatment of patients have been significantly increased. The pathogenesis of this disease is not clear, there is a lack of effective clinical treatment. Viaminati vitamin A acid as a drug of first generation, but with the promotion of epithelial cells of normal sexual differentiation, promote normal keratinized epithelial cells of the role, but also inhibit bacteria, anti inflammation and low the immune regulatory role; a matrix diagonalization and subungual hyperkeratosis is a common cause of separation, after the separation of Chang Jifa under a bacterial or fungal infection and physical or chemical injury often affect the separation of healing even To increase the original separation. Combining with the drug action principle of VC, the regulation of diversification role should have therapeutic effect on a separation. Mentor 10 years ago he noticed this, and carry out the application of Viaminati regulating keratosis to clinical observation on the treatment of a separation, and achieved satisfactory results. To evaluate the efficacy and safety of objective to treat the separation of Viaminati, master the treatment indications, the pathogenesis of a separation. Methods literatures were reviewed and analyzed. The design of unified treatment of a separate observation table, was recorded on September 2011 -2013 in December in Liaocheng Second People's Hospital Outpatient Department of Dermatology onycholysis patients, observe the main contents include the patient's name, gender, age, occupation, and may cause a number of involvement and disease, with other symptoms, the laboratory examination, there is no other concurrent disease, treatment And after each course of treatment of skin lesions and other changes were successfully completed. Of the 76 patients, 153 nail treatment. The specific treatment methods: no medication contraindications to met the inclusion criteria were given oral viaminate, according to 1~2.0mg/kg/ days, adult each time 25~50mg, daily for 2~3 times continuously. One month of treatment for a complete course of treatment, a total observation of three complete treatment. Results a separation from age 17 to 68 years old, the average age of 42.82 + 11.34 years old, the age distribution in 40-49 at the age of 28, accounting for 36.84% of the total, in 30-59 years of age a total of 61 people, accounted for 80.26%. of the total number of 18 men, women accounted for 23.68%; 58 people, accounting for 76.32%, the number of nails were treated for 153, there is a maximum separation of the right thumb, there were a separation of 45, accounting for 29.41% of the total, followed by the left hand thumb Refers to 27, accounting for 17.65% of the total, there is at least a separation of the little finger of his left hand, formula of the total area of 3.92%. decline index: (total area of the total area before treatment after treatment before treatment) / total area. The total area of all treatment before a separation nail is 8580 mm, the average a separation the area is 56.08 mm for a month after the total area reduced to 6678 square millimeter, drop index was 0.22; after two months of treatment with a separation of the total area decreased to 5379 square mm, drop index is 0.19; three months after treatment the total area under a separation is reduced to 4412 mm, drop index was 0.18. before treatment the total score was 283 points, out of 459 points, each a separation of the nail an average score of 1.85, a separate one month after treatment decreased total score index was 0.22, two months after treatment the total score decreased index was 0.19, three months after treatment the total points Drop index for 0.18. after three months of treatment were separated 64 nail healed. There were observed during the treatment period of three months 13 patients had mild adverse reactions, accounting for 17% of the total, including 7 cases of skin and mucosa with dry desquamation, only 4 cases of dry lips. Slightly chapped, dry skin without performance, there are two cases appeared eye dry. Because of the mild reaction, did not affect the normal treatment and observation, and the adverse reactions were thoroughly relieved after drug withdrawal. Conclusion: a separation is associated with a variety of internal and external factors, internal factors have a variety of system disease, systemic medication, external factors are urgent chronic physical and chemical damage, the more it is based on the susceptible factors of common cause. Now known as the prevention and treatment of a separation measures: to encourage a high protein diet change Good nutritional status of the body; maintain a separation of the clean and dry, avoid physical and chemical damage further; housewives to use gloves and washing machine, craftsmen and farmers to rely on the use of tools to reduce chronic physical damage, avoid contact nails and harmful substances; primary disease leads to active treatment of primary disease; in the use of photosensitive drugs when attention to anti light skin and nails; in the use of chemotherapy drugs before freezing reduce circulation and metabolism and glove parts. Viaminate has therapeutic effect is significant for a separation of patients with no contraindications, and no obvious side effects. The reason is not sensitive to treatment. On the part of patients may Viaminati: there are other potential factors in aggravating a separation, such as malnutrition caused by nail dystrophy, bacterial and fungal infections and other local factors, machine body or local variable The state of reactivity and the degree of damage to the nail bed or methoa were heavy.

【学位授予单位】：泰山医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R758.72

【参考文献】