UVA1联合复方卡力孜然酊治疗稳定期白癜风的临床疗效观察

发布时间：2018-06-03 17:25

本文选题：白癜风 + 复方卡力孜然酊　；参考：《大连医科大学》2017年硕士论文

【摘要】：目的:白癜风是一种常见的皮肤黏膜色素脱失性疾病,是皮肤科常见疾病之一,病因复杂,发病机制尚不清楚。在我国人群中患病率为0.1%~2.7%。好发于暴露及摩擦部位,影响患者的美观和人际交往,给患者带来较大的心理障碍。白癜风的治疗比较困难,随着医学的逐渐发展,其治疗方法也在日益增多。近年来,光疗法和光化学疗法逐渐兴起,PUVA是其中应用较多的一种疗法,它是补骨脂素与长波紫外线UVA的联合应用,其疗效虽已经获得临床认可,但其带来的不良反应也不容忽视。UVA1(340~400 nm)是长波紫外线UVA的一个波段,其皮肤穿透能力更强。本研究中通过对稳定期白癜风患者三种不同治疗方法的观察,探讨UVA1联合外用复方卡力孜然酊治疗稳定期白癜风的疗效,为临床治疗白癜风提供新的方案。方法:本研究收集2016年09月份~2016年12月大连医科大学附属第二医院皮肤科门诊符合纳入标准和排除标准的白癜风患者,筛选26例进行研究。治疗过程中有2例退出,故共入选24例,其中男性12例,女性12例。年龄14~57岁,病程6个月~23年。共包括靶皮损72片,皮损分布于面部、颈部、胸部、腹部、背部、臀部、腰部、手足部、四肢部等等,符合自身对照试验要求。将24例白癜风患者邻近或对称部位的3处白斑,随机分为复方卡力孜然酊组、UVA1组和联合组,采取自身对照的研究方法进行治疗,观察白癜风皮损复色状况。复方卡力孜然酊外用每日3~4次,UVA1照射每周2次。在治疗8周、12周后,根据白癜风的疗效判定标准进行评估,分为痊愈、显效、好转、无效。将皮损统计后,计算总有效率,对三个组的疗效进行对比。并在治疗12周后,将联合组内不同部位的皮损进行统计,对疗效进行比较。结果:1.临床疗效对比:在治疗8周后,复方卡力孜然酊组的总有效率为33.33%;UVA1组总有效率为37.50%,联合组的总有效率为58.33%。经统计学检验,三组间疗效差异无统计学意义(P0.05)。治疗12周后,复方卡力孜然酊组的总有效率为50.00%;UVA1组的总有效率为54.17%,联合组的总有效率为79.17%。经统计学检验,复方卡力孜然酊组与UVA1组疗效差异无统计学意义(P0.05),联合组的疗效高于复方卡力孜然酊组及UVA1组,差异有统计学意义(P0..05)。2.联合组不同部位的疗效对比:在治疗12周后,面颈部的疗效显著高于四肢部和手足部,差异有统计学意义(P0.05),躯干部的疗效高于手足部,差异有统计学意义(P0.05),其余各部位之间疗效差异无统计学意义(P0.05)。结论:UVA1联合复方卡力孜然酊治疗白癜风的疗效明显优于复方卡力孜然酊、UVA1的单独应用,疗效显著,而且不良反应少,应用安全,其疗效差异与部位有关,是临床上治疗稳定期白癜风的一种新选择,值得进一步推广和研究。
[Abstract]:Objective: vitiligo is a common skin and mucosal pigment loss disease, is one of the common dermatologic diseases, the etiology is complex, the pathogenesis is not clear. The prevalence rate in Chinese population was 0.1% and 2.7%. It affects the beauty and interpersonal communication of the patients, and brings great psychological obstacles to the patients. Vitiligo treatment is more difficult, with the development of medicine, its treatment methods are increasing. In recent years, phototherapy and photochemotherapy are becoming more and more widely used as a combination of psoralen and ultraviolet UVA. However, the adverse reactions can not be ignored. UVA1 340Nm) is a band of long wavelength ultraviolet (UVA), and its skin penetration is stronger. In this study, we observed three different treatment methods of stable vitiligo patients, and discussed the efficacy of UVA1 combined with compound Kalizilan tincture in the treatment of stable vitiligo, and provided a new scheme for clinical treatment of vitiligo. Methods: from September 2016 to December 2016, 26 patients with vitiligo were selected from Department of Dermatology, second affiliated Hospital of Dalian Medical University. In the course of treatment, 2 cases quit, so 24 cases were enrolled, including 12 cases of male and 12 cases of female. The disease course ranged from 6 months to 23 years. A total of 72 target lesions were found in the face, neck, chest, abdomen, back, buttocks, waist, hands and feet, limbs and so on. Two hundred and twenty-four patients with vitiligo were randomly divided into two groups: UVA1 group and UVA1 group. Compound kalicumin tincture was irradiated with UVA1 4 times a day, twice a week. After 8 weeks and 12 weeks of treatment, vitiligo was evaluated according to the criteria of curative effect. The total effective rate was calculated and the curative effect of the three groups was compared. After 12 weeks of treatment, the skin lesions of different parts in the combined group were statistically analyzed and the curative effects were compared. The result is 1: 1. Comparison of clinical efficacy: after 8 weeks of treatment, the total effective rate of compound Kalidzilan tincture group was 33.33 and the total effective rate of UVA1 group was 37.50, and the total effective rate of combined group was 58.33. There was no significant difference in curative effect among the three groups by statistical test (P 0.05). After 12 weeks of treatment, the total effective rate of compound Carrizin tincture group was 50.00and the total effective rate of UVA1 group was 54.17, and the total effective rate of combined group was 79.17. By statistical test, there was no significant difference in curative effect between compound Kalidzilan tincture group and UVA1 group. The curative effect of combined group was higher than that of compound Kalidzilan tincture group and UVA1 group, and the difference was statistically significant. After 12 weeks of treatment, the curative effect of face and neck was significantly higher than that of limbs and hands and feet, the difference was statistically significant (P 0.05), and the curative effect of trunk was higher than that of hand and foot. The difference was statistically significant (P 0.05), but there was no significant difference between the other parts (P 0.05). Conclusion the curative effect of the treatment of vitiligo is obviously better than that of UVA1 combined with compound Kalidzilan tincture. The curative effect is remarkable, the adverse reaction is less, and the application is safe. The difference of curative effect is related to the part of vitiligo. It is a new choice in the treatment of stable vitiligo.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R758.41

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