白癜风的流行病学病因学调查及导师治验

发布时间：2018-08-06 11:46

【摘要】：本论文主要包括文献综述、临床调查研究和导师治疗经验三部分。文献综述：从现代医学和传统医学两种角度阐述关于白癜风病因及治疗进展的研究概况,包括国内外西医学对白癜风发病机制的最新研究、近年来治疗方面的研究进展及临床科研成果；中医学对白癜风病因病机的认识、近现代大家的临证经验及经方验药和近年来中医治疗白癜风的临床疗效观察及实验研究。临床调查研究部分：目的：通过对2011年6月一2011年12月期间门诊就诊于北京中医医院皮肤科的白癜风患者进行流行病学病因学调查,统计白癜风一病的流行病学资料,主要包括性别、年龄、病程、发病季节、肤色、初发及目前皮损的部位及大小、临床分型分布情况、家族史、伴发病史、常见病因、诱因及可能相关危险因素、舌苔、脉象、中医辨证分型等内容,在此基础上总结白癜风的各年龄段、男女之间发病率有无差异；平均病程；皮损有无好发部位及季节性规律；临床各种分型的发病比例；白癜风与其他疾病的关系,有无家族遗传倾向；临床常见病因、诱发因素及可能相关危险因素的探讨；舌苔脉及中医辨证分型的规律,为今后白癜风病因及治疗方面的科研提供一些研究依据和思路。方法：制定“白癜风的流行病学病因学调查表”,对符合纳入标准的患者经其知情同意后进行病例采集,认真填写表格各项数据,尊重患者隐私权。收集完所有病例之后,对数据进行集中处理。所得数据均输入Excel表格,用SPSS17.0软件进行统计学处理,并得出相应结论。计数资料采用均值、标准差描述,计量资料用构成比描述。结果：共收集了104例白癜风患者,女性75例,男性29例,女：男为2.6：1,女性白癜风患病率高于男性。白癜风首次发病可在任何年龄,从1岁到74岁不等,平均年龄32.17±17.29,72.1%的白癜风患者集中在11-50岁,其中以21-30岁者所占比例最多,为19.2%；小于10岁及高于50岁组所占比例较少,均低12%；白癜风各年龄段除11-20岁组外,均为女性发病率高于男性,尤以21-60岁阶段表现突出,女性发病率均为男性3倍以上。平均病程4.12±5.96年,其中病程1年一3年者最多,占24.04%,病程1年者62例,占59.6%。104例白癜风患者中肤色正常者80例,偏黑者19例,偏白者5例,本研究显示黄种人中肤色偏黑者患病率高于偏白者。104例白癜风患者中,有100例患者能回忆起初次发病或本次加重的季节,初次发病或本次加重时间春季29例,夏季44例,秋季14例,冬季13例,春夏季节发病率明显高于秋冬季节。目前皮损主要分布于面部、手部和颈部,且躯干部头面颈部上肢下肢。初发皮损好发于面部、手部和腹部,且头面颈部躯干部上肢下肢。104例白癜风患者中,节段型4例,寻常型100例,其中以散在型和局限型为主；处于进展期的21例,以散在型和肢端型为主,稳定期的83例,以散在型和局限型为主；完全性白斑91例,不完全性白斑13例。皮损严重程度以轻度和中度为主。本研究中有12.5%的白癜风患者有家族史,家族成员中共有16例患本病,其中Ⅰ级亲属5例,占31.3%,Ⅱ级亲属8例,占50%,Ⅲ级亲属3例,占18.7%,Ⅲ级亲属患病率低于Ⅰ、Ⅱ级。在众多相关病因中,精神心理因素所占比例最大,有72.12%的白癜风患者在起病之前、疾病发展阶段或者复发阶段曾有过精神创伤、生活工作压力过大、用脑过度、紧张焦虑等状况出现。免疫方面,约有22.12%的白癜风患者伴发甲状腺疾病、类风湿、肝炎、哮喘、斑秃、湿疹、糖尿病、慢性鼻炎、慢性胃炎等自身免疫性或与免疫相关的疾病；33.65%的白癜风患者中出现同形反应。较多摄入维生素C,较多接触电脑、电视以及某些化学物质,微量元素缺乏等都是本病的相关危险因素。104例白癜风患者中,气滞血瘀型18例,肝肾阴虚型48例,其他证型38例。舌暗红(50.0%),苔薄白(54.8%),脉沉(47.1%)及沉弦(35.0%)所占比例最多。导师治疗经验：针对白癜风的多种致病因素,单一治疗方法难以取得理想效果,导师采用综合疗法取得了较好的临床疗效,包括辨证论治中药内服,药汤外敷以引气血,饮食疗法,心理疏导,巩固性治疗。
[Abstract]:This paper mainly includes three parts: literature review, clinical investigation and tutor treatment experience.
Literature review: from two angles of modern medicine and traditional medicine, this paper expounds the general situation of the research on the etiology and treatment progress of vitiligo, including the latest research on the pathogenesis of vitiligo at home and abroad, the progress in the treatment of treatment and the achievements of clinical research in recent years, the understanding of the pathogenesis of vitiligo in traditional Chinese medicine, and the recent modern people Clinical experience and experience in the treatment of vitiligo in recent years.
Clinical research research part:
Objective: through the epidemiological investigation of vitiligo patients in Department of Dermatology of Beijing Chinese Medicine Hospital during the period of December 2011 June 2011, the epidemiological data of vitiligo, including sex, age, course of disease, disease season, skin color, location and size of skin lesions, and the distribution of clinical types, were mainly included. Conditions, family history, associated history, common cause, inducement and possible related risk factors, tongue coating, pulse image, TCM syndrome differentiation, and so on. On this basis, we summarize the age of vitiligo, the incidence of men and women has no difference, the average course of disease, the skin lesions have no good hair position and seasonal regularity; the incidence of various types of clinical types; The relationship between vitiligo and other diseases, the familial hereditary tendency, the clinical common cause, the inducing factor and the possible related risk factors, the tongue coating pulse and the pattern of TCM syndrome differentiation, provide some research basis and thought for the research of the etiology and treatment of vitiligo in the future.
Methods: formulating the epidemiological etiological questionnaire for vitiligo, collecting the cases after their informed consent, carefully filling out the data of the form and respecting the patient's right to privacy. After collecting all the cases, the data were concentrated. All the data were entered into the Excel form and used in the SPSS17.0 software. Statistics were processed, and corresponding conclusions were obtained. Counting data were described by mean, standard deviation, and measured data were described by constituent ratio.
Results: a total of 104 patients with vitiligo were collected, 75 women, 29 male and female: male was 2.6:1. The incidence of vitiligo in women was higher than that of men. The first onset of vitiligo was at any age, ranging from 1 to 74 years old. The average age of 32.17 + 17.29,72.1% of vitiligo was 11-50 years old, with the largest proportion of 21-30 years old, 19.2%. The proportion of the group less than 10 years old and the 50 year old group was less than 12%. The incidence of female vitiligo in all ages except 11-20 years old was higher than that of men, especially in the stage of 21-60 years, the incidence of women was 3 times more than that of men. The average course of disease was 4.12 + 5.96 years, of which the course of disease was 1 years and 3 years, accounting for 24.04%, 62 cases of 1 years in the course of illness accounted for 59. In.6%.104 patients with vitiligo, there were 80 cases of normal skin color, 19 cases of blacken and 5 cases of whiteness. This study showed that the prevalence rate of black people in the yellow race was higher than that of vitiligo patients in.104 cases, and 100 patients could recall the first onset or this aggravation season, 29 cases in the first onset or this aggravation time, 44 in summer and 14 in the autumn. The incidence of 13 cases in winter was obviously higher than that of autumn and winter in the spring and summer season. At present, the lesions mainly distributed in the face, hand and neck, and the upper limbs of the head and neck of the body. The primary skin lesions were in the face, the hand and the abdomen, and the upper limbs of the head and neck trunk of the upper limbs were.104 cases of white purpura, 4 cases of segmental type and 100 cases of common type. In the 21 cases of progressive period, 21 cases were mainly scattered and acromegaly, 83 cases in the stable period, mainly scattered and localized, 91 cases of complete leukoplakia and 13 cases of incomplete leukoplakia. The severity of skin lesions was mild and moderate. In this study, 12.5% of the patients with white purpura had family history, and the family members had 16 cases. Among them, there were 5, 31.3%, 8, 50%, 3, 18.7%, and class III of relatives lower than I, class II. Among the many related causes, psycho psychological factors accounted for the largest proportion, and 72.12% of vitiligo patients had had mental trauma before the onset of disease or in the relapse stage. There are about 22.12% of vitiligo patients with thyroid diseases, rheumatoid, hepatitis, asthma, alopecia, eczema, diabetes, chronic rhinitis, chronic gastritis and other autoimmune or immune related diseases, and 33.65% of vitiligo patients have homomorphic reactions. Intake of vitamin C, more exposure to computers, television and some chemicals, and the lack of trace elements were all associated risk factors for the disease in.104 patients with vitiligo, 18 cases of qi stagnation and blood stasis, 48 cases of yin deficiency of liver and kidney, 38 cases of other syndrome types, tongue dark red (50%), moss white (54.8%), pulse sinks (47.1%) and sunk chord (35%).
Tutor treatment experience: in view of the various pathogenic factors of vitiligo, the single treatment method is difficult to achieve the ideal effect, the tutor adopts comprehensive therapy to achieve better clinical effect, including syndrome differentiation and treatment of Chinese medicine, medicine soup external application to lead Qi and blood, diet therapy, psychological counseling, sera fixation.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R758.41

【参考文献】