保湿润肤剂对特应性皮炎辅助治疗的作用及安全性观察
发布时间：2018-08-18 21:01
【摘要】：研究背景 特应性皮炎（atopic dermatitis,AD）是一种慢性、复发性皮肤疾病，以皮肤干燥、瘙痒和炎症为主要特征。其发病机制尚不完全清楚，与遗传、环境、免疫等因素相关。近年的研究发现，皮肤屏障结构和功能异常可能是特应性皮炎发病的首要机制。AD的临床表现多种多样，除有红斑、丘疹、渗出、表皮剥脱和苔藓样变等多种表现外，约有80%的AD患者有不同程度的干皮症，表现为皮肤干燥和脱屑，尤其在秋冬季节，AD皮损也往往在此季节加重。因此，恢复皮肤屏障功能、缓解皮肤干燥、脱屑以及瘙痒是治疗AD和预防AD再次发作的重要措施。采用具有修复皮肤屏障作用的保湿润肤剂作为基础治疗措施已成为AD治疗的共识。目前，国外有研究表明外用糖皮质激素联合保湿润肤剂能有效降低AD复发率并延长其缓解期。本研究采用随机、平行对照方法，观察单独外用糖皮质激素与外用糖皮质激素联合保湿润肤剂治疗AD的疗效，并对其安全性进行评估。 目的 评价保湿润肤剂辅助治疗儿童轻~中度特应性皮炎临床疗效和安全性，保湿润肤剂延缓儿童轻~中度特应性皮炎复发的情况。 方法 采用随机、平行对照实验。本研究共纳入2~12岁轻~中度AD患儿30例，均满足Hanifin-Rajka标准。其中男14例，女16例，平均年龄为4.95±2.80岁。随机分为试验组及对照组，试验组予以糖皮质激素联合保湿润肤剂外用治疗，对照组仅予以糖皮质激素外用治疗。分别于治疗的第14天、第28天、第56天进行随访。治疗前及每次随访时对患儿疾病严重程度SCORAD（Scoring of Atopic Dermatitis）及客观体征红斑、丘疹/水肿、渗出/结痂、表皮剥脱/抓痕、苔藓化、皮肤干燥及主观症状瘙痒、睡眠障碍进行评分，并就每项评分比较试验组及对照组的差异。 结果 30例纳入研究的AD患儿均完成随访。 1.SCORAD值：首诊当天，试验组与对照组疾病严重程度SCORAD值无统计学差异（39.4±7.781、38.0±9.016，P＞0.05）。第14、28天随访时，试验组与对照组SCORAD值亦无统计学差异。而在第56天，试验组SCORAD值较对照组明显降低（3.933±5.885、12.133±9.855，P＜0.05）。 2.有效率和复发率：试验组在治疗第14天有效率与对照组相当（66.7%、46.7%，P＞0.05），而在第28、56天有效率均高于对照组（第28天：100%、66.7%，P＜0.05；第56天：93.3%、53.3%，P＜0.05）。试验组在治疗第56天复发率明显低于对照组（6.6%、46.7%，P＜0.05）。 3.客观体征：首诊当天，试验组与对照组的客观体征评分均无统计学差异（P＞0.05），而试验组的红斑评分在第56天较对照组明显降低（0.13±0.352、0.53±0.640，P＜0.05），干燥评分在第28、56天较对照组明显降低（第28天：0.133±0.352、0.6±0.507，P＜0.05；第56天：0.067±0.258、0.467±0.518，P＜0.05）。整个随访过程中，丘疹/水肿、渗出/结痂、表皮剥脱/抓痕、苔藓化的评分在试验组及对照组之间均无统计学差异（P＞0.05）。 4.主观症状：首诊当天，，试验组与对照组的瘙痒及睡眠障碍评分均无统计学差异（P＞0.05），而试验组的瘙痒评分在第56天较对照组有明显降低（1.333±1.447、2.533±1.685，P＜0.05），整个随访过程中，睡眠障碍的评分在试验组及对照组之间无统计学差异（P＞0.05）。 5.整个试验过程中无不良反应事件发生。 结论 糖皮质激素联合保湿润肤剂外用治疗轻~中度特应性皮炎可以提高治疗的有效率，较长时间规则使用润肤剂有助于减轻疾病严重程度并改善患儿皮肤的红斑、干燥、瘙痒，同时可以降低特应性皮炎的复发率。
[Abstract]:Research background
Atopic dermatitis (AD) is a chronic, recurrent skin disease characterized by dry skin, pruritus and inflammation. The pathogenesis of AD is not fully understood, and is related to genetic, environmental and immune factors. In addition to erythema, papules, exudation, exfoliation and lichenoid degeneration, about 80% of AD patients have different degrees of xerodermia, characterized by dry skin and scaling, especially in autumn and winter, AD skin lesions are often aggravated in this season. Therefore, restore the skin barrier function, alleviate skin dryness, scaling to And itching is an important measure to treat AD and prevent the recurrence of AD. It has become a common understanding to use moisturizing and emollient with skin barrier repairing function as the basic treatment for AD. At present, foreign studies have shown that topical glucocorticoid combined with moisturizing and emollient can effectively reduce the recurrence rate of AD and prolong the remission period. A randomized, parallel controlled trial was conducted to evaluate the efficacy and safety of glucocorticoid combined with moisturizing emollient in the treatment of AD.
objective
To evaluate the efficacy and safety of moisturizing and emollient in adjuvant treatment of mild to moderate atopic dermatitis in children, and to delay the recurrence of mild to moderate atopic dermatitis in children.
Method
Thirty children aged 2 to 12 years with mild to moderate AD were enrolled in this study. They all met the Hanifin-Rajka criteria. There were 14 males and 16 females with an average age of 4.95 (+ 2.80 years). They were randomly divided into experimental group and control group. The experimental group was treated with glucocorticoid combined with moisturizing and emollient, while the control group was treated only with glucocorticoid. The severity of SCORAD (Scoring of Atopic Dermatitis) and the objective signs of erythema, papules/edema, exudation/scab, exfoliation/scratch, lichening, dry skin and subjective symptoms, pruritus, sleep disorders were scored before and during each follow-up. The differences between the experimental group and the control group were compared with each score.
Result
30 children with AD who were included in the study were followed up.
1. SCORAD value: On the first day of diagnosis, there was no significant difference in SCORAD value between the experimental group and the control group (39.4 7.781, 38.0 9.016, P > 0.05). At the 14th and 28th day of follow-up, there was no significant difference in SCORAD value between the experimental group and the control group.
2. Effective rate and recurrence rate: The effective rate of the experimental group was similar to that of the control group on the 14th day (66.7%, 46.7%, P > 0.05), but higher than that of the control group on the 28th and 56th day (100%, 66.7%, P < 0.05; 93.3%, 53.3%, P < 0.05) on the 56th day. The recurrence rate of the experimental group was significantly lower than that of the control group on the 56th day (6.6%, 46.7%, P < 0.05).
3. Objective Signs: On the first day of diagnosis, there was no significant difference between the experimental group and the control group (P > 0.05), but the erythema score of the experimental group was significantly lower than that of the control group on the 56th day (0.13.352, 0.53.640, P < 0.05), and the dry score was significantly lower than that of the control group on the 28th and 56th day (0.133.352, 0.6 65507, P < 0.05). During the whole follow-up period, papules/edema, exudation/scab, epidermal exfoliation/scratch, and mossy scores were not significantly different between the experimental group and the control group (P > 0.05).
4. Subjective symptoms: On the first day of diagnosis, there was no significant difference in the itching and sleep disorder scores between the experimental group and the control group (P > 0.05), while the itching score of the experimental group on the 56th day was significantly lower than that of the control group (1.333 (+ 1.447), 2.533 (+ 1.685), P < 0.05). Academic differences (P > 0.05).
5. no adverse events occurred during the whole experiment.
conclusion
Glucocorticoid combined with moisturizing emollients can improve the efficacy of topical treatment of mild to moderate atopic dermatitis. Regular use of emollients for a long time can help to reduce the severity of the disease and improve the erythema, dryness, itching of the skin, and reduce the recurrence rate of atopic dermatitis.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R758.3
本文编号：2190664
[Abstract]:Research background
Atopic dermatitis (AD) is a chronic, recurrent skin disease characterized by dry skin, pruritus and inflammation. The pathogenesis of AD is not fully understood, and is related to genetic, environmental and immune factors. In addition to erythema, papules, exudation, exfoliation and lichenoid degeneration, about 80% of AD patients have different degrees of xerodermia, characterized by dry skin and scaling, especially in autumn and winter, AD skin lesions are often aggravated in this season. Therefore, restore the skin barrier function, alleviate skin dryness, scaling to And itching is an important measure to treat AD and prevent the recurrence of AD. It has become a common understanding to use moisturizing and emollient with skin barrier repairing function as the basic treatment for AD. At present, foreign studies have shown that topical glucocorticoid combined with moisturizing and emollient can effectively reduce the recurrence rate of AD and prolong the remission period. A randomized, parallel controlled trial was conducted to evaluate the efficacy and safety of glucocorticoid combined with moisturizing emollient in the treatment of AD.
objective
To evaluate the efficacy and safety of moisturizing and emollient in adjuvant treatment of mild to moderate atopic dermatitis in children, and to delay the recurrence of mild to moderate atopic dermatitis in children.
Method
Thirty children aged 2 to 12 years with mild to moderate AD were enrolled in this study. They all met the Hanifin-Rajka criteria. There were 14 males and 16 females with an average age of 4.95 (+ 2.80 years). They were randomly divided into experimental group and control group. The experimental group was treated with glucocorticoid combined with moisturizing and emollient, while the control group was treated only with glucocorticoid. The severity of SCORAD (Scoring of Atopic Dermatitis) and the objective signs of erythema, papules/edema, exudation/scab, exfoliation/scratch, lichening, dry skin and subjective symptoms, pruritus, sleep disorders were scored before and during each follow-up. The differences between the experimental group and the control group were compared with each score.
Result
30 children with AD who were included in the study were followed up.
1. SCORAD value: On the first day of diagnosis, there was no significant difference in SCORAD value between the experimental group and the control group (39.4 7.781, 38.0 9.016, P > 0.05). At the 14th and 28th day of follow-up, there was no significant difference in SCORAD value between the experimental group and the control group.
2. Effective rate and recurrence rate: The effective rate of the experimental group was similar to that of the control group on the 14th day (66.7%, 46.7%, P > 0.05), but higher than that of the control group on the 28th and 56th day (100%, 66.7%, P < 0.05; 93.3%, 53.3%, P < 0.05) on the 56th day. The recurrence rate of the experimental group was significantly lower than that of the control group on the 56th day (6.6%, 46.7%, P < 0.05).
3. Objective Signs: On the first day of diagnosis, there was no significant difference between the experimental group and the control group (P > 0.05), but the erythema score of the experimental group was significantly lower than that of the control group on the 56th day (0.13.352, 0.53.640, P < 0.05), and the dry score was significantly lower than that of the control group on the 28th and 56th day (0.133.352, 0.6 65507, P < 0.05). During the whole follow-up period, papules/edema, exudation/scab, epidermal exfoliation/scratch, and mossy scores were not significantly different between the experimental group and the control group (P > 0.05).
4. Subjective symptoms: On the first day of diagnosis, there was no significant difference in the itching and sleep disorder scores between the experimental group and the control group (P > 0.05), while the itching score of the experimental group on the 56th day was significantly lower than that of the control group (1.333 (+ 1.447), 2.533 (+ 1.685), P < 0.05). Academic differences (P > 0.05).
5. no adverse events occurred during the whole experiment.
conclusion
Glucocorticoid combined with moisturizing emollients can improve the efficacy of topical treatment of mild to moderate atopic dermatitis. Regular use of emollients for a long time can help to reduce the severity of the disease and improve the erythema, dryness, itching of the skin, and reduce the recurrence rate of atopic dermatitis.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R758.3
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