光动力疗法联合中药外洗方治疗痤疮的临床观察

发布时间：2018-08-31 17:19

【摘要】：目的根据Pillsbury分类法在Ⅱ-Ⅳ度的痤疮患者,经光动力治疗后,随机分为两组,将一组患者治疗后用中药外洗而另一组无中药外洗,观察临床疗效及不良反应,通过两组对比证实中药外用对光动力疗法治疗中重度痤疮后具有辅助治疗作用,并能减少不良反应的持续时间,从而为临床寻找安全有效的中西医结合疗法治疗中重度痤疮提供理论依据。临床观察 1.所有病例来源为2011年6月至2011年12月武汉市一医院皮肤科门诊41名患者。所有病例均符合诊断标准及排除标准。按就诊顺序随机分为两组：中药联合光动力治疗组22人,光动力治疗组19人。其中中药联合光动力治疗组中Ⅱ度6例,Ⅲ度7例,Ⅳ度9例；光动力治疗组中Ⅱ度7例,Ⅲ度5例,Ⅳ度7例。两组患者在年龄、性别、病程、治疗前评分等方面均无统计学显著性差异(P0.05),具有可比性。 2.中药联合光动力治疗组经光动力治疗后使用中药外洗面部,1日2次。光动力治疗组仅接受光动力治疗。光动力疗法每2周治疗1次,治疗结束后每月随访1次,共随访3个月。 3.外用中药外洗组方为薏苡仁10g、黄芩10g、金银花10g、侧柏叶10g或中药配方颗粒：薏苡仁2包、黄芩2包、金银花2包、侧柏叶2包,每次治疗后将中药加水浓煎或开水冲化,水温适宜时清洗患处,每次清洗10分钟,每日早晚各1次。 4.两组均采用评分法,分别于治疗前、每次治疗后及随访时根据病情变化评分后判定疗效。在治疗期间观察疗效及不良反应。 5.使用统计软件spssl2.0进行数据处理,病情评分结果采用t检验,总有效率采用X2检验。结果 1.疗效评定 (1)两组在光动力治疗前无明显差异(X2=0.15,P0.1)。经1次治疗后(X2=1.31,P0.1),2次治疗后(X2=0.21,P0.1)和3次治疗后(X2=2.10,P0.1)的痤疮皮损面积和严重程度指数评分均未出现显著的差异； (2)在4次治疗后,使用中药外洗的患者组痤疮皮损面积和严重程度指数评分明显低于不使用中药外洗的患者组(X2=3.15,P0.05)； (3)中药外洗联合光动力治疗痤疮患者2周后总有效率9.1%,4周后为45.5%,6周后为66.7%,8周后上升至100%；光动力组的总有效率在第2、4、6、8周时分别为15.8%、31.6%、41.7%和91.7%。中药联合光动力组的疗效要优于光动力组,但两组无显著性差异(P0.05)。 2.不良反应评定 (1)中药联合光动力组患者出现红斑(84.5%)、肿胀疼痛(53.5%)、脱屑(78.9%)、反应性痤疮(69.0%)、色素沉着(11.3%)、面部瘙痒(7.0%)等症状；光动力组患者出现红斑(95.2%)、肿胀疼痛(69.4%)、脱屑(91.9%)、反应性痤疮(75.8%)、色素沉着(30.6%)、面部瘙痒(9.7%)等症状。两组不良反应中红斑、肿胀疼痛、脱屑、反应性痤疮、面部瘙痒发生率比较无显著性差异(P0.05)。但是色素沉着的发生率在两组之间有显著性差异(P0.05)。 (2)不良反应中,出现红斑后持续的时间：两组之间有显著差异(X2=4.27,P0.05)；出现肿胀疼痛后持续的时间：两组之间有非常显著差异(X2=9.54,P0.01)；出现脱屑后持续的时间：两组之间有显著差异(X2=4.37,P0.05)；出现反应性痤疮后持续的时间：两组之间有非常显著差异(X2=8.13,P0.01)；出现色沉后持续的时间：两组之间有非常显著差异(X2=9.69,P0.01)；出现面部瘙痒后持续的时间：两组之间无显著差异(X2=1.27,P0.1)。结论 ①用中药外洗联合光动力治疗痤疮,治疗1至3次后能较好的缓解临床不适症状。 ②治疗4次后两组痤疮皮损面积和严重程度指数评分中药外洗联合光动力治疗组优于光动力治疗组(P0.05),说明治疗4次后中药外洗方能够较快减少面部痤疮皮损面积和减轻严重程度。 ③治疗总有效率,中药外洗联合光动力治疗组和光动力治疗组两者无明显差异(P0.05)。 ④治疗中,出现的不良反应发生率中药外洗联合光动力治疗组均小于光动力治疗组,两组不良反应中红斑、肿胀疼痛、脱屑、反应性痤疮、面部瘙痒发生率比较无显著性差异(P0.05),但是色素沉着的发生率在两组之间有显著性差异(P0.05)。不良反应如红斑、肿胀疼痛、脱屑、反应性痤疮、色沉的持续时间,中药外洗联合光动力治疗组少于光动力治疗组(P0.05),说明中药外洗方在减少不良反应发生率上无明显作用,但能有效的减少大多不良反应出现后持续的时间。
[Abstract]:objective
According to Pillsbury classification, acne patients with grade II-IV were randomly divided into two groups after photodynamic therapy. One group was treated with traditional Chinese medicine and the other group was not treated with traditional Chinese medicine. And can reduce the duration of adverse reactions, so as to find a safe and effective combination of traditional Chinese and Western medicine in the clinical treatment of moderate and severe acne provides a theoretical basis.
Clinical observation
1. All the cases were from 41 outpatients of Dermatology Department of Wuhan First Hospital from June 2011 to December 2011. All the cases met the diagnostic criteria and exclusion criteria. They were randomly divided into two groups according to the order of visiting: 22 cases in Chinese medicine combined with photodynamic therapy group and 19 cases in photodynamic therapy group. In the photodynamic therapy group, there were 7 cases of grade II, 5 cases of grade III and 7 cases of grade IV. There was no significant difference in age, sex, course of disease and score before treatment between the two groups (P 0.05).
2. Chinese herbal medicine combined with photodynamic therapy group was used to wash face twice a day after photodynamic therapy. Photodynamic therapy group only received photodynamic therapy.
3. External use of Chinese herbal medicine washing group for coix seed 10g, Scutellaria baicalensis 10g, honeysuckle 10g, Platycladus orientalis leaf 10g or Chinese herbal formula granules: Coix seed 2 packs, baicalein 2 packs, honeysuckle 2 packs, Platycladus oris leaves 2 packs, after each treatment of Chinese herbal medicine will be decocted or boiled water flushing, water temperature appropriate time to clean the affected area, each time 10 minutes, morning and evening once a day.
4. The two groups were assessed by scoring method before treatment, after each treatment and at follow-up according to the changes in the state of the disease.
5. Data were processed by statistical software spssl 2.0. The result of disease score was tested by t test, and the total effective rate was tested by X2 test.
Result
1. curative effect assessment
(1) There was no significant difference between the two groups before photodynamic therapy (X2 = 0.15, P 0.1). After one treatment (X2 = 1.31, P 0.1), two treatments (X2 = 0.21, P 0.1) and three treatments (X2 = 2.10, P 0.1), there was no significant difference in acne lesion area and severity index scores.
(2) After 4 times of treatment, the acne lesion area and severity index score of the patients who used Chinese herbal wash were significantly lower than those who did not use Chinese herbal wash (X2 = 3.15, P 0.05).
(3) The total effective rate was 9.1% after 2 weeks, 45.5% after 4 weeks, 66.7% after 6 weeks and 100% after 8 weeks. The total effective rate of photodynamic group was 15.8%, 31.6%, 41.7% and 91.7% at 2, 4, 6 and 8 weeks, respectively.
2. ADR evaluation
(1) Erythema (84.5%), swelling and pain (53.5%), desquamation (78.9%), reactive acne (69.0%), pigmentation (11.3%), facial itching (7.0%) and other symptoms were found in the Chinese medicine combined with photodynamic therapy group; erythema (95.2%), swelling and pain (69.4%), desquamation (91.9%), reactive acne (75.8%), pigmentation (30.6%) and facial pruritus (9.7%) were found in the photodynamic therapy group. There was no significant difference in the incidence of erythema, swelling and pain, scaling, reactive acne and facial pruritus between the two groups (P 0.05). However, there was a significant difference in the incidence of pigmentation between the two groups (P 0.05).
(2) In adverse reactions, the duration of erythema onset was significantly different between the two groups (X2 = 4.27, P 0.05); the duration of swelling and pain onset was significantly different between the two groups (X2 = 9.54, P 0.01); the duration of desquamation onset was significantly different between the two groups (X2 = 4.37, P 0.05); Time: There was a very significant difference between the two groups (X2 = 8.13, P 0.01); duration after the occurrence of color sedimentation: there was a very significant difference between the two groups (X2 = 9.69, P 0.01); duration after the occurrence of facial pruritus: there was no significant difference between the two groups (X2 = 1.27, P 0.1).
conclusion
(1) using traditional Chinese medicine combined with photodynamic therapy to treat acne can relieve the clinical symptoms better after 1 to 3 times.
(2) The score of acne lesion area and severity index of the two groups after 4 times of treatment was better than that of the photodynamic therapy group (P 0.05). It showed that after 4 times of treatment, the area of facial acne lesion and the severity of acne could be reduced quickly.
There was no significant difference in the total effective rate between the two groups (P 0.05).
(4) In the treatment, the incidence of adverse reactions was lower in the treatment group than in the photodynamic treatment group. There was no significant difference in the incidence of erythema, swelling and pain, scaling, reactive acne and facial itching between the two groups (P 0.05), but the incidence of pigmentation was significantly different between the two groups (P 0.05). Adverse reactions such as erythema, swelling and pain, peeling, reactive acne, color sedimentation duration, Chinese herbal wash combined with photodynamic treatment group was less than photodynamic treatment group (P 0.05), indicating that Chinese herbal wash has no obvious effect in reducing the incidence of adverse reactions, but can effectively reduce the duration of most adverse reactions.
【学位授予单位】：湖北中医药大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R758.733

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