中西医对色素性紫癜性皮病的探讨及导师临床经验总结

发布时间：2018-01-19 19:11

本文关键词： 色素性紫癜性皮病血热血瘀虚中医辨证　出处：《北京中医药大学》2014年硕士论文　论文类型：学位论文

【摘要】：色素性紫癜性皮病(Pigmentary purpuric dermatosis, PPD)是一组紫癜性皮肤病,主要包括进行性色素性紫癜皮病(progressive pigmented purpuric dermatosis)、色素性紫癜性苔藓样皮病(pigmented purpuric lichenoid dermatosis)以及毛细血管扩张性环状紫癜(purpura annularis telangiectosis)。临床一般无自觉症状,部分患者伴瘙痒,皮损以下肢多发性细小紫癜样皮疹及色素沉着为典型特点,本病可发生于任何年龄段。这些疾病关系密切,临床形态及组织病理相似,大部分病例为慢性经过,皮损常持续存在,可自行消退,但常复发。临床观察发现,近年来PPD发病率有所升高,就诊患者增多,因其皮损多发于下肢等暴露部位,皮损消退缓慢,反复发作,部分患者可伴皮肤明显痒痛及下肢肿胀,影响患者身心健康及生活质量。本病临床诊断相对容易,但尚无特效治疗方法,其病因及治疗仍存在争议。中医辨证治疗PPD存在一定优势。目的：通过对就诊的PPD患者进行临床信息采集,分析总结其发病的男女比例,职业类型,发病诱因,病程分布情况,初发年龄,初发部位,疾病分型分期与PPD发病的相关性,对纳入研究的PPD患者进行中医辨证治疗,探讨中医辨证治疗PPD的临床疗效。方法：通过文献查阅,制定PPD临床资料表,采用临床观察的方法,对符合PPD纳入标准及排除标准的24例患者进行病例收集,所有入组患者均采用中医辨证治疗,观察3个疗程(以4周为1个疗程)。收集、整理相关信息并录入Excel,用Excel、 SPSS19.0软件进行数据分析。结果：纳入的PPD男性9例,女性15例,男女比例为3:5。1.初发年龄从24岁至78岁不等,平均初发年龄为52.667±13.419,其中：20-29岁1例,30-39岁2例,40-49岁6例,50-59岁9例,60-69岁2例,70-79岁4例。男性平均初发年龄：56.222±14.298,女性平均初发年龄：50.533±12.883。2.24例PPD患者病程从1月至9年不等,平均病程为20.958±24.275月,男性平均病程：9.667±10.368月,女性平均病程：27.733±27.848月,其中就诊患者病程在1年之内者15例,占62.50%。3.24例PPD患者中文职人员13例,占51.47%；退休人员3例,占12.50%;司机、售货员、厨师各2例,各占8.33%；农民及保姆各1例,各占4.17%。从事长期坐立及站立工作的患者,多发本病。4.有明确诱因者3例,蚊虫叮咬后1例,磕伤后1例,口服温热性质中药1例。基础疾病：下肢静脉曲张6例,原发性高血压6例,糖尿病4例,冠心病2例,甲亢1例,银屑病1例,慢性支气管炎1例,贫血1例。其中1例患者有家族史。5.患者皮损初发部位存在差异,其中上肢1例,占4.17%；膝盖周围2例,占8.33%；足踝部6例,占25.00%；小腿部15例,占62.50%。发病部位：小腿足踝膝盖上肢,可见PPD好发于下肢部位。6.24例PPD患者中,7例为进行性色素性紫癜性皮病患者,其中5例为急性期,2例为慢性期；17例色素性紫癜性苔藓样皮病患者中,6例为急性期,11例为慢性期。7.PPD中医证型分布：血热妄行10例,占41.67%；血瘀阻络9例,占37.50%；气血亏虚5例,占20.83%,血热妄行证血瘀阻络证气血亏虚证。8.24例PPD患者经中医辨证治疗3个疗程,痊愈5例,占20.83%;显效12例,占50%；有效4例,占16.67%；无效3例,占12.50%；总显愈率70.83%,总有效率87.50%。其中,血热妄行证显愈率70.00%,有效率90.00%；血瘀阻络证显愈77.78%,有效率88.89%；气血亏虚证显愈率60.00%,有效率80.00%;总有效率：血热妄行证血瘀阻络证气血亏虚证。结论：PPD好发于中老年；PPD起病隐匿；因工作需要长期坐位或站立者本病多发；PPD初发部位以下肢为主,尤以小腿及足踝部为著。PPD证型分布以血热妄行最多(41.67%),血瘀阻络次之(37.50%),总有效率：血热妄行证血瘀阻络证气血亏虚证；中医中药辨证治疗PPD显愈率70.83%,总有效率87.50%,疗效显著,副作用小,临床值得推广。
[Abstract]:Pigmented purpuric purpura ( PPD ) is a group of purpuric dermatosis , mainly including progressive purpuric purpura , pigmented purpuric purpura oid and capillary dilatational ring purpura . Clinical observation shows that the incidence of PPD in the lower extremities is similar , and most of the cases are chronic , the lesions often persist . Most of the cases are chronic , the lesions often persist , and some patients have obvious itch pain and swelling of the lower limbs . The clinical diagnosis of the disease is relatively easy . However , there is still a dispute between the etiology and treatment of the patients . Objective : To collect and analyze the clinical information of PPD patients and summarize the relationship between the incidence of the disease , the type of occupation , the cause of disease , the distribution of disease course , the primary age , the primary site , the stage of disease typing and PPD , the PPD patients who were included in the study were treated with TCM syndrome differentiation , and the clinical curative effect of PPD in TCM syndrome differentiation was discussed . Methods : According to the clinical data of PPD , the PPD clinical data table was established , and 24 patients who met PPD in standard and exclusion criteria were collected . All enrolled patients were treated with TCM syndrome differentiation , 3 courses of treatment were observed ( 4 weeks as one treatment course ) . Data were collected , collated and entered into Excel , and the data were analyzed by Excel and SPSS 10.0 software . Results : There were 9 cases of PPD male , 15 female and 3 : 5.1 for male and female . The average age was 52.667 卤 13.419 . Among them , there were 1 case , 30 - 39 years old , 2 cases 40 - 49 years old , 1 case aged between 50 - 59 years old , 1 case aged 60 - 69 years old and 70 - 79 years old . Among them , there were 6 cases of primary hypertension , 6 cases of primary hypertension , 4 cases of diabetes , 2 cases of coronary heart disease , 1 case of hyperthyroidism , 1 case of psoriasis and 1 case of chronic bronchitis . There were 1 case of anemia . Among them , 1 patient had family history . 5 . There was a difference in the primary lesion of skin lesion of the patients . Among them , 6 cases were acute phase , 2 cases were chronic phase , 7 cases were progressive pigmented purpura patients . The effective rate is 88.89 % ; the apparent recovery rate of qi and blood deficiency syndrome is 60.00 % , the effective rate is 80.00 % ; the total effective rate is : the blood heat and blood stasis obstructing the blood stasis obstructing the syndrome of qi and blood deficiency syndrome . Conclusion : PPD is good for middle - aged and old - aged people ; PPD is hidden in the disease . The PPD syndrome is mainly composed of lower limbs and lower limbs , especially the lower limbs and ankle parts . PPD syndrome differentiation is the most important ( 37.50 % ) . The total effective rate is 87.50 % , the curative effect is obvious , the side effect is small , and the clinical value is worthy of popularization .

【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】：2014
【分类号】：R275.9

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