清热除湿解毒法治疗痤疮湿热证及对皮肤生理指标和主要致病菌影响

发布时间：2018-01-03 18:42

本文关键词：清热除湿解毒法治疗痤疮湿热证及对皮肤生理指标和主要致病菌影响　出处：《北京中医药大学》2016年博士论文　论文类型：学位论文

【摘要】：背景痤疮是皮肤科常见病,发病率高,涉及青春期前后各年龄阶段。本病常反复发作,临床实践证明,中药复方能够全面调整身体机能,从而取得良好的效果。以清热除湿汤为代表的清热除湿解毒类中药常用于治疗急性湿热性皮肤病。不同疾病在其发展过程中可以出现相同的证,即可采取“异病同治"的方法。对于湿热型痤疮的治疗,也是根据证的表现,而应用清热除湿汤治疗,临床取得较好的疗效。痤疮的病因复杂,发病机制涉及遗传、免疫、内分泌、微生物感染、毛囊皮脂腺导管角化等多方面因素。目前尚缺乏中医药治疗在皮肤屏障功能修复以及皮肤生理指标改善方面的研究。本研究基于清热除湿解毒类中药对湿热型痤疮的治疗探索中医药在改善皮肤微环境方面的作用。目的(1)观察痤疮患者皮损和中医证候的改善情况,客观性评价清热除湿解毒类中药治疗湿热型痤疮的临床疗效,为指导临床规范化辨证分型治疗,推广应用奠定基础。(2)结合痤疮患者皮肤生理指标的检测结果及对痤疮主要致病菌的抑制研究,为清热除湿解毒类中药治疗痤疮及预后评估提供数据支持。方法(1)临床疗效及安全性评价本研究采用随机、对照的试验设计,评价清热除湿汤对于痤疮湿热证的临床疗效。以2：1比例随机纳入72例湿热型痤疮患者,试验组48例,给予清热除湿汤治疗,对照组24例,给予丹参酮胶囊治疗。疗程4周。观察痤疮皮损和临床综合证候的改善情况评定疗效,记录不良反应发生情况,进行安全性评价。(2)皮肤生理指标测定应用VISIA面部图像分析系统和SOFT5.5皮肤检测仪测定受试者面部红色区、棕色斑、毛孔、紫质和皮肤水分含量、皮肤油脂、PH数值,以治疗前后和每次复诊时作为检测时点,从不同时间节点皮肤生理指标的检测数据,动态反映皮肤屏障功能的修复情况,以客观数据资料为依据说明中药对于不同皮肤生理指标所起到的调节作用,最终对皮肤表面微环境的改善产生的影响,揭示特定皮肤生理指标改善与中药治疗的相关性。(3)中药抑菌研究痤疮患者毛囊、皮脂腺中存在多种微生物,抑制其生长可以使痤疮病情得到缓解。本试验将痤疮丙酸杆菌标准菌株进行进一步传代培养,进行体外抑菌试验研究,以不同浓度的清热除湿汤为试验药物,为临床应用提供实验室依据。结果(1)临床疗效及安全性评价结果清热除湿汤治疗湿热型痤疮患者,临床痊愈16.28%,显效30.23%,有效39.53%,无效13.95%,愈显率(痊愈+显效)为46.51%,总有效率(痊愈+显效+有效)为86.04%。对照组丹参酮胶囊治疗寻常痤疮患者,临床痊愈9.52%,显效19.05%,有效28.57%,无效42.86%,愈显率为28.57%,总有效率为57.14%。试验组的皮损消退率为62.86%,综合证候疗效率为62.41%,优于对照组,具有统计学意义,说明清热除湿汤对改善皮损和中医临床证候方面优于对照组。对两组受试患者疗前、疗后进行安全性实验室检查,经观察试验组中5例患者血肌酐、尿素氮略低于正常。对照组中3例患者出现尿素氮偏低,4例出现尿白细胞±,但无尿频尿急尿痛等不适。试验组中4例患者服药后出现轻度胃肠道反应、对照组中有1例患者,均以胃脘不适及轻度腹泻为主,调整用药方式后即缓解。(2)皮肤生理指标测定结果治疗后试验组的红色区和棕色斑分值较对照组减少,具有统计学意义,研究结果显示,清热解毒除湿类中药有较好的改善皮肤炎症和皮肤棕色斑的作用,其疗效优于对照组。治疗前后紫质和毛孔的分值减少无统计学意义,说明两组药物在改善紫质和毛孔方面效果不明显。治疗后试验组皮肤油脂含量为18.74±10.263,较对照组(23.90±12.498)数值减少,虽不具有统计学意义,但说明清热解毒除湿类中药在改善皮肤油脂含量方面有一定优势。治疗结束后,两组痤疮患者的皮肤水分含量和PH数值对比显示无显著性差异(P0.05),说明两组药物在改善皮肤水分和PH值方面疗效相当。(3)中药抑菌研究结果采用试管稀释法进行清热除湿汤对痤疮丙酸杆菌的抑菌试验研究。将P.acne标准株进行转种培养后,中药倍比稀释后进行抑菌作用的研究。经72h厌氧培养后,各试管中的中药从1：2进行倍比稀释,在药物浓度为500mg/ml时可见细菌生长,即清热除湿汤的最小抑菌浓度为500mg/ml。在同体积相同实验条件下进行定量接种,结果显示清热除湿汤对痤疮丙酸杆菌有抑制作用,菌落计数为1500CFU/ml。结论(1)清热除湿汤治疗湿热型痤疮有较好效果,在改善皮损情况和综合证候方面疗效优于对照组,值得临床推广应用。(2)清热除湿汤在改善痤疮患者的皮肤水分、油脂、红色区、棕色斑方面有一定作用。提示我们在临床诊疗过程中,要注意皮肤屏障的保护和修复从而达到治疗痤疮的目的。(3)清热除湿汤在浓度为500mg/ml时可见细菌生长,说明试验药物对痤疮丙酸杆菌有一定抑制作用,但与以往文献报道的相关中药比较,其抑菌作用偏弱。在进一步定量接种实验中显示,清热除湿汤对痤疮丙酸杆菌具有明确的抑制作用,菌落计数为1500CFU/ml,明显少于对照管中的细菌数量。此种情况可能与药物的整体调节作用有关,而对于皮肤表面的致病菌,单纯应用内服药物只能起到一定的抑制作用。
[Abstract]:Background: acne vulgaris is a common disease in Department of Dermatology, the incidence rate is high, the age of puberty involved. The disease often repeated attacks, clinical practice has proved that the medicine can fully adjust the body function, so as to achieve good results. Qingrechushi detoxifying herbs in qingrechushi Tang on the commonly used in the treatment of acute exudative skin disease. The disease can appear the same card in its development process, can take "different diseases". For the treatment of damp heat type acne, but also according to the certificate of performance, and the application of qingrechushi decoction has a better clinical curative effect. The cause of acne pathogenesis is complex, involving genetic, immune, endocrine, microbial infection many factors, such as keratinized pilosebaceous duct. There is still a lack of treatment of traditional Chinese medicine research in the repair of skin barrier function and skin physiology index based on the improved. The treatment of Chinese traditional medicine on detoxification of heat and dampness heat type acne to explore Chinese medicine to improve the skin micro environment to effect. (1) observed in patients with acne lesions and TCM syndromes, clinical efficacy evaluation objectivity qingrechushi antidotal traditional Chinese medicine for treating damp heat type acne, for guiding clinical standardization of syndrome differentiation treatment, laid the foundation of application. (2) study on inhibiting the binding of test results in patients with acne and acne skin physiological index of main pathogenic bacteria, to provide data support for the evaluation of qingrechushi detoxifying herbs for the treatment of acne and prognosis. Methods (1) the clinical efficacy and safety evaluation of the randomized, controlled clinical trial design. Evaluation of curative effect of Qingre Chushi Decoction for acne of damp heat syndrome. 2:1 were randomly enrolled 72 patients with damp heat syndrome of acne patients, 48 cases of experimental group, given qingrechushi decoction, 24 cases in the control group, to To Danshentong Capsules for treatment. The treatment course of 4 weeks. The improvement of curative effect observation of acne lesions and clinical syndromes, record the occurrence of adverse reactions, the safety evaluation was carried out. (2) the determination of test subjects face red zone, the application of VISIA facial image analysis instrument detection system and SOFT5.5 skin physiological index of skin brown spots, pores numerical and skin moisture content, porphyrin, skin oils, PH, before and after the treatment and at every visit as the detection point, from the test data of different time node skin physiology index, reflecting the dynamic skin barrier repair, with objective data illustrate the regulatory effect of traditional Chinese medicine for different skin physiological indexes play finally, effects of the skin surface micro environment produced by correlation to reveal the specific physiological indexes of skin and traditional Chinese medicine treatment. (3) traditional Chinese medicine antibacterial research of acne hair follicle There are a variety of microorganisms, sebaceous glands, can inhibit the growth of the acne remission. The standard of Propionibacterium acnes strains were further subcultured to study the antibacterial test in vitro, with different concentrations of Qingre Chushi Decoction for drug testing, and provide laboratory evidence for the clinical application. Results (1) the results of clinical evaluation safety and qingrechushi Decoction in the treatment of damp heat type acne patients, 16.28% cured, 30.23% markedly effective, 39.53% effective, 13.95% ineffective, markedly effective rate (cure + markedly) was 46.51%, the total effective (cure and significant effect and effective) to 86.04%. control group Danshentong Capsules in the treatment of acne vulgaris, 9.52% cured, 19.05% markedly effective 28.57%, invalid 42.86%, the effective rate was 28.57%, the total efficiency of 57.14%. lesions in experimental group, remission rate was 62.86%, syndrome treatment efficiency of 62.41%, better than the control group, with statistical significance, That qingrechushi Decoction to improve the skin lesions and TCM syndrome than the control group. The two groups of patients before treatment, after treatment for safety of laboratory examination, the observation group in 5 cases of patients with serum creatinine, urea nitrogen is slightly lower than the normal control group. 3 cases had low blood urea nitrogen, 4 cases there were white blood cell, but no frequent micturition discomfort. Mild gastrointestinal reaction occurred in the experimental group of 4 patients after treatment, 1 patients in the control group, both with epigastric discomfort and mild diarrhea, adjust medication after remission. (2) the skin physiological index determination results after treatment the test group of red and brown spot area score decreased than the control group, with statistical significance, the results of the study show that Chinese medicine has Qingrejiedu dehumidification can improve skin inflammation and skin brown spot, its effect is better than the control group before and after treatment. The pores and porphyrin. The scores decrease was not statistically significant, indicating that two groups of drugs is not obvious in improving the effect of porphyrins and pores. The experimental group after treatment of skin fat content is 18.74 + 10.263, compared with the control group (23.90 + 12.498) values to reduce, although not statistically significant, but that detoxification has certain advantages in traditional Chinese medicine in improving wet the skin grease content. After the end of treatment, the skin moisture content and PH value were compared between the two groups of acne patients showed no significant difference (P0.05), two groups of drugs in improving skin moisture and pH effect. (3) Chinese medicine inhibitory results by test tube dilution method was used to study the bacteriostatic test of Qingre Chushi Decoction on acne Propionibacterium. P.acne standard strains to culture, traditional Chinese medicine research dilution after inhibition by 72h. Anaerobic culture, traditional Chinese medicine in vitro from 1:2 were diluted in. The drug concentration for visible growth of bacteria 500mg/ml, the minimal inhibitory concentration of Qingre Chushi Decoction for 500mg/ml. in the same volume under the same experimental conditions for quantitative inoculation, results showed that qingrechushi decoction can inhibit the Propionibacterium acnes, colony count of 1500CFU/ml. (1) conclusion qingrechushi Decoction in the treatment of damp heat type acne has good effects in improving skin lesions and syndromes has better effect than the control group, it is worthy of clinical application. (2) qingrechushi Decoction in improving skin moisture, acne oil, red, brown spots have a certain effect. We suggest that in the process of clinical practice, pay attention to the protection and repair of the skin barrier to the treatment of acne. (3) qingrechushi Decoction in the concentration of visible growth of bacteria 500mg/ml, indicating the experimental drug has inhibitory effect on Propionibacterium acnes, but with previous report Comparison of the antimicrobial effect of traditional Chinese medicine, weak. Shown in further quantitative inoculation experiments, qingrechushi decoction has marked inhibitory effects on Propionibacterium acnes, colony count was 1500CFU/ml, significantly less than the number of bacteria in such a situation. Take care of drugs may be related to the whole regulation function, and the pathogenic bacteria on the skin surface, simple the application of oral drugs can play a certain effect.

【学位授予单位】：北京中医药大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R275.9

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