散发型白癜风的中医证型临床分析

发布时间：2018-05-02 05:59

  本文选题：散发型白癜风 + 中医证型　； 参考：《大连医科大学》2016年硕士论文

【摘要】：目的:探讨散发型白癜风的中医辨证分型的分布及特点,分析本病与不同发病年龄、临床分期和病程的关系,以指导本病的中医辨证和临床用药。方法:收集108例于2015年1月至2015年12月期间在我科门诊就诊诊断为散发型白癜风患者资料,填写统一调查表,根据中国中西医结合学会皮肤性病专业委员会色素病学组2009年制定的白癜风治疗共识将患者证型分为风湿郁热证、肝郁气滞证、肝肾不足证和瘀血阻络证、脾胃虚弱证五证,将辩证不明确归为不明确证型组。统计分析108例散发型白癜风患者中医辨证分型及其与发病年龄、病程、临床分期的关系。结果:1.中医证型:108例中风湿郁热型20例(18.5%),肝肾不足型26例(24.1%),肝郁气滞型26例(24.1%),脾胃虚弱型18例(16.4%),瘀血阻络型4例(3.6%),不明确型14例(12.7%)。2.不同年龄阶段的中医证型总体上有差异(P0.05);16-35岁年龄组发病人数最多,占50%;16岁年龄组以脾胃虚弱型为主,占32.1%;16-35岁以肝肾不足型为主,占29.6%;35岁以肝郁气滞型为主,占42.3%。(P0.05)3.稳定期患者比例多于进展期,分别是65例(60.2%)、43例(39.8%),不同分期的中医证型有差异(P0.05)。进展期患者风湿郁热型占有较高的比例,为28.9%,而稳定期白癜风以肝肾不足型为主,占30.8%,提示肝肾不足型患者稳定期多于进展期(PO.05);进展期以风湿郁热型为主,比例占30.2%,提示进展期风湿郁热型较多(PO.05)。有统计学意义(PO.05)。4.病程在1年以下以风湿郁热、肝肾不足型为主,所占比例23.4%、25%,病程1年以上以肝郁气滞型为主,占34.1%,有统计学意义(P0.05);病程按≤1年、1年组统计,各中医证型比例发生变化,风湿郁热型患者比例减少,分别为23.4%、11.45,肝郁气滞型比例升高,分别为17.2%、22.3%(P0.05);肝肾不足型在病程≤1年、1年比重都较高,分别为25%、22.7%(P0.05);不确定型在≤1年多于1年组,分别为15.6%、9%。结论:散发型白癜风患者在不同年龄、临床分期和病程的中医证型存在差异性,具有一定规律性,治疗上需辩证后个体化治疗,具体如下:1.表明散发型白癜风以肝肾不足型、肝郁气滞型为主要证型。2.发病年龄而言,总体在疏风除湿基础上,儿童患者脾胃虚弱型较多,应加强补益脾肺、益气固表;青年人应注重补益肝肾;中年侧重疏肝理气,情绪疏导。3.在临床分期上,进展期应以祛风散湿、调和气血为要,稳定期宜以补益肝肾、调和气血为主,而疏肝解郁、活血化瘀应兼顾之。4.在病程上,病程较短的,治疗当注重调和气血、疏风散湿;病程长者当侧重疏肝解郁、活血祛风,并加以必要的心理辅导治疗,调节情志;滋补肝肾应当贯穿病程始终。
[Abstract]:Objective: to investigate the distribution and characteristics of TCM syndrome differentiation and classification of sporadic vitiligo, and to analyze the relationship between the disease and its onset age, clinical stage and course of disease, so as to guide the TCM syndrome differentiation and clinical medication of this disease. Methods: 108 patients with sporadic vitiligo were collected from January 2015 to December 2015. According to the consensus on vitiligo treatment made by the pigmentology group of the Committee on Dermatology and venereal Diseases of the Chinese Society of Integrated Chinese and Western Medicine in 2009, the patients' syndrome types were divided into rheumatism and stagnation of heat syndrome, liver stagnation and qi stagnation syndrome, liver and kidney deficiency syndrome and blood stasis blocking collaterals syndrome, spleen and stomach weakness syndrome five syndromes. The dialectical ambiguity is classified as the ambiguous syndrome group. The relationship between TCM syndrome differentiation and onset age, course of disease and clinical stage of 108 patients with sporadic vitiligo was analyzed statistically. The result is 1: 1. Among 108 cases of TCM syndromes, 20 cases with rheumatism and stagnation and heat type, 26 cases with deficiency of liver and kidney, 26 cases with liver and kidney deficiency, 26 cases with liver stagnation and qi stagnation, 18 cases with spleen and stomach weakness, 4 cases with blood stasis and collaterals obstruction, 4 cases with dampness and collaterals, 14 cases with unclear type. There were different TCM syndromes in different age groups. The number of patients in the age group of 16 years old was the most, and the main type was deficiency of spleen and stomach, the type of deficiency of liver and kidney in 32.1 cases, the type of stagnation of qi in the liver of 29.60.35 years old, and the proportion of 42.3.P0.05t3 in the age group of 50 years old and the age group of 16 years old was mainly deficiency of the spleen and stomach, and the deficiency of liver and kidney was the main type in the age group of 32.1 ~ 35 years old. The proportion of stable stage patients was more than that of advanced stage, which were 65 cases (60.2%) and 43 cases (39.8%). There were differences in different stages of TCM syndrome types (P 0.05). The proportion of progressive patients with rheumatism, stagnation and heat was 28.9, while the stable vitiligo was characterized by deficiency of liver and kidney (30.8%), suggesting that the stable stage of liver-kidney deficiency was more than that of advanced stage (P < 0.05), and the advanced stage of vitiligo was mainly rheumatism, stagnation and heat. The proportion was 30.2%, indicating that the type of rheumatism, stagnation and heat was more than PO. 05. There is statistical significance of PO.05. 4. The course of disease was less than one year with rheumatism, stagnation and heat, deficiency of liver and kidney, the proportion of which was 23.40.25%, the course of disease was mainly characterized by stagnation of liver-qi (34.1g), there was statistical significance (P0.05N) in the course of disease, according to the statistics of 鈮，

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