玫瑰痤疮的临床特点及中医辨证分型研究

发布时间：2018-08-30 16:37

【摘要】：目的:通过对玫瑰痤疮患者的临床资料及中医证候资料进行分析,探讨玫瑰痤疮的临床特点、危险因素、中医病因病机及证型分布特点,以提高对该疾病的整体认识,为中医辨证施治提供新的思路,为临床规范化研究提供客观依据。方法:本研究采用专人一对一问卷调查的方式,181例患者均来自2016年4月-2017年1月就诊于江苏省中医院皮肤科的玫瑰痤疮患者,符合本研究的纳入标准,不符合排除标准,并以性别、年龄1:1设置对照组,将所有采集的信息录入excel建立数据库,运用SPSS20.0软件进行相关统计学分析。运用单因素及多因素logistic回归分析该病的危险因素,系统聚类法及因子分析法归纳出该病的主要致病因素及证型分类。结果:1.一般情况:181例患者中,男33例,女148例,男女比1:4.48,平均年龄36.17±11.294岁,20-50岁为该病的高发年龄;病程3天-25年,平均2.49±3.57年,女性病程低于男性。2.诊疗现状:150例有既往诊疗史的病人中,40例(22.1%)表示治疗无效,11例(6.1%)表示治疗后症状加重,可疑误诊率高达34%;既往诊疗过程中,系统治疗以口服抗生素(64.7%)、中药汤剂(56.9%)、抗组胺药(19.9%)为主,局部治疗以激素(44.9%)、钙调磷酸酶抑制剂(33.7%)为主。3.临床特点:临床分型以红斑毛细血管扩张型(ETR)及丘疹脓疱型(PPR)最为多见,分别占57.5%及33.7%;以阵发性潮红(88.4%)、持久性红斑(86.2%)、毛细血管扩张(82.3%)为常见皮损表现,双颊(83.4%)、鼻部(68.0%)、口周(66.3%)为最常累及部位,女性患者双颊、口周、额部受累频率明显高于男性;干燥(68.4%)、瘙痒(66.7%)、灼热(64.2%)为三大主要自觉症状;高温高热、食辛辣刺激食物、日晒、情绪波动是该病最常见的诱发、加重因素。ETR在阵发性潮红、面部皮肤干燥方面的严重程度高于PPR,PPR在持久性红斑、丘疹脓疱、灼热和/或刺痛感、肿胀、肥大增生性改变方面严重程度高于ETR。4.危险因素:单因素logistic回归分析显示:嗜食辛辣刺激食物、消化系统不适症状、性格急躁易怒、防晒与玫瑰痤疮发病相关,P值均0.05,将这些因素进行共线性诊断后纳入多因素条件logistic回归分析,得出嗜食辛辣刺激食物、性格急躁易怒是玫瑰痤疮发病的危险因素(OR1),防晒是发病的保护因素(OR1)。5.中医病因病机及证型分布:运用因子分析得出痰、湿、热、瘀为该病的主要致病因素;聚类分析结果显示:肺胃热盛证、脾胃湿热证、痰湿凝滞证、气滞血瘀证、肝郁化火证是临床常见证型。结论:玫瑰痤疮好发于中年女性,常伴有面部不适症状,应加强对该病的认识,临床需与激素依赖性皮炎、过敏性皮炎、脂溢性皮炎等加以鉴别。嗜食辛辣刺激食物、性格急躁易怒为该病的危险因素,防晒为该病的保护因素。痰、湿、热、瘀为该病的主要病理因素,病位涉及肺、脾、肝,痰湿在发病过程中起到了重要的作用。
[Abstract]:Objective: to explore the clinical characteristics, risk factors, etiology and pathogenesis of roseacne and the distribution of syndromes by analyzing the clinical data and TCM syndromes of patients with roseacne, in order to improve the overall understanding of the disease. To provide new ideas for TCM syndrome differentiation and treatment, and to provide objective basis for clinical standardized research. Methods: in this study, 181 patients with roseacne from April 2016 to January 2017 in the Department of Dermatology of Jiangsu Provincial traditional Chinese Medicine Hospital were investigated by a one-to-one questionnaire, which met the inclusion criteria of this study and did not meet the exclusion criteria. The control group was set up at 1:1 by sex and age, and all the collected information was input into excel to establish the database, and the related statistical analysis was carried out by SPSS20.0 software. By using univariate and multivariate logistic regression analysis, the main pathogenic factors and syndromes classification of the disease were summarized by systematic clustering and factor analysis. The result is 1: 1. There were 33 males and 148 females with a male to female ratio of 1: 4.48, with an average age of 36.17 卤11.294 years or 20-50 years old. The course of disease was from 3 days to 25 years with an average of 2.49 卤3.57 years, and the course of disease of female was lower than that of male. Of the 150 patients with a history of previous diagnosis and treatment, 40 (22.1%) indicated that treatment was ineffective, 11 (6.1%) indicated that symptoms had worsened after treatment, and the rate of suspected misdiagnosis was as high as 34%; in the course of past diagnosis and treatment, Oral antibiotics (64.7%), traditional Chinese medicine decoction (56.9%), antihistamines (19.9%) were used as systemic therapy, hormone (44.9%) and calcium modulation phosphatase inhibitor (33.7%). Clinical features: erythema capillary dilated (ETR) and papular pustular (PPR) were the most common clinical types, accounting for 57.5% and 33.7%, respectively, with paroxysmal flashes (88.4%), persistent erythema (86.2%), capillary dilatation (82.3%). Buccal (83.4%), nasal (68.0%), perioral (66.3%) were the most frequently involved sites. The frequency of buccal, perioral and frontal involvement in female patients was significantly higher than that in men, while dryness (68.4%), pruritus (66.7%) and burning heat (64.2%) were the three major symptoms. Emotional fluctuation is the most common cause of the disease. The severity of ETR in paroxysmal flushing, facial dryness is higher than that of PPR,PPR in persistent erythema, papules, burning and / or tingling, swelling. The severity of hypertrophic changes is higher than that of ETR.4.. Risk factors: univariate logistic regression analysis showed that eating spicy food, digestive system discomfort, irritability, irritability and irritability, The relative P values of sunscreen and rose-acne were 0.05. After co-linear diagnosis, these factors were analyzed by multivariate conditional logistic regression analysis. Irritability and irritability are risk factors (OR1) and sunscreen is the protective factor (OR1). The main pathogenic factors of the disease were phlegm, dampness, heat and blood stasis. Cluster analysis showed that: lung and stomach heat syndrome, spleen and stomach dampness heat syndrome, phlegm dampness stagnation syndrome, qi stagnation and blood stasis syndrome, Liver depression and fire syndrome is a common clinical syndrome type. Conclusion: rose-acne is common in middle-aged women and often accompanied with facial symptoms. It is necessary to recognize the disease and differentiate it from hormone dependent dermatitis, allergic dermatitis and seborrheic dermatitis. Irritability and irritability were the risk factors of the disease, and sun protection was the protective factor. Phlegm, dampness, heat and blood stasis are the main pathological factors of the disease. The location of the disease involves the lung, spleen, liver and phlegm dampness, which plays an important role in the pathogenesis of the disease.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R275.9

【相似文献】