凉血活血汤联合走罐疗法治疗斑块型银屑病的疗效观察
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摘要
目的:研究凉血活血汤联合走罐疗法治疗斑块型银屑病的疗效。方法:选取2015年7月至2017年10月来杭州市第三人民医院门诊及住院的138例斑块型银屑病患者,随机数字表法分为治疗组(69例)和对照组(69例),治疗组患者给予凉血活血汤联合走罐疗法治疗,对照组患者仅给予凉血活血汤治疗,连续治疗8周并随访6个月,观察两组患者临床疗效、中医证候积分、银屑病皮损面积及严重程度指数(PASI评分)、皮肤CT的变化情况、安全性及复发情况。结果:两组患者临床疗效存在差异(Z=-2.045,P=0.041),治疗组有效率显著高于对照组(98.55%和79.71%,χ~2=12.641,P=0.000);治疗后4周、6周、8周两组患者中医症候积分均显著降低,且治疗组患者中医症候积分显著低于对照组,差异具有统计学意义(P<0.05);治疗后两组患者PASI评分均显著降低,且治疗组患者PASI评分显著低于对照组,差异具有统计学意义(P<0.05);治疗后两组患者棘层厚度和乳头环宽度均显著减小,且治疗组显著低于对照组,差异具有统计学意义(P<0.05);治疗前后三大常规、凝血功能、小生化等检查均未见明显异常;治疗组复发率显著低于对照组(3.23%和25.81%,χ~2=4.679,P=0.031)。结论:凉血活血汤联合走罐疗法治疗斑块型银屑病能显著提高临床疗效,改善患者棘层厚度以及乳头环宽度,减少患者复发率,且具有较高的安全性,值得临床推广。
AIM: To study the curative effect of Liangxuehuoxue Decoction combined with cupping therapy on plaque psoriasis. METHODS:138 patients with plaque psoriasis from July 2015 to October 2017 in the Hangzhou Third People's Hospital were randomly divided into treatment group(69 cases) and control group(69 cases) by random number table method. Patients in the treatment group were treated with Liangxuehuoxue Decoction combined with cupping therapy, while patients in the control group were treated with Liangxuehuoxue Decoction only for 8 weeks and followed up for 6 months. The clinical efficacy, psoriatic lesion area and severity index(PASI score), skin CT changes, safety and recurrence of the two groups were observed. RESULTS:There were significant differences in clinical efficacy between the two groups(Z=-2.045,P=0.041). The effective rate of the treatment group was significantly higher than that of the control group(98.55% vs. 79.71%,χ~2=12.641,P=0.000). After treatment 4 weeks, 6 weeks, 8 weeks, the traditional Chinese medical syndrome scores in the two groups of patients were significantly reduced, and the traditional Chinese medical symptom scores of the treatment group was significantly lower than that of the control group(P<0.05). After treatment, the PASI scores of the two groups were significantly reduced, and the PASI score of the treatment group was significantly lower than that of the control group(P<0.05). After treatment, the thickness of the spinous layer and the width of the nipple ring of the two groups were significantly reduced, and these two indicators in the treatment group were significantly lower than those in the control group(P<0.05). There were no obvious abnormalities in the three routine tests, coagulation function and biochemical examination before and after treatment. The recurrence rate of the treatment group was significantly lower than that of the control group(3.23% vs. 25.81%, χ~2= 4.679, P=0.031). CONCLUSION:Liangxuehuoxue Decoction combined with cupping therapy can significantly improve the clinical efficacy and has high safety in the treatment of plaque psoriasis. Therefore, this treatment is worthy of clinical promotion.
AIM: To study the curative effect of Liangxuehuoxue Decoction combined with cupping therapy on plaque psoriasis. METHODS:138 patients with plaque psoriasis from July 2015 to October 2017 in the Hangzhou Third People's Hospital were randomly divided into treatment group(69 cases) and control group(69 cases) by random number table method. Patients in the treatment group were treated with Liangxuehuoxue Decoction combined with cupping therapy, while patients in the control group were treated with Liangxuehuoxue Decoction only for 8 weeks and followed up for 6 months. The clinical efficacy, psoriatic lesion area and severity index(PASI score), skin CT changes, safety and recurrence of the two groups were observed. RESULTS:There were significant differences in clinical efficacy between the two groups(Z=-2.045,P=0.041). The effective rate of the treatment group was significantly higher than that of the control group(98.55% vs. 79.71%,χ~2=12.641,P=0.000). After treatment 4 weeks, 6 weeks, 8 weeks, the traditional Chinese medical syndrome scores in the two groups of patients were significantly reduced, and the traditional Chinese medical symptom scores of the treatment group was significantly lower than that of the control group(P<0.05). After treatment, the PASI scores of the two groups were significantly reduced, and the PASI score of the treatment group was significantly lower than that of the control group(P<0.05). After treatment, the thickness of the spinous layer and the width of the nipple ring of the two groups were significantly reduced, and these two indicators in the treatment group were significantly lower than those in the control group(P<0.05). There were no obvious abnormalities in the three routine tests, coagulation function and biochemical examination before and after treatment. The recurrence rate of the treatment group was significantly lower than that of the control group(3.23% vs. 25.81%, χ~2= 4.679, P=0.031). CONCLUSION:Liangxuehuoxue Decoction combined with cupping therapy can significantly improve the clinical efficacy and has high safety in the treatment of plaque psoriasis. Therefore, this treatment is worthy of clinical promotion.
引文
[1] 唐艳,梁虹.NB-UVB不同照射方案治疗中重度银屑病疗效比较[J].现代仪器与医疗,2017,23(1):70-72.
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[3] 孙少馨,瞿幸,李玲玲,等.紫草油走罐治疗斑块型银屑病临床研究[J].现代中医临床,2016,23(1):29-32.
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[12] 王倩,李元文,马一兵,等.中药内服联合中药熏蒸疗法治疗寻常性银屑病临床观察[J].实用皮肤病学杂志,2015,8(3):212-215.
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[14] 罗芮,刘智艳,马忠,等.镵针配合拔罐治疗血瘀型寻常型银屑病(静止期)15例临床研究[J].中医杂志,2016,57(15) :1308-1312.
[15] 丰靓,郭菲,吉燕,等.以走罐疗法为主治疗血瘀证斑块状银屑病临床研究[J].中华中医药杂志,2014,29(10):3343-3345.
[16] 李玉柱,张福仁.走罐治疗斑块型银屑病的疗效观察[J].中医药导报,2017,23(12):93-94.
[17] Moscarella E,Argenziano G,Lallas A,et al.Confocal microscopy:a new era in understanding the pathophysiologic background of inflammatory skin diseases [J].Exp Dermatol,2014,23(5):320-321.
[18] Ardigo M,Longo C,Gonzalez S.Multicentre study on inflammatory skin diseases from The International Confocal Working Group:specific confocal microscopy features and an algorithmic method of diagnosis [J].Br J Dermatol,2016,175(2):364-374.
[19] Welzel J.Reflectance confocal microscopy:new micromorphological insights into inflammatory skin diseases [J].Br J Dermatol,2016,175(2):239-240.
[20] Hoogedoorn L,Wolberink EA,Pc VDK,et al.Noninvasive differentiation between stable and unstable chronic plaque psoriasis using in vivo reflectance confocal microscopy[J].J Am Acad Dermatol,2015,73(5):870-872.
[2] 丁佩军,顾志英,徐平,等.清热活血合剂治疗血热型寻常型银屑病临床研究[J].中国中医药信息杂志,2017,24(1):37-40.
[3] 孙少馨,瞿幸,李玲玲,等.紫草油走罐治疗斑块型银屑病临床研究[J].现代中医临床,2016,23(1):29-32.
[4] 中华医学会皮肤性病分会银屑病学组.中国银屑病治疗专家共识(2014版)[J].中华皮肤科杂志,2014,47(3):213-215.
[5] 中华中医药学会皮肤科分会.寻常型银屑病(白疕)中医药循证临床实践指南(2013版)[J].中医杂志,2014,55(1):76-82.
[6] 王颖娟,王娟,曹伟.苦参汤药浴配合 NB-UVB照射治疗寻常型银屑病50例[J].陕西中医,2015,36(7):887-888.
[7] 郑筱萸.中药新药临床研究指导原则(试行)[M].中国医药科技出版社,2002:299-302.
[8] 王上游,金忠,米雄飞.凉血消银方治疗进行期寻常型银屑病(血热证)疗效观察[J].陕西中医,2017,38(10):1449-1450.
[9] 汤自洁,庞晓文,刘芳,等.121例关节病型银屑病皮损和关节损伤特征的临床分析[J].空军医学杂志,2017,33(3):200-203.
[10] 吕萌,沈萃萃,闫玉红.活血化瘀方药或联合其他疗法治疗寻常型银屑病有效性和安全性的Meta分析[J].中药新药与临床药理,2018,29(2):211-216.
[11] 邹建飞.紫外线联合中药疗法治疗寻常性银屑病的临床疗效观察[J].河北医学,2013,19(6):864-866.
[12] 王倩,李元文,马一兵,等.中药内服联合中药熏蒸疗法治疗寻常性银屑病临床观察[J].实用皮肤病学杂志,2015,8(3):212-215.
[13] 张志礼.张志礼皮肤病临床经验辑要[M].北京:中国医药科技出版社,2002:116-117.
[14] 罗芮,刘智艳,马忠,等.镵针配合拔罐治疗血瘀型寻常型银屑病(静止期)15例临床研究[J].中医杂志,2016,57(15) :1308-1312.
[15] 丰靓,郭菲,吉燕,等.以走罐疗法为主治疗血瘀证斑块状银屑病临床研究[J].中华中医药杂志,2014,29(10):3343-3345.
[16] 李玉柱,张福仁.走罐治疗斑块型银屑病的疗效观察[J].中医药导报,2017,23(12):93-94.
[17] Moscarella E,Argenziano G,Lallas A,et al.Confocal microscopy:a new era in understanding the pathophysiologic background of inflammatory skin diseases [J].Exp Dermatol,2014,23(5):320-321.
[18] Ardigo M,Longo C,Gonzalez S.Multicentre study on inflammatory skin diseases from The International Confocal Working Group:specific confocal microscopy features and an algorithmic method of diagnosis [J].Br J Dermatol,2016,175(2):364-374.
[19] Welzel J.Reflectance confocal microscopy:new micromorphological insights into inflammatory skin diseases [J].Br J Dermatol,2016,175(2):239-240.
[20] Hoogedoorn L,Wolberink EA,Pc VDK,et al.Noninvasive differentiation between stable and unstable chronic plaque psoriasis using in vivo reflectance confocal microscopy[J].J Am Acad Dermatol,2015,73(5):870-872.
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