台湾地区女性经前痤疮与中医证候的相关性研究
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摘要
目的：
寻常痤疮是一种临床常见的皮肤病,其发病主要与内分泌失调、体内激素水平、细菌感染及毛囊、皮脂腺炎症等多种因素相关,多发于青年期男女。台湾地区雨湿较盛且气候炎热,该疾病发生率较高,且通常此愈彼发,难以根治。传统中医药治疗寻常痤疮具有丰富的临床经验与确切的疗效优势,但由于其证治标准未能规范化,从而阻碍了对其临床诊疗原理的科学阐述,因此,对寻常痤疮的发病规律及致病机理进行流行病学研究,规范其证治标准势在必行。因此,本文以在台湾地区开展的经前痤疮的中医临床流行病学研究为基础,对有关寻常痤疮证治规律的进行了探索。
中医认为,痤疮的发生是机体阴阳失调,气血不和,导致的脏腑病理变化的外在反映。本研究以大量的临床样本调查为依据,在充分总结经前痤疮的证侯特点的基础上,从血清性激素水平层面研究痤疮发生的内分泌机理与其中医证侯之间的关系,为痤疮的中医标准化临床诊疗提供规范的研究思路。
方法：
研究对象寻常痤疮患者。共收到合格研究对象调查表130份,其中筛选后符合纳入标准的经前痤疮患者100名,30例健康者作为对照组。病例来源为新竹天佑中医诊所、高雄佑昌中医诊所、台中崇德中医诊所皮肤科门诊患者,收集了筛选符合纳入标准的经前痤疮患者100名；30例健康者作为对照组。对照组30例受试者亦均来自新竹、高雄、台中三家诊所的健康体检中心。采用中医辩证、血清性激素为指标。血清八项性激素包括睾酮(T)、雌二醇(E2)、孕酮、泌乳素(PRL)、卵泡刺激素(FSH)、黄体生成素(LH)、雄烯二酮、硫酸脱氢表雄酮(DHEA-S)及皮质醇检测检测。
结果：
本研究共有合格研究对象130例,研究以正常女性作为对照,研究发现：
(1)发病就诊年龄区间尤以19-35岁的青年较突出,13-18岁青少年就诊率也较高,中年患者亦占有一定就诊比率。
(2)皮肤类型属油型52例(52.0%)；干燥型4例(4.0%)；中间型17例(17.0%)；混合型27例(27.0%)。各型皮肤发病率依次为油型>混合型>中间型>干燥型。油型最高,干型最低。
(3)痤疮发生以及相关症状的出现与月经周期有关。经前减轻12例,经前加重88例,以经前加重居多。伴随单一或合并症状者51例,占51.0%。其中便秘30例,尿黄22例,口臭16例,咽痛11例,口疮13例,口干7例,便溏4例,眠差3例,乏力2例,口苦1例,目矢多1例。便秘居伴随症状之首。
(4)应用面部望诊二维坐标体系,可见从痤疮好发位置来看,多出现在额部以及下颌部。
(5)本次调查结果是：肺经风热型24例,湿热蕴结型40例,痰湿凝结型8例、气滞血瘀7例、冲任不调型21例。湿热蕴结型最常见,占发病率40.0%,肺经风热型次之,占24.0%,冲任不调型占21.0%。
(6)女性痤疮患者性激素检测：患者组睾酮、雄烯二酮、硫酸脱氢表雄酮及睾酮/雌二醇值均高于对照组,经统计学处理(P<0.01)；雌二醇、孕酮、泌乳素、FSH、LH无明显变化(P>0.05)；患者组皮质醇较对照组显著降低(P<0.01)。
(7)通过辨证分型与血清雌二醇的相关性研究,发现肺经风热、湿热蕴结、痰湿凝结、气滞血瘀、冲任不调型痤疮与雌二醇水平无明显相关性,痰湿凝结型、冲任不调型患者血清睾酮水平却明显升高。
结论：
(1)痤疮发生以及相关症状的出现与月经周期有关。前痤疮好发于额部以及下颌部,但也会发生在颈部、背部、胸部、臀部等皮脂腺发达的部位。
(2)本次研究表明,在经前痤疮的各种证型中,湿热蕴结型居多。台湾地区气候炎热多雨,湿热蕴结型痤疮是台湾地区痤疮的主要证型。
(3)女性痤疮患者组睾酮、雄烯二酮、硫酸脱氢表雄酮及睾酮/雌二醇值均极显著高于对照组,患者组皮质醇较对照组极显著降低。通过辨证分型与血清雌二醇的相关性研究,发现肺经风热、湿热蕴结、痰湿凝结、气滞血瘀、冲任不调型痤疮与雌二醇水平无明显相关性,痰湿凝结型、冲任不调型患者血清睾酮水平却明显升高。在辨病基础上强调“病证结合”,能够为痤疮的临床治疗提供新方法。
Objective
Acne vulgaris is a common skin disease, its pathogenesis is mainly related to endocrine disorders, hormone levels, bacterial infection and hair follicles, sebaceous gland inflammation and other factors, multiple in the period of youth men and women. Taiwan rain wet more Sheng and hot climate, the disease incidence is higher, and often this is Peter, difficult to cure. Traditional Chinese medicine in the treatment of acne vulgaris with rich clinical experience and exact curative effect advantage, but because of its syndrome differentiation standard is not standardized, thus preventing a scientific explanation for the clinical diagnosis and treatment principle, therefore, the pathogenesis and regularity of acne vulgaris epidemiological studies, standardize the treatment standard be imperative. Therefore, in this paper, in order to carry out in Taiwan area by the research of TCM clinical epidemiology of acne as a foundation, has carried on the exploration to the rule of syndrome and treatment of acne vulgaris.
Traditional Chinese medicine thought that the occurrence of acne is the body imbalance of yin and Yang, Qi and blood feud, reflection of pathological changes of the viscera. In this study, based on a large number of clinical sample survey, in full to summarize the syndrome characteristic based on the former acne, endocrine mechanism from the relationship between serum sex hormone level of acne and Chinese medicine syndrome, provides research ideas for the standardization of clinical treatment for acne.
Methods
The research object of acne vulgaris patients. Had received qualified research object questionnaire130, of which screening criteria meet the acne patients before100,30cases of health as control group. Source:cases for people and hall, kaohsiung chang TCM clinic on traditional Chinese medicine clinic, taichung chong DE TCM clinic patients dermatologist outpatient service, collect the screening criteria of the accord with acne patients before100;30cases of health as control group.30cases in subjects are from hsinchu, also kaohsiung, taichung three hospital health medical center. The Chinese medicine dialectical, serum sex hormones for index. Serum eight sex hormones including testosterone (T), estradiol (E2), progesterone, prolactin (PRL), follicle-stimulating hormone (FSH), corpus luteum erythropoietin (LH), male androstenedione, dehydroepiandrosterone sulfate as dhea-s,) and cortisol testing detection..
Results
This study were qualified research object130cases, we found that:
(1) The onset age range especially in19~35year-old youth is relatively outstanding,13-18teenager visiting rate is higher, the middle-aged patients also occupied a certain treatment ratio.
(2) Skin type belongs to oil type in52cases (52%);4cases of dry type (4%);17cases of intermediate (17%);27cases of mixed type (27%). Various types of skin incidence were oil type> mixed type> middle> drying. Oil type the highest, lowest dry type.
(3) The occurrence of acne and related symptoms associated with the menstrual cycle. The former was relieved in12cases,88cases of premenstrual exacerbation, premenstrual exacerbation in the majority. It accounted for51%with single or combined symptoms in51patients. Among the30cases of constipation, yellow urine in22cases,16cases and11cases of bad breath, sore throat, dry mouth ulcer in13cases,7cases,4cases of diarrhea, poor sleep in3cases,2cases and1cases of weakness, bitter taste in the mouth,1cases of multiple vector. The first was constipation in the accompanying symptoms.
(4)Application of face inspection two-dimensional coordinate system, visible from acne good position, appear in the forehead and chin.
(5)The results are:24cases of lung by wind-heat type, damp-heat accumulation type in40cases, phlegm coagulation type in8cases,7cases of qi stagnation and blood stasis, red does not transfer any type of21cases. The most common wet-hot type, incidence rate of40%, the lung by wind-heat type, accounting for24%, red does not transfer any type accounted for21%.
(6) Detection of sex hormone in female patients with acne:Patients testosterone, androstene two testosterone, dehydroepiandrosterone sulfate and testosterone/estradiol values were higher than those in the control group, statistically (P<0.01); estradiol, progesterone, prolactin, FSH, no significant change in LH (P>0.05); patients were significantly lower than the control group (P<0.01).
(7) Study on the correlation between the syndrome differentiation and serum estradiol, found the lung by wind-heat, accumulation of damp heat, phlegm coagulation, qi stagnation and blood stasis, red does not transfer any type of acne has no significant correlation with the levels of estradiol, phlegm coagulation type, red does not transfer any type of serum testosterone level was obviously increased.
Conelusion
(1) The occurrence of acne and related symptoms associated with the menstrual cycle. Before the acne occurs on the forehead and chin, but can also occur in the neck, back, chest, buttocks developed parts of sebaceous glands.
(2) This study showed that in the premenstrual acne various syndrome types, damp-heat accumulation type. Taiwan climate is hot and rainy, wet-hot type acne is the main syndrome of acne in Taiwan.
(3) Female acne patients testosterone, androstene two testosterone, dehydroepiandrosterone sulfate and testosterone/estradiol were significantly higher than those in the control group, patients group than in the control group significantly decreased cortisol. Study on the correlation between the syndrome differentiation and serum estradiol, found the lung by wind-heat, accumulation of damp heat, phlegm coagulation, qi stagnation and blood stasis, red does not transfer any type of acne has no significant correlation with the levels of estradiol, phlegm coagulation type, red does not transfer any type of serum testosterone level was obviously increased. The disease should be emphasized on the basis of "the combination of disease and syndrome", can provide a new method for the treatment of acne.
寻常痤疮是一种临床常见的皮肤病,其发病主要与内分泌失调、体内激素水平、细菌感染及毛囊、皮脂腺炎症等多种因素相关,多发于青年期男女。台湾地区雨湿较盛且气候炎热,该疾病发生率较高,且通常此愈彼发,难以根治。传统中医药治疗寻常痤疮具有丰富的临床经验与确切的疗效优势,但由于其证治标准未能规范化,从而阻碍了对其临床诊疗原理的科学阐述,因此,对寻常痤疮的发病规律及致病机理进行流行病学研究,规范其证治标准势在必行。因此,本文以在台湾地区开展的经前痤疮的中医临床流行病学研究为基础,对有关寻常痤疮证治规律的进行了探索。
中医认为,痤疮的发生是机体阴阳失调,气血不和,导致的脏腑病理变化的外在反映。本研究以大量的临床样本调查为依据,在充分总结经前痤疮的证侯特点的基础上,从血清性激素水平层面研究痤疮发生的内分泌机理与其中医证侯之间的关系,为痤疮的中医标准化临床诊疗提供规范的研究思路。
方法：
研究对象寻常痤疮患者。共收到合格研究对象调查表130份,其中筛选后符合纳入标准的经前痤疮患者100名,30例健康者作为对照组。病例来源为新竹天佑中医诊所、高雄佑昌中医诊所、台中崇德中医诊所皮肤科门诊患者,收集了筛选符合纳入标准的经前痤疮患者100名；30例健康者作为对照组。对照组30例受试者亦均来自新竹、高雄、台中三家诊所的健康体检中心。采用中医辩证、血清性激素为指标。血清八项性激素包括睾酮(T)、雌二醇(E2)、孕酮、泌乳素(PRL)、卵泡刺激素(FSH)、黄体生成素(LH)、雄烯二酮、硫酸脱氢表雄酮(DHEA-S)及皮质醇检测检测。
结果：
本研究共有合格研究对象130例,研究以正常女性作为对照,研究发现：
(1)发病就诊年龄区间尤以19-35岁的青年较突出,13-18岁青少年就诊率也较高,中年患者亦占有一定就诊比率。
(2)皮肤类型属油型52例(52.0%)；干燥型4例(4.0%)；中间型17例(17.0%)；混合型27例(27.0%)。各型皮肤发病率依次为油型>混合型>中间型>干燥型。油型最高,干型最低。
(3)痤疮发生以及相关症状的出现与月经周期有关。经前减轻12例,经前加重88例,以经前加重居多。伴随单一或合并症状者51例,占51.0%。其中便秘30例,尿黄22例,口臭16例,咽痛11例,口疮13例,口干7例,便溏4例,眠差3例,乏力2例,口苦1例,目矢多1例。便秘居伴随症状之首。
(4)应用面部望诊二维坐标体系,可见从痤疮好发位置来看,多出现在额部以及下颌部。
(5)本次调查结果是：肺经风热型24例,湿热蕴结型40例,痰湿凝结型8例、气滞血瘀7例、冲任不调型21例。湿热蕴结型最常见,占发病率40.0%,肺经风热型次之,占24.0%,冲任不调型占21.0%。
(6)女性痤疮患者性激素检测：患者组睾酮、雄烯二酮、硫酸脱氢表雄酮及睾酮/雌二醇值均高于对照组,经统计学处理(P<0.01)；雌二醇、孕酮、泌乳素、FSH、LH无明显变化(P>0.05)；患者组皮质醇较对照组显著降低(P<0.01)。
(7)通过辨证分型与血清雌二醇的相关性研究,发现肺经风热、湿热蕴结、痰湿凝结、气滞血瘀、冲任不调型痤疮与雌二醇水平无明显相关性,痰湿凝结型、冲任不调型患者血清睾酮水平却明显升高。
结论：
(1)痤疮发生以及相关症状的出现与月经周期有关。前痤疮好发于额部以及下颌部,但也会发生在颈部、背部、胸部、臀部等皮脂腺发达的部位。
(2)本次研究表明,在经前痤疮的各种证型中,湿热蕴结型居多。台湾地区气候炎热多雨,湿热蕴结型痤疮是台湾地区痤疮的主要证型。
(3)女性痤疮患者组睾酮、雄烯二酮、硫酸脱氢表雄酮及睾酮/雌二醇值均极显著高于对照组,患者组皮质醇较对照组极显著降低。通过辨证分型与血清雌二醇的相关性研究,发现肺经风热、湿热蕴结、痰湿凝结、气滞血瘀、冲任不调型痤疮与雌二醇水平无明显相关性,痰湿凝结型、冲任不调型患者血清睾酮水平却明显升高。在辨病基础上强调“病证结合”,能够为痤疮的临床治疗提供新方法。
Objective
Acne vulgaris is a common skin disease, its pathogenesis is mainly related to endocrine disorders, hormone levels, bacterial infection and hair follicles, sebaceous gland inflammation and other factors, multiple in the period of youth men and women. Taiwan rain wet more Sheng and hot climate, the disease incidence is higher, and often this is Peter, difficult to cure. Traditional Chinese medicine in the treatment of acne vulgaris with rich clinical experience and exact curative effect advantage, but because of its syndrome differentiation standard is not standardized, thus preventing a scientific explanation for the clinical diagnosis and treatment principle, therefore, the pathogenesis and regularity of acne vulgaris epidemiological studies, standardize the treatment standard be imperative. Therefore, in this paper, in order to carry out in Taiwan area by the research of TCM clinical epidemiology of acne as a foundation, has carried on the exploration to the rule of syndrome and treatment of acne vulgaris.
Traditional Chinese medicine thought that the occurrence of acne is the body imbalance of yin and Yang, Qi and blood feud, reflection of pathological changes of the viscera. In this study, based on a large number of clinical sample survey, in full to summarize the syndrome characteristic based on the former acne, endocrine mechanism from the relationship between serum sex hormone level of acne and Chinese medicine syndrome, provides research ideas for the standardization of clinical treatment for acne.
Methods
The research object of acne vulgaris patients. Had received qualified research object questionnaire130, of which screening criteria meet the acne patients before100,30cases of health as control group. Source:cases for people and hall, kaohsiung chang TCM clinic on traditional Chinese medicine clinic, taichung chong DE TCM clinic patients dermatologist outpatient service, collect the screening criteria of the accord with acne patients before100;30cases of health as control group.30cases in subjects are from hsinchu, also kaohsiung, taichung three hospital health medical center. The Chinese medicine dialectical, serum sex hormones for index. Serum eight sex hormones including testosterone (T), estradiol (E2), progesterone, prolactin (PRL), follicle-stimulating hormone (FSH), corpus luteum erythropoietin (LH), male androstenedione, dehydroepiandrosterone sulfate as dhea-s,) and cortisol testing detection..
Results
This study were qualified research object130cases, we found that:
(1) The onset age range especially in19~35year-old youth is relatively outstanding,13-18teenager visiting rate is higher, the middle-aged patients also occupied a certain treatment ratio.
(2) Skin type belongs to oil type in52cases (52%);4cases of dry type (4%);17cases of intermediate (17%);27cases of mixed type (27%). Various types of skin incidence were oil type> mixed type> middle> drying. Oil type the highest, lowest dry type.
(3) The occurrence of acne and related symptoms associated with the menstrual cycle. The former was relieved in12cases,88cases of premenstrual exacerbation, premenstrual exacerbation in the majority. It accounted for51%with single or combined symptoms in51patients. Among the30cases of constipation, yellow urine in22cases,16cases and11cases of bad breath, sore throat, dry mouth ulcer in13cases,7cases,4cases of diarrhea, poor sleep in3cases,2cases and1cases of weakness, bitter taste in the mouth,1cases of multiple vector. The first was constipation in the accompanying symptoms.
(4)Application of face inspection two-dimensional coordinate system, visible from acne good position, appear in the forehead and chin.
(5)The results are:24cases of lung by wind-heat type, damp-heat accumulation type in40cases, phlegm coagulation type in8cases,7cases of qi stagnation and blood stasis, red does not transfer any type of21cases. The most common wet-hot type, incidence rate of40%, the lung by wind-heat type, accounting for24%, red does not transfer any type accounted for21%.
(6) Detection of sex hormone in female patients with acne:Patients testosterone, androstene two testosterone, dehydroepiandrosterone sulfate and testosterone/estradiol values were higher than those in the control group, statistically (P<0.01); estradiol, progesterone, prolactin, FSH, no significant change in LH (P>0.05); patients were significantly lower than the control group (P<0.01).
(7) Study on the correlation between the syndrome differentiation and serum estradiol, found the lung by wind-heat, accumulation of damp heat, phlegm coagulation, qi stagnation and blood stasis, red does not transfer any type of acne has no significant correlation with the levels of estradiol, phlegm coagulation type, red does not transfer any type of serum testosterone level was obviously increased.
Conelusion
(1) The occurrence of acne and related symptoms associated with the menstrual cycle. Before the acne occurs on the forehead and chin, but can also occur in the neck, back, chest, buttocks developed parts of sebaceous glands.
(2) This study showed that in the premenstrual acne various syndrome types, damp-heat accumulation type. Taiwan climate is hot and rainy, wet-hot type acne is the main syndrome of acne in Taiwan.
(3) Female acne patients testosterone, androstene two testosterone, dehydroepiandrosterone sulfate and testosterone/estradiol were significantly higher than those in the control group, patients group than in the control group significantly decreased cortisol. Study on the correlation between the syndrome differentiation and serum estradiol, found the lung by wind-heat, accumulation of damp heat, phlegm coagulation, qi stagnation and blood stasis, red does not transfer any type of acne has no significant correlation with the levels of estradiol, phlegm coagulation type, red does not transfer any type of serum testosterone level was obviously increased. The disease should be emphasized on the basis of "the combination of disease and syndrome", can provide a new method for the treatment of acne.
引文
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