穴位埋线、火针、耳针综合治疗女性青春期后痤疮及对血清性激素水平的影响
|
摘要
目的:比较女性青春期后痤疮患者与健康女性血清性激素水平;探讨穴位埋线、火针、耳针综合针灸疗法治疗女性青春期后痤疮皮损的疗效及作用机制。方法:将107例女性青春期后痤疮患者分为综合针灸组(54例,4例剔除)和药物组(53例,5例剔除)。综合针灸组采用穴位埋线、火针、耳针综合疗法,埋线取大椎、印堂、阳白透鱼腰等为主,配合辨证取穴,并于面部脓疱、囊肿皮损处行火针治疗,取耳尖及额、口等相应部位行耳针治疗;药物组口服丹参酮胶囊,每次4粒,每日3次,外用0.1%阿达帕林凝胶,每晚1次,两组均治疗8周。分别于治疗前、治疗4周、治疗8周后评价两组痤疮皮损。治疗前综合针灸组50例患者及46例健康对照组均于月经来潮24 h内检测血清睾酮(T)和雌二醇(E2)水平,并观察综合针灸组中21例性激素水平异常的患者治疗后的性激素水平变化。结果:综合针灸组治疗前E2水平明显低于健康对照组(P<0.01);T/E2明显高于健康对照组(P<0.01)。综合针灸组21例性激素异常的患者治疗后E2水平显著提高(P<0.01),T/E2显著降低(P<0.01)。两组治疗4周、8周后痤疮皮损积分显著降低(均P<0.01),治疗4周后组间差异无统计学意义(P>0.05),治疗8周后综合针灸组痤疮皮损评分低于药物组(P<0.05)。治疗4周后两组疗效差异无统计学意义(P>0.05);治疗8周后综合针灸组、药物组愈显率分别为66.0%(33/50)、45.8%(22/48),综合针灸组优于药物组(P<0.05)。结论:女性青春期后痤疮患者与健康女性血清性激素水平比较,E2水平降低导致T水平相对升高;穴位埋线、火针、耳针综合疗法对女性青春期后痤疮皮损具有比药物更好的疗效,并对异常的性激素水平具有调整作用。
Objective To compare the difference of serum sex hormone between female patients with post-adolescent acne and healthy women, and to explore the efficacy and action mechanism of acupoint catgut embedding, fire needle, auricular acupuncture on skin lesion in female patients of post-adolescent acne. Methods A total of 107 female patients of post-adolescent acne were divided into an integrated acupuncture group(54 cases, 4 cases were excluded) and a medication group(53 cases, 5 cases were excluded). The patients in the integrated acupuncture group were treated with comprehensive treatment of acupoint catgut embedding, fire needle, auricular acupuncture; the acupoint catgut embedding was applied at Dazhui(GV 14), Yintang(GV 29), Yangbai(GB 14) through Yuyao(EX-HN 4) and other acupoints based on syndrome differentiation; the fire needle was applied at skin lesion; the auricular acupuncture was applied at erjian(HX6,7 i), e(AT1), kou(CO1), etc. The patients in the medication group were treated with oral administration of tanshinone capsules(4 capsules each time, 3 times a day) and external use of adapalene gel(one treatment per day at night). Patients in the two groups were treated for 8 weeks. The skin lesion of acne was evaluated before treatment as well as 4 weeks and 8 weeks after treatment in the two groups; the serum levels of testosterone(T) and estradiol(E2) were tested 24 hours before menstruation in the integrated acupuncture group(50 cases) and healthy control group(46 cases), and the change of serum sex hormone aftertreatment was observed in 21 patients with sex hormone disorder in the integrated acupuncture group. Results Before treatment, the level of E2 in the integrated acupuncture group was significantly lower than that in the healthy control group(P<0.01), but T/E2 in the integrated acupuncture group was significantly higher than that in the healthy control group(P<0.01). After treatment, the level of E2 was significantly increased(P<0.01) and T/E2 was reduced(P<0.01) in the 21 patients with sex hormone disorder in the integrated acupuncture group. The skin lesion scale of acne was significantly reduced in the two groups after 4-week and 8-week treatment(all P<0.01); the difference between the two groups was not significant after 4-week treatment(P>0.05); the skin lesion scale of acne in the integrated acupuncture group was significantly lower than that in the medication group after 8-week treatment(P<0.01). The efficacy between the two groups was not significant after 4-week the treatment(P>0.05); after 8-week treatment, the cured and effective rate was 66.0%(33/50) in the integrated acupuncture group, which was superior to 45.8%(22/48) in the medication group(P<0.05). Conclusion Compared with healthy women, the level of serum sex hormone of E2 is reduced in the female patients of post-adolescent acne, resulting in relative increased level of T; the acupoint catgut embedding, fire needle, auricular acupuncture have better efficacy than medication for post-adolescent acne, which have regulation effects on sex hormone disorder.
Objective To compare the difference of serum sex hormone between female patients with post-adolescent acne and healthy women, and to explore the efficacy and action mechanism of acupoint catgut embedding, fire needle, auricular acupuncture on skin lesion in female patients of post-adolescent acne. Methods A total of 107 female patients of post-adolescent acne were divided into an integrated acupuncture group(54 cases, 4 cases were excluded) and a medication group(53 cases, 5 cases were excluded). The patients in the integrated acupuncture group were treated with comprehensive treatment of acupoint catgut embedding, fire needle, auricular acupuncture; the acupoint catgut embedding was applied at Dazhui(GV 14), Yintang(GV 29), Yangbai(GB 14) through Yuyao(EX-HN 4) and other acupoints based on syndrome differentiation; the fire needle was applied at skin lesion; the auricular acupuncture was applied at erjian(HX6,7 i), e(AT1), kou(CO1), etc. The patients in the medication group were treated with oral administration of tanshinone capsules(4 capsules each time, 3 times a day) and external use of adapalene gel(one treatment per day at night). Patients in the two groups were treated for 8 weeks. The skin lesion of acne was evaluated before treatment as well as 4 weeks and 8 weeks after treatment in the two groups; the serum levels of testosterone(T) and estradiol(E2) were tested 24 hours before menstruation in the integrated acupuncture group(50 cases) and healthy control group(46 cases), and the change of serum sex hormone aftertreatment was observed in 21 patients with sex hormone disorder in the integrated acupuncture group. Results Before treatment, the level of E2 in the integrated acupuncture group was significantly lower than that in the healthy control group(P<0.01), but T/E2 in the integrated acupuncture group was significantly higher than that in the healthy control group(P<0.01). After treatment, the level of E2 was significantly increased(P<0.01) and T/E2 was reduced(P<0.01) in the 21 patients with sex hormone disorder in the integrated acupuncture group. The skin lesion scale of acne was significantly reduced in the two groups after 4-week and 8-week treatment(all P<0.01); the difference between the two groups was not significant after 4-week treatment(P>0.05); the skin lesion scale of acne in the integrated acupuncture group was significantly lower than that in the medication group after 8-week treatment(P<0.01). The efficacy between the two groups was not significant after 4-week the treatment(P>0.05); after 8-week treatment, the cured and effective rate was 66.0%(33/50) in the integrated acupuncture group, which was superior to 45.8%(22/48) in the medication group(P<0.05). Conclusion Compared with healthy women, the level of serum sex hormone of E2 is reduced in the female patients of post-adolescent acne, resulting in relative increased level of T; the acupoint catgut embedding, fire needle, auricular acupuncture have better efficacy than medication for post-adolescent acne, which have regulation effects on sex hormone disorder.
引文
[1]中国痤疮治疗指南专家组.中国痤疮治疗指南(2014修订版)[J].临床皮肤科杂志,2015,44(1):52-57.
[2]黄碧玉,龚顺波,林丽莉,等.针刺对女性迟发性痤疮生活质量的影响[J].中国针灸,2004,24(11):759-762.
[3]马勇,黄丽群,汪敏,等.青春期后痤疮患者心理健康调查研究[J].中外医疗,2008(25):109.
[4]卢文,解春桃,朱礼刚.穴位埋线与刺血治疗寻常痤疮临床对照观察[J].上海针灸杂志,2009,28(12):700-702.
[5]顾春英,卢文,任虹.埋线、火针、耳针综合疗法治疗寻常痤疮136例[J].南京中医药大学学报,2009,25(6):476-477.
[6]卢文,斯维特娜·曼恩.埋线为主治疗黄褐斑临床观察[J].中国针灸,2006,26(10):713-715.
[7]郑筱萸.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:292-295.
[8]许杨,陈德宇,熊霞,等.阿达帕林凝胶治疗寻常痤疮[J].中华皮肤科杂志,2001,34(5):409.
[9]薛筑云,杜承权,刘国红,等.阿达帕林凝胶个体化治疗寻常痤疮的临床研究[J].中华皮肤科杂志,2003,36(4):198-200.
[10]陈福如.祛痤汤治疗寻常型痤疮40例临床观察[J].中医药导报,2008,14(5):69.
[11]盛文婷,陈建浩.女性迟发性痤疮血清性激素及皮质醇水平的研究[J].岭南皮肤性病科杂志,2003,10(4):241-242,245.
[12]于中蛟,陆洁,段昕所,等.女性痤疮患者卵泡期血清六项性激素水平的测定[J].皮肤病与性病,2006,28(1):9-11.
[13]周春红,宋珊,康旻.迟发性痤疮与性激素水平的相关性分析[J].临床医学工程,2012,19(7):1096-1097.
[14]李璟蓉,曾仁山,王建琴,等.米诺环素联合螺内酯治疗中度女性成人痤疮的疗效[J].广州医学院学报,2014,42(1):60-62.
[15]柳朴,张霞.女性青春期后迟发性痤疮与雄激素的相关性研究[J].中国医药指南,2013,11(21):183-184.
[16]张选平,贾春生,王建岭,等.穴位埋线疗法的优势病种及应用规律[J].中国针灸,2012,32(10):947-951.
[17]姜敏,曾宪玉,王玮蓁.火针治疗中重度寻常型痤疮疗效观察[J].中国针灸,2014,34(7):663-666.
[18]刘炼,李龙,赵建华.耳穴贴压治疗寻常痤疮对血清睾酮雌二醇的影响[J].中国针灸,2004,24(1):57-58.
[19]陈海燕,韩春雷,邱瑰君,等.丹参酮胶囊联合螺内酯治疗对女性青春期后痤疮患者血清性激素水平的影响[J].中国皮肤性病学杂志,2015,29(5):469-471.
[20]葛新红,焦亚宁,张秀娟,等.夫西地酸乳膏联合阿达帕林凝胶治疗200例寻常痤疮疗效观察[J].临床皮肤科杂志,2013,42(9):565-566.
[2]黄碧玉,龚顺波,林丽莉,等.针刺对女性迟发性痤疮生活质量的影响[J].中国针灸,2004,24(11):759-762.
[3]马勇,黄丽群,汪敏,等.青春期后痤疮患者心理健康调查研究[J].中外医疗,2008(25):109.
[4]卢文,解春桃,朱礼刚.穴位埋线与刺血治疗寻常痤疮临床对照观察[J].上海针灸杂志,2009,28(12):700-702.
[5]顾春英,卢文,任虹.埋线、火针、耳针综合疗法治疗寻常痤疮136例[J].南京中医药大学学报,2009,25(6):476-477.
[6]卢文,斯维特娜·曼恩.埋线为主治疗黄褐斑临床观察[J].中国针灸,2006,26(10):713-715.
[7]郑筱萸.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:292-295.
[8]许杨,陈德宇,熊霞,等.阿达帕林凝胶治疗寻常痤疮[J].中华皮肤科杂志,2001,34(5):409.
[9]薛筑云,杜承权,刘国红,等.阿达帕林凝胶个体化治疗寻常痤疮的临床研究[J].中华皮肤科杂志,2003,36(4):198-200.
[10]陈福如.祛痤汤治疗寻常型痤疮40例临床观察[J].中医药导报,2008,14(5):69.
[11]盛文婷,陈建浩.女性迟发性痤疮血清性激素及皮质醇水平的研究[J].岭南皮肤性病科杂志,2003,10(4):241-242,245.
[12]于中蛟,陆洁,段昕所,等.女性痤疮患者卵泡期血清六项性激素水平的测定[J].皮肤病与性病,2006,28(1):9-11.
[13]周春红,宋珊,康旻.迟发性痤疮与性激素水平的相关性分析[J].临床医学工程,2012,19(7):1096-1097.
[14]李璟蓉,曾仁山,王建琴,等.米诺环素联合螺内酯治疗中度女性成人痤疮的疗效[J].广州医学院学报,2014,42(1):60-62.
[15]柳朴,张霞.女性青春期后迟发性痤疮与雄激素的相关性研究[J].中国医药指南,2013,11(21):183-184.
[16]张选平,贾春生,王建岭,等.穴位埋线疗法的优势病种及应用规律[J].中国针灸,2012,32(10):947-951.
[17]姜敏,曾宪玉,王玮蓁.火针治疗中重度寻常型痤疮疗效观察[J].中国针灸,2014,34(7):663-666.
[18]刘炼,李龙,赵建华.耳穴贴压治疗寻常痤疮对血清睾酮雌二醇的影响[J].中国针灸,2004,24(1):57-58.
[19]陈海燕,韩春雷,邱瑰君,等.丹参酮胶囊联合螺内酯治疗对女性青春期后痤疮患者血清性激素水平的影响[J].中国皮肤性病学杂志,2015,29(5):469-471.
[20]葛新红,焦亚宁,张秀娟,等.夫西地酸乳膏联合阿达帕林凝胶治疗200例寻常痤疮疗效观察[J].临床皮肤科杂志,2013,42(9):565-566.