二黄补白方治疗气血失调型白癜风临床疗效观察
|
摘要
目的：
对二黄补白颗粒方治疗气血失调型白癫风进行临床疗效观察,客观评价其对白癜风的临床疗效,并进一步分析和探讨其作用机理。
资料与方法：
1.对在2009年1月至2009年11月期间就诊的武汉市第一医院95例白癜风专科患者进行回顾性统计研究发现,46例患者使用二黄补白颗粒方,49例患者使用祛白糖浆(以下简称为治疗组和对照组)。治疗组46例,男17例,女29例,年龄13—56岁；对照组49例,男20例,女29例,年龄2—54岁。治疗组给予二黄补白颗粒方(黄芪20g、黄芩10g、补骨脂10g、白蒺藜10g、当归10g)每日一付冲服、分两次口服；对照组口服祛白糖浆(鸡血藤、钩藤、白蒺藜、丹参、当归、生地、丹皮、赤芍、夜交藤)一日两次,每次20m1。两组患者均口服腺苷钻胺片,每次2片,每日三次；进展期均外用卤米松软膏,稳定期均外擦白芷酊(武汉市一医院自制)或者祛白酊(安徽国创药业有限公司生产)每日2次,1个月为一疗程,连续治疗3个疗程。
2.临床疗效评价参考《白癜风临床分型及疗效标准》(2003年修订稿)分：痊愈：白斑全部消退,恢复正常肤色；显效：白斑部分消退或缩小,恢复正常肤色的面积占原皮损面积≥50%；有效：白斑部分消退或缩小,恢复正常肤色面积占原皮损面积的10%-50%；无效：白斑无变化或恢复正常肤色的面积占原皮损面积的10%以下。痊愈率=痊愈数／治疗数×100%,总显效率=(痊愈数+显效数)／治疗数×100%,总有效率=(痊愈数+显效数+有效数)／治疗数×100%。
3.以上两组患者均符合白癜风诊断(诊断标准参照1994年6月国家中医药管理局发布的《白驳风的诊断依据、证候分类、疗效评定标准》),并且以中医辨证为气血失调型为观察对象。两组在性别、年龄、病程等方面经统计学处理差异无显著性(P>0.05),具有可比性,观察时间均为3个月。
4.对药物治疗的安全性进行检测和反馈,记录不良事件。
5.比较治疗组与对照组治疗前后白癜风病人皮疹面积的变化,进行数理统计分析,得出结论。
结果：
1.复诊发现部分病人原有正常肤色普遍加深,一般在用药3-4周左右,白斑处皮肤,尤其是曝光或运动后白斑变红,白斑边界开始清晰稳定,白斑处出现新生的毛囊性色素斑点。4-8周左右大部分进展期病人病情可以得到控制。
2.经3个月治疗后,治疗组痊愈率、总显效率与对照组比较二者无明显差异；治疗组总有效率76.09%与对照组53.06%比较,P<0.05二者有明显差异。
3.选择对酪氨酸酶有激活作用及对动物致色素作用较强的中药组方治疗白癫风疗效肯定。
4.二黄补白颗粒方较之于祛白糖浆能明显提高白癜风患者对治疗的依从性和配合度,更好的提高疗效。
结论：
中医辨证治疗白癫风可以对改变白斑的色素,减少皮疹面积。二黄补白方治疗白癫风安全性好、疗效确切,深得患者好评,值得临床推广
Objective:
Filler particles on the two yellow treatment of Qi and blood disorders square type Vitiligo clinical efficacy and objective evaluation of its clinical efficacy of Vitiligo, and further analysis and to explore its mechanism.
Methods:
1. Pairs from January 2009 to November 2009 during the First Hospital of Wuhan City,95 cases of patients with Vitiligo specialist retrospective study found 46 cases of the use of two yellow filler particles side,49 cases of the use of cured white syrup(hereinafter referred to as the treatment group and control group). The treatment group 46 cases, male 17, female 29, age 13-56 years old; the control group 49 cases, male 20 cases, female 29, age 2-54 years old. Treatment group was given two yellow filler particle side twice daily oral administration of a pair of blunt; the control group was treated with cured white syrup twice a day, each 20ml. Drilling amine groups of adenosine in patients with oral tablets, each 2 tablets three times a day; advanced Halometasone ointment are for external use, stable period are outside the rub Angelica tincture (Wuhan City, First hospital-made), or cured white tincture (Anhui Guochuang drug Co., Ltd. production) 2 times a day, 1 month for a course of treatment, continuous treatment of 3 courses
2. Criteria of therapeutic effect referred to the clinical types
and Criteria of therapeutic effect of Vitiligo.2003 edition was given as follows:recovery:after 5 months of the treatment, the lesion area recovers the normal skin; Remarkable effect:after 5 months of the treatment, the recovered area is accounting for at least 50% of the original area; Effect:after 5 months of the treatment, the recovered area is accounting for 10%-50% of the original area; Failure:After 5 months of the treatment, the recovered area is unchanged or not accounting for 10% of the original area.
3. These two groups are in line with Vitiligo Diagnosis (diagnostic criterion-referenced assessment in June 1994 the State Chinese Medicine Administration issued a "white barge wind diagnostics based on syndrome classification, efficacy evaluation standards"), and TCM as a blood disorder type is to observe them. The two groups in gender, age, duration, etc, The difference was not statistically significant (P> 0.05), with a comparable observation period was 3 months.
4. The safety of drug treatment testing and feedback, recording adverse events.
5. Comparing the treatment group and control group before and after treatment of Vitiligo patients with skin rash changes in the area to carry out mathematical statistical analysis and drawing conclusions.
Results:
1. Return visit found that some patients in general to enhance the existing normal skin, usually around 3-4 weeks of medication, the skin white, especially after exercise exposure or white red, white border began to clear and stable spot occurring at the new hair follicle pigment spots.4-8 weeks most of the patients with advanced disease can be controlled.
2. After 3 months after treatment, the treatment group cure rate, with a total effective rate compared with the control group, no significant difference between the two, the total efficiency of 76.09% and 53.06% compared the control group, P<0.05 significant difference between the two.
3. Choice of tyrosinase enzyme activity and animal-induced pigment potent Medicines side effect of treatment of Vitiligo with a positive.
4. two yellow filler particles compared to cured white syrup can significantly improve the treatment of vitiligo patients and with the degree of compliance, and better improve the curative effect.
Conclusion:
TCM treatment of Vitiligo can change the pigment spot to reduce the rash area. Two yellow filler on Treatment of Vitiligo with good safety, efficacy accurate, patients won praise, worthy to be popularized.
对二黄补白颗粒方治疗气血失调型白癫风进行临床疗效观察,客观评价其对白癜风的临床疗效,并进一步分析和探讨其作用机理。
资料与方法：
1.对在2009年1月至2009年11月期间就诊的武汉市第一医院95例白癜风专科患者进行回顾性统计研究发现,46例患者使用二黄补白颗粒方,49例患者使用祛白糖浆(以下简称为治疗组和对照组)。治疗组46例,男17例,女29例,年龄13—56岁；对照组49例,男20例,女29例,年龄2—54岁。治疗组给予二黄补白颗粒方(黄芪20g、黄芩10g、补骨脂10g、白蒺藜10g、当归10g)每日一付冲服、分两次口服；对照组口服祛白糖浆(鸡血藤、钩藤、白蒺藜、丹参、当归、生地、丹皮、赤芍、夜交藤)一日两次,每次20m1。两组患者均口服腺苷钻胺片,每次2片,每日三次；进展期均外用卤米松软膏,稳定期均外擦白芷酊(武汉市一医院自制)或者祛白酊(安徽国创药业有限公司生产)每日2次,1个月为一疗程,连续治疗3个疗程。
2.临床疗效评价参考《白癜风临床分型及疗效标准》(2003年修订稿)分：痊愈：白斑全部消退,恢复正常肤色；显效：白斑部分消退或缩小,恢复正常肤色的面积占原皮损面积≥50%；有效：白斑部分消退或缩小,恢复正常肤色面积占原皮损面积的10%-50%；无效：白斑无变化或恢复正常肤色的面积占原皮损面积的10%以下。痊愈率=痊愈数／治疗数×100%,总显效率=(痊愈数+显效数)／治疗数×100%,总有效率=(痊愈数+显效数+有效数)／治疗数×100%。
3.以上两组患者均符合白癜风诊断(诊断标准参照1994年6月国家中医药管理局发布的《白驳风的诊断依据、证候分类、疗效评定标准》),并且以中医辨证为气血失调型为观察对象。两组在性别、年龄、病程等方面经统计学处理差异无显著性(P>0.05),具有可比性,观察时间均为3个月。
4.对药物治疗的安全性进行检测和反馈,记录不良事件。
5.比较治疗组与对照组治疗前后白癜风病人皮疹面积的变化,进行数理统计分析,得出结论。
结果：
1.复诊发现部分病人原有正常肤色普遍加深,一般在用药3-4周左右,白斑处皮肤,尤其是曝光或运动后白斑变红,白斑边界开始清晰稳定,白斑处出现新生的毛囊性色素斑点。4-8周左右大部分进展期病人病情可以得到控制。
2.经3个月治疗后,治疗组痊愈率、总显效率与对照组比较二者无明显差异；治疗组总有效率76.09%与对照组53.06%比较,P<0.05二者有明显差异。
3.选择对酪氨酸酶有激活作用及对动物致色素作用较强的中药组方治疗白癫风疗效肯定。
4.二黄补白颗粒方较之于祛白糖浆能明显提高白癜风患者对治疗的依从性和配合度,更好的提高疗效。
结论：
中医辨证治疗白癫风可以对改变白斑的色素,减少皮疹面积。二黄补白方治疗白癫风安全性好、疗效确切,深得患者好评,值得临床推广
Objective:
Filler particles on the two yellow treatment of Qi and blood disorders square type Vitiligo clinical efficacy and objective evaluation of its clinical efficacy of Vitiligo, and further analysis and to explore its mechanism.
Methods:
1. Pairs from January 2009 to November 2009 during the First Hospital of Wuhan City,95 cases of patients with Vitiligo specialist retrospective study found 46 cases of the use of two yellow filler particles side,49 cases of the use of cured white syrup(hereinafter referred to as the treatment group and control group). The treatment group 46 cases, male 17, female 29, age 13-56 years old; the control group 49 cases, male 20 cases, female 29, age 2-54 years old. Treatment group was given two yellow filler particle side twice daily oral administration of a pair of blunt; the control group was treated with cured white syrup twice a day, each 20ml. Drilling amine groups of adenosine in patients with oral tablets, each 2 tablets three times a day; advanced Halometasone ointment are for external use, stable period are outside the rub Angelica tincture (Wuhan City, First hospital-made), or cured white tincture (Anhui Guochuang drug Co., Ltd. production) 2 times a day, 1 month for a course of treatment, continuous treatment of 3 courses
2. Criteria of therapeutic effect referred to the clinical types
and Criteria of therapeutic effect of Vitiligo.2003 edition was given as follows:recovery:after 5 months of the treatment, the lesion area recovers the normal skin; Remarkable effect:after 5 months of the treatment, the recovered area is accounting for at least 50% of the original area; Effect:after 5 months of the treatment, the recovered area is accounting for 10%-50% of the original area; Failure:After 5 months of the treatment, the recovered area is unchanged or not accounting for 10% of the original area.
3. These two groups are in line with Vitiligo Diagnosis (diagnostic criterion-referenced assessment in June 1994 the State Chinese Medicine Administration issued a "white barge wind diagnostics based on syndrome classification, efficacy evaluation standards"), and TCM as a blood disorder type is to observe them. The two groups in gender, age, duration, etc, The difference was not statistically significant (P> 0.05), with a comparable observation period was 3 months.
4. The safety of drug treatment testing and feedback, recording adverse events.
5. Comparing the treatment group and control group before and after treatment of Vitiligo patients with skin rash changes in the area to carry out mathematical statistical analysis and drawing conclusions.
Results:
1. Return visit found that some patients in general to enhance the existing normal skin, usually around 3-4 weeks of medication, the skin white, especially after exercise exposure or white red, white border began to clear and stable spot occurring at the new hair follicle pigment spots.4-8 weeks most of the patients with advanced disease can be controlled.
2. After 3 months after treatment, the treatment group cure rate, with a total effective rate compared with the control group, no significant difference between the two, the total efficiency of 76.09% and 53.06% compared the control group, P<0.05 significant difference between the two.
3. Choice of tyrosinase enzyme activity and animal-induced pigment potent Medicines side effect of treatment of Vitiligo with a positive.
4. two yellow filler particles compared to cured white syrup can significantly improve the treatment of vitiligo patients and with the degree of compliance, and better improve the curative effect.
Conclusion:
TCM treatment of Vitiligo can change the pigment spot to reduce the rash area. Two yellow filler on Treatment of Vitiligo with good safety, efficacy accurate, patients won praise, worthy to be popularized.
引文
[1]Schallreuter KU, Lemke R, Brandt O, et al. Vitiligo and other diseases:coexistenceor true association[J]. Dermatology,1994, 188(2):269-272.
[2]Bethea D, Fuller B Syed S, et al. Psoralen photobio logy and photochemotherapy:50 years of science and medicine [J]. J Dermatol Sci,1999,19(2):78—88.
[3]Hirobe T. Role of keratinocyte-derived factores involved in regulating the proliferation and differentiation of mammalian epidermal melanocytes. Pigment Cell Res,2005,18 (1):2-12.
[4]张志礼.中西结合皮肤性病学[M].北京：人民卫生出版社,2000：306.
[5]梁勇才.实用皮肤病诊疗全书[M].北京：学苑出版社,1996：820.
[6]杨赛,陈其华,等.关于白癜风的中医治疗及研究进展[J].中医药导报,2008,3(14)：1672.
[7]高天文,李强,等.白癜风2008例的临床分析[J].中国皮肤性病学杂志,2002,916-5：0304.
[8]朱仁康.中医外科学.第1版.北京：人民卫生出版,1987：672-675.
[9]朱铁君.白癫风650例临床研究[J].临床皮肤科杂志,1995；24(5)：279
[10]黄惠明.人头发钻含量与白癫风[J].江西医药,1995；30(1)：6
[11]张淑妍.白癫风患者123例毛发锌铜测定分析[J].岭南皮肤性病科杂志,1997；4(3)：6.
[12]涂彩霞,陈海波,林熙然.白癫风患者血清及皮肤组织液硒元素测定[J].中华皮肤科杂志,Ⅰ999；32(3)：184.
[13]石得仁,刘旭辉,李民乾等.白癫风微量元素测定及驱虫斑鸡菊治疗白癫风[J].中华皮肤科杂志,1989；22(5)：326.
[14]涂彩霞,林熙然,殷峰.白癫风患者血清及皮肤组织液铜、锌含量测定[J].中国皮肤性病学杂志.1991；5(1)：20.
[15]周建平,商建军,胡玉玲.商氏消白方Ⅰ号治疗120例白癜风的临床观察[J].北京中医,1996,15(3)：42.499.
[16]曾令济,刘祖武,冯良甫,等.复方归芷汤治疗白厕风627例分析.中国皮肤性病学杂志,1993： 7(3)： 159.
[17]王国辉.活血祛风汤治疗白癜风52例临床报告[J].中医药学报,1998,(2)：34.
[18]魏守建,杨军.祛白愈癫片药理作用的实验研究.中国中医药信息杂志,1999：6(12)：29.
[19]尉京成.中西医结合治疗白癫风40例[J].中国民间疗法,2004,12(6)：7.
[20]许爱娥,钟晓明.中药加皮质激素治疗186例白癫风[J].中华皮肤科杂志,1995,28(4)：252—253.
[21]陈思宏,黄屏.白癜风制剂配合激素治疗进展期白癜风30例[J]陕西中医,2005,(12)
[22]吐尔逊·吾莆尔,艾尼瓦尔·加马力.维吾尔医治疗白癜风610例临床观察[J].中国民族医药杂志,2003,9(1)：8—9.
[23]阿西尔江,西迪克·热比亚.维医治疗3076例白癜风临床总结[J]中国民族医药杂志,2006,12(5)：21.
[24]许爱娥,王遂泉.常用中药对酪氨酸酶的激活作用[J].中华皮肤科志,1998,31(1)：48.
[25]刘之力,涂彩霞.56种中药乙醇提取物对酪氨酸酶活性影响及动物致色素作用的研究[J].中华皮肤科杂志,2001,34(4)：284—285.
[26]Arrunategui A, Arroyo C, Garcia L et al. Melanocyte Reservoir in Vitiligo. lnt [J] dermatol,1994; 33:484-487.
[27]Vennegoor C, Hageman P, Van Nouhuijs H, et aLA monoclonal antibody specific for cells of the melanocyte lineage.Am [J] Pathol.1988:130(1):179-92.
[28]耿长山.黄芪的免疫药理作用研究[J].中西医结合杂志,1986(1)：62.
[29]杨风华,张文竹,康成等.黄茂水溶性黄酮类对小鼠T淋巴细胞及其亚群影响的量效关系研究[T].中国新医药,2003,2(4)：10.
[30]刘璋,胡佑伦,韩瑞玲.黑素生成过程中黄芩的调节作用[J]武汉大学学报(医学版),2005,(01)
[31]雷铁池,朱文元,夏明玉,张美华,范卫新.89味中药乙醇提取物对酪氨酸酶活性的上调作用[J]临床皮肤科杂志,1999,(03)
[32]李勇伟,许爱娥等.单味中药提取物对体外培养的黑素细胞酪氨酸酶基因和c-kit基因表达的激活作用[J].中华皮肤科杂志,2004 37(10)：598-600.
[33]王淑兰,李淑莲,董祟田等.构祀子等八种中药提取液对体外培养细胞和小鼠腹腔巨噬细胞影响的实验研究[J].白求恩医科大学学报,1990,16(4)： 325-328.
[34]刘娟,朱兆荣等.补骨脂粗黄酮对去卵巢小鼠的影响[J].中兽医学杂志,2005,1：4-6.
[35]杨柳,赖梅生等.白姨慕血清对酪氨酸酶活性的双向调节作用[J].陕西中医,2005,26(4)：370—373.
[36]陈昭,马照奎等.探讨蒺藜总皂贰对AMI大鼠模型血清中微量元素的变化[J].微量元素与健康研究,2001,18(3)：15.
[37]王燕平,李晓玉等当归补血汤中不同组分对正常及血虚小鼠免疫功能的影响[J].中草药,2002,33(2)：135-138.
[38]白润红,任娅等.三种中药多糖含量测定及与免疫关系研究结果[J].甘肃中医学院学报,1997,14(4)：25-28.
[2]Bethea D, Fuller B Syed S, et al. Psoralen photobio logy and photochemotherapy:50 years of science and medicine [J]. J Dermatol Sci,1999,19(2):78—88.
[3]Hirobe T. Role of keratinocyte-derived factores involved in regulating the proliferation and differentiation of mammalian epidermal melanocytes. Pigment Cell Res,2005,18 (1):2-12.
[4]张志礼.中西结合皮肤性病学[M].北京：人民卫生出版社,2000：306.
[5]梁勇才.实用皮肤病诊疗全书[M].北京：学苑出版社,1996：820.
[6]杨赛,陈其华,等.关于白癜风的中医治疗及研究进展[J].中医药导报,2008,3(14)：1672.
[7]高天文,李强,等.白癜风2008例的临床分析[J].中国皮肤性病学杂志,2002,916-5：0304.
[8]朱仁康.中医外科学.第1版.北京：人民卫生出版,1987：672-675.
[9]朱铁君.白癫风650例临床研究[J].临床皮肤科杂志,1995；24(5)：279
[10]黄惠明.人头发钻含量与白癫风[J].江西医药,1995；30(1)：6
[11]张淑妍.白癫风患者123例毛发锌铜测定分析[J].岭南皮肤性病科杂志,1997；4(3)：6.
[12]涂彩霞,陈海波,林熙然.白癫风患者血清及皮肤组织液硒元素测定[J].中华皮肤科杂志,Ⅰ999；32(3)：184.
[13]石得仁,刘旭辉,李民乾等.白癫风微量元素测定及驱虫斑鸡菊治疗白癫风[J].中华皮肤科杂志,1989；22(5)：326.
[14]涂彩霞,林熙然,殷峰.白癫风患者血清及皮肤组织液铜、锌含量测定[J].中国皮肤性病学杂志.1991；5(1)：20.
[15]周建平,商建军,胡玉玲.商氏消白方Ⅰ号治疗120例白癜风的临床观察[J].北京中医,1996,15(3)：42.499.
[16]曾令济,刘祖武,冯良甫,等.复方归芷汤治疗白厕风627例分析.中国皮肤性病学杂志,1993： 7(3)： 159.
[17]王国辉.活血祛风汤治疗白癜风52例临床报告[J].中医药学报,1998,(2)：34.
[18]魏守建,杨军.祛白愈癫片药理作用的实验研究.中国中医药信息杂志,1999：6(12)：29.
[19]尉京成.中西医结合治疗白癫风40例[J].中国民间疗法,2004,12(6)：7.
[20]许爱娥,钟晓明.中药加皮质激素治疗186例白癫风[J].中华皮肤科杂志,1995,28(4)：252—253.
[21]陈思宏,黄屏.白癜风制剂配合激素治疗进展期白癜风30例[J]陕西中医,2005,(12)
[22]吐尔逊·吾莆尔,艾尼瓦尔·加马力.维吾尔医治疗白癜风610例临床观察[J].中国民族医药杂志,2003,9(1)：8—9.
[23]阿西尔江,西迪克·热比亚.维医治疗3076例白癜风临床总结[J]中国民族医药杂志,2006,12(5)：21.
[24]许爱娥,王遂泉.常用中药对酪氨酸酶的激活作用[J].中华皮肤科志,1998,31(1)：48.
[25]刘之力,涂彩霞.56种中药乙醇提取物对酪氨酸酶活性影响及动物致色素作用的研究[J].中华皮肤科杂志,2001,34(4)：284—285.
[26]Arrunategui A, Arroyo C, Garcia L et al. Melanocyte Reservoir in Vitiligo. lnt [J] dermatol,1994; 33:484-487.
[27]Vennegoor C, Hageman P, Van Nouhuijs H, et aLA monoclonal antibody specific for cells of the melanocyte lineage.Am [J] Pathol.1988:130(1):179-92.
[28]耿长山.黄芪的免疫药理作用研究[J].中西医结合杂志,1986(1)：62.
[29]杨风华,张文竹,康成等.黄茂水溶性黄酮类对小鼠T淋巴细胞及其亚群影响的量效关系研究[T].中国新医药,2003,2(4)：10.
[30]刘璋,胡佑伦,韩瑞玲.黑素生成过程中黄芩的调节作用[J]武汉大学学报(医学版),2005,(01)
[31]雷铁池,朱文元,夏明玉,张美华,范卫新.89味中药乙醇提取物对酪氨酸酶活性的上调作用[J]临床皮肤科杂志,1999,(03)
[32]李勇伟,许爱娥等.单味中药提取物对体外培养的黑素细胞酪氨酸酶基因和c-kit基因表达的激活作用[J].中华皮肤科杂志,2004 37(10)：598-600.
[33]王淑兰,李淑莲,董祟田等.构祀子等八种中药提取液对体外培养细胞和小鼠腹腔巨噬细胞影响的实验研究[J].白求恩医科大学学报,1990,16(4)： 325-328.
[34]刘娟,朱兆荣等.补骨脂粗黄酮对去卵巢小鼠的影响[J].中兽医学杂志,2005,1：4-6.
[35]杨柳,赖梅生等.白姨慕血清对酪氨酸酶活性的双向调节作用[J].陕西中医,2005,26(4)：370—373.
[36]陈昭,马照奎等.探讨蒺藜总皂贰对AMI大鼠模型血清中微量元素的变化[J].微量元素与健康研究,2001,18(3)：15.
[37]王燕平,李晓玉等当归补血汤中不同组分对正常及血虚小鼠免疫功能的影响[J].中草药,2002,33(2)：135-138.
[38]白润红,任娅等.三种中药多糖含量测定及与免疫关系研究结果[J].甘肃中医学院学报,1997,14(4)：25-28.