活血祛淤解毒方治療尋常型銀屑病血淤證的臨床研究

1、活血祛淤解毒方治療尋常型銀屑病血淤證的臨床研究                    作者：王倩，王萍，蔡念寧，王禾，張廣中，王莒生 【摘要】  目的評(píng)價(jià)北京地區(qū)名老中醫(yī)經(jīng)驗(yàn)方活血祛淤解毒方治療尋常型銀屑病血淤證的臨床療效及安全性，以及對(duì)患者血液流變學(xué)及皮損浸潤(rùn)程度的影響。方法將42例尋常型銀屑病血淤證患者隨機(jī)分為治療組和對(duì)照組，治療組口服活血祛淤解毒方，對(duì)照組口服接診醫(yī)師自擬

2、方。觀察兩組的臨床療效及PASI評(píng)分,并同時(shí)檢測(cè)兩組治療前后血液流變學(xué)及皮損浸潤(rùn)程度的改變。結(jié)果治療組、對(duì)照組總有效率分別為73.68%，82.61%，無(wú)統(tǒng)計(jì)學(xué)差異(P>0.05)。兩組治療后PASI評(píng)分均降低(P<0.01)、血漿粘度均降低(P<0.05)，治療組皮損真皮厚度明顯降低(P<0.01)，對(duì)照組皮損表皮、真皮厚度均降低(P<0.05)。結(jié)論活血祛淤解毒方治療尋常型銀屑病血淤證療效滿意，與醫(yī)師自擬方療效相當(dāng)，值得臨床推廣應(yīng)用。其作用機(jī)制可能在于降低血液粘度、改善微循環(huán)、減輕皮損浸潤(rùn)程度。 【關(guān)鍵詞】  銀屑??； 血淤證； 活血祛瘀解毒方； 血

3、液流變學(xué)； 皮損厚度Abstract：ObjectiveTo evaluate the clinical effects and safety of Huoxue-quyu-jiedu formula created by a few famous herbalist doctors in Beijing on blood stasis syndrome of psoriasis vulgaris，and to observe its influence on hemorheology and soakage degrees of skin lesions . Methods42 patien

4、ts were selected and randomly divided into 2 groups: therapeutic group and control group. Patients in the therapeutic group took Huoxue-quyu-jiedu formula and those in the control group had the recipe prescribed by doctors themselves for 8 weeks. Therapeutic effect and PASI scores were recorded and

5、the influence on hemorheology and soakage degrees of skin lesions were observed before and after treatment. ResultsThe effective rates were 73.68% and 82.61% in the therapeutic group and in the controll group respectively. There was no statistical difference in therapeutic effects between the two gr

6、oups(P>0.05). PASI scores decreased in both groups and showed significant difference statistically before and after treatment(P<0.01). Plasma viscosity decreased in both groups and showed statistical difference before and after treatment(P<0.05). The dermis thickness decreased significantly

7、 in therapeutic group (P<0.01). The epidermis and dermis thickness both decreased in the control group (P<0.05). ConclusionHuoxue-quyu-jiedu formula had a satisfying effect on treating blood stasis syndrome of psoriasis vulgaris, similar to the recipes prescribed by doctors themselves. It is w

8、orth to clinical application and extension. Its mechanism probably lies in reducing the plasma viscosity, improving microcirculation and reducing the soakage degree of skin rash.Key words：Psoriasis vulgaris；  Blood stasis syndrome；  Huoxue-quyu-jiedu formula；  Hemorheology；  Lesi

9、on thickness of skin    銀屑病是一種慢性炎癥性、紅斑鱗屑性、反復(fù)發(fā)作的難治性皮膚病,發(fā)病率高,是目前國(guó)內(nèi)外皮膚科領(lǐng)域內(nèi)的重點(diǎn)研究課題?；钛铕鼋舛痉绞潜本┑貐^(qū)16位名老中醫(yī)治療銀屑病血淤證的基本方，本研究觀察了“活血祛淤解毒方”治療銀屑病血淤證的臨床療效，取得滿意效果，并與醫(yī)師自擬方進(jìn)行比較，同時(shí)觀察該方對(duì)銀屑病血淤證患者的血液流變學(xué)及皮損浸潤(rùn)程度的影響，探討該方的可能作用機(jī)制。1  臨床資料1.1  診斷標(biāo)準(zhǔn)1.2  一般資料尋常型銀屑病患者42例,隨機(jī)分為治療組和對(duì)照組，治療組19例,其中男16例，女3例，

10、年齡2265歲,平均(43.84±12.63)歲；病程半年45年,平均(11.50±11.72)年；PASI評(píng)分4.8044.00分，平均(17.40±10.33)分。對(duì)照組23例，其中男19例，女4例，年齡2364歲,平均(43.48±13.20)歲，病程1 38年，平均(13.78±9.61)年；評(píng)分4.6037.60分，平均(14.40±9.20)分。兩組資料構(gòu)成差異無(wú)顯著性，在近2月內(nèi)均未使用糖皮質(zhì)激素、免疫抑制劑和維甲酸類(lèi)。2  治療及檢測(cè)方法2.1  治療方法治療組口服活血祛淤解毒方（桃仁、紅花、丹參、

11、雞血藤、莪術(shù)、鬼箭羽、白花蛇舌草），隨證加減：熱重：大青葉、紫草；瘀重：赤芍、三棱；夾燥：生地、麻仁、元參；夾濕：苦參、虎杖、陳皮；咽痛：北豆根。每日1劑，水煎日2次，早晚服用。    對(duì)照組口服醫(yī)師自擬方（初診醫(yī)師要求主治醫(yī)師以上資格、有多年臨床經(jīng)驗(yàn)，治則：活血化瘀解毒，沒(méi)有規(guī)定固定的方藥，從而使醫(yī)師自擬方更具普遍性意義），兩組病人均采用外用芩柏軟膏（北京中醫(yī)醫(yī)院院內(nèi)制劑）。連續(xù)用藥8周，每2周復(fù)診1次，療程結(jié)束后分別統(tǒng)計(jì)療效。2.2  觀察項(xiàng)目及檢測(cè)方法3  結(jié)果3.1  兩組療效比較治療組痊愈1例，顯效3例，有效10例，無(wú)效5例，痊愈顯效率為21.05%，總有效率（痊愈顯效有效）為73.68%；對(duì)照組痊愈0例，顯效4例，有效15例，無(wú)效4例，痊愈顯效率為17.39%，總有效率（痊愈顯效有效）為82.61%。經(jīng)2檢驗(yàn)，兩組患者臨床療效無(wú)顯著性差異（P>0.05）。3.2  兩組治療前后皮損面積、紅斑、鱗屑、浸潤(rùn)、瘙癢程度及PASI評(píng)分比較見(jiàn)表1。結(jié)果表明