【作者】 李智珍；

【导师】 池凤好；

【作者基本信息】 广州中医药大学 ， 中医外科学， 2007， 硕士

【摘要】 一、背景是皮肤科门诊的常见病、多发病。国内外的研究资料显示，青春期人群中80-90％的人都患过痤疮。其发病率逐年上升，且年龄跨度变大。痤疮的防治日益受到关注。国内外的流行病学资料提示，成年人痤疮以女性为主，且多为持续性。所以女性痤疮的治疗成为了目前痤疮研究的热点。西医治疗寻常痤疮的药物主要有抗雄性激素药、抑制皮脂腺分泌和抗角化药、抗生素和维生素等，另外，还有许多激光等物理治疗方法。但这些药物有着较大的副作用，激光治疗的费用昂贵，对于女性痤疮患者，目前仍需探讨一个可以长期使用又有效的理想治疗方案。痤疮在中医学中称为“肺风粉刺”，中医学文献很早就有记载。近几十年来，许多医家在传统痤疮病机理论的基础上提出了血瘀、湿热、痰结、肾阴不足、肝郁等新观点。在女性痤疮方面，临床中患者的病情往往与月经有关，我们认为女性痤疮的发生、发展与肝失疏泄，冲任不调密切相关，并且与肝经郁热也关系密切。据此我们根据多年的临床经验，拟定了滋阴清肝消痤方(女贞子、旱莲草、柴胡、郁金、丹参、鱼腥草等)，临床上用于阴虚火旺、肝经郁热型女性痤疮的治疗，取得了满意的临床疗效。痤疮常反复发作，影响美容，会对青少年的身心健康都带来不良影响，容易导致焦虑、抑郁、情绪低落，这些情况在女性中更为多见，甚至影响到他们的生存质量，而上述因素又会反过来影响痤疮的病情。因此，有关痤疮患者的生存质量研究也是一个研究热点。二、目的1．为寻求一种服用方便且疗效确切的中药制剂，本临床研究采用单味中药免煎颗粒，配成滋阴清肝消痤方颗粒，以观察滋阴清肝消痤方治疗女性痤疮的临床疗效。2．探讨中文版皮肤病生活质量表(DQOLS)和Cardiff痤疮伤残指数(CADI)在国内的适用性，以方便今后痤疮的生存质量调查。三、方法1．将列入观察的120例女性痤疮患者按随机分组原则分为滋阴清肝消痤方颗粒组60例，美满霉素组60例，分别治疗4周，两组均使用痤灵酊外搽。2．120例成年女性痤疮患者在4周治疗的前后均填写中文版皮肤病生活质量表(DQOLS)和Cardiff痤疮伤残指数(CADI)两种量表，然后分析量表的信度、效度和反应度。四、结果1．滋阴清肝消痤方颗粒治疗组治愈4例，显效14例，有效26例，无效8例，总有效率为84.6％；美满霉素对照组治愈5例，显效13例，有效25例，无效5例，总有效率为89.6％，两组疗效相仿(P＞0.05)。但治疗组发生药物不良反应事件7例，对照组发生不良反应事件9例，治疗组较对照组少。2．中文版皮肤病生活质量表(DQOLS)和Cardiff痤疮伤残指数(CADI)两量表的信度、效度均较好，而反应度均无统计学意义。五、结论1．滋阴清肝消痤方对成年女性痤疮患者的疗效好，与美满霉素的疗效相当，而且发生不良事件少，症状轻。2．皮肤病生活质量表(DQOLS)和Cardiff痤疮伤残指数(CADI)中文版量表具有较好的信度及效度，进行部分修改后，能作为我国痤疮患者生存质量的测评工具，但是量表的反应度有待进一步研究。更多还原

【Abstract】 Background: Ache vulgaris is a chronic and inflammatory skin disease involving in hair follicle and sebaceous gland that commonly occurs in adolescence and in young adulthood. It.is.commonly seen at department of dermatology, the major pathogenic factors involved are hyperkeratinization, obstruction of sebaceous follicles resulting from abnormal keratinization of the infundibular epithelium, stimulation of sebaceous gland secretion by androgens, and microbial colonization of pilosebaceous units by Propionibacterium aches, which promotes perifollicular inflammation. The lesions are often seen on the face, back and chest because the sebaceous glands in these regions are particularly active. It is characteristic of papules, pustule, node, cyst, and so on, with occurring repeatedly. Ache often appears on the surface of the facial skin, which has an effect on the beauty. With the improvement of the living conditions, people attach more and more importance to the treatment of the ache.Being founded from many researches, a majority of adult ache patients are female, and is durative. In western medicine, the main drugs for treating ache include the drugs of anti-androgen, the drugs that can restrict the secretionof sebaceous gland and anti-keratinization, antibiotics, vitamin and so on. In spite of numerous treatments available, they have some side-effect, no achetherapeutics has been found that is security, valid and ideal for women up to now.In traditional Chinese medicine, acne vulgaris is generally called as "lung-wind acne", it was recorded very early in Chinese literature. After systematically arranging historical records related to the pathogeny and mechanism of ache vulgaris, and carrying out an overview on literature in recent years, great advancement has been made in the understanding the pathogeny and mechanism of ache vulgaris in Traditional Chinese Medicine(TCM). The doctor of TCM form some new point of view that "Blood Deficiency", "Dampness and Heat", "Phlegm Accumulation", "Yin Deficiency of Kidney", "Liver Depression" and so on. For women, acne often outbreaks associated with menstruation, which is related to "Failure of the Liver to Dredge and Regulate" and "Dysfunction of Thoroughfare Vessel and Conception Vessel". The occurrence of ache vulgaris is closely associated with "Heat in Liver Meridian" besides "in Deficiency of Kidney" and "Yin Deficiency and Blood Heat". Based on the theory of above, we use Ziyin Qinggan Xiaocuo prescription (ZQXP, mainly composed of Fructus Ligustri Lucidi, Herba Ecliptae, Radix Bupleuri, Radix Curcumae, Radix Salviae Miltiorrhizae, Herba Houttuyniae, etc.) to treat ache of women. The therapeutic effect is satisfaction.Purpose: 1. In order to find a preparation of TCM, which has definite clinical effect and be convenience for taking, we use Single TCM concentrated Granules, of which Ziyin Qinggan Xiaocuo prescription Granules is composed. We study the clinical therapeutic effect of Ziyin Qinggan Xiaocuo prescription in treating female ache. 2. To research the applicability of Dermatology of Life Scales (DQOLS) and the Cardiff Ache Disability Index (CADI) in China, to convenient for the follow research about ache patients’ life quality.Method: 1. One hundred and twenty about female ache vulgaris patients were randomized into two groups by random number table. The two groups received external application of Cuo Ling Tincture (CLT, mainly composed of Radix Salviae Miltiorrhizae, Radix Angelicae Dahuricae, Radix Astragali, etc.), and group A was treated with Ziyin Qinggan Xiaocuo prescription and group B with minocyclin additionally. The treatment lasted 28 days. 2. 120 female adult ache patients fill the forms before and after four weeks. Than analyze the reliability, validity and responsivity.Results: 1. In group A, 4 were cured, 14 markedly effective, 26 effective and 8 ineffective, the total effective rate being 84.6%. In group B, 5 were cured, 13 markedly effective, 25 effective and 5 ineffective, the total effective rate being 89.6%, which is similar to that in group A (P＞0.05). Adverse action was found in 7 patients of group A and in 9 of group B. 2. The quality of two life forms have well reliability and validity. But the responsivities have no statistical meaning. Conclusion: 1. Ziyin Qinggan Xiaocuo prescription has a good therapeutic effect for adult female acne vulgaris, which is similar to minocyclin. Meanwhile, ZQXP has less and slight adverse actions. 2. Both DQOLS and CADI have well reliability and validity, and they can be used to measure the quality of life for Chinese acne patients after amended. But the responsivity needs more studies.更多还原