基于真实世界探讨蜈蚣败毒饮治疗寻常性银屑病的证候分布与基线特征

Exploration of the Syndrome Distribution and Baseline Characteristics of Wugong Baidu Yin(蜈蚣败毒饮)in the Treatment of Psoriasis Vulgaris Based on the Real World

目的基于真实世界整理和归纳蜈蚣败毒饮治疗寻常性银屑病的证候分布特点,同时对其基线特征进行分析,为临床科学应用蜈蚣败毒饮提供依据。方法采用医院信息管理系统(hospital information system,HIS)和电子病历系统(electronic medical record,EMR)对近5年使用蜈蚣败毒饮治疗的2836例寻常性银屑病患者的证候分布与基线资料进行分析,从血热、血燥、血瘀、血虚、血寒、血毒6种证候对患者进行分类,再从人口学特征、银屑病病情严重程度特征及中医症状特征的基线水平上进行分证候研究。结果在证候分布方面,蜈蚣败毒饮最多应用于血热证患者,其次为血瘀证和血毒证。在人口学基线特征方面,蜈蚣败毒饮的治疗靶向以肥胖或偏胖的中年人群为主,多发生于冬季,尤以哈尔滨本地及黑龙江北部的寒冷地区患者为多,皮损多位于下肢或躯干部,其中血热证年龄最低(P<0.01),血瘀证年龄最高(P<0.05);男性居多,尤以血毒证比例最高;血瘀证患者多伴酗酒史;血热证、血寒证、血毒证的部分患者可因感染而诱发。在银屑病病情严重程度基线特征方面,所治疗的主要为银屑病体表面积和严重程度指数(psoriasis area and severity index,PASI)>10,体表面积(body surface area,BSA)>10%,皮肤病生活质量指数(dermatology life quality index,DLQI)>10的重度寻常性银屑病患者,严重程度依次为血毒证、血瘀证、血热证(P<0.05或P<0.01)。在中医症状基线特征方面,多伴有瘙痒和便干的症状,以血热证、血毒证最为显著(P<0.05或P<0.01)。结论蜈蚣败毒饮可用于寻常性银屑病以血热、血瘀、血毒为主的各证候的治疗,肥胖、寒冷、感染、中下部、重度、瘙痒、便干等为其主要的应用参考指征。

Objective Sorting out and summarizing the syndrome distribution characteristics of Wugong Baidu Yin(蜈蚣败毒饮)in the treatment of psoriasis vulgaris based on the real world,at the same time,the baseline characteristics are analyzed to provide evidences for clinical scientific application of Wugong Baidu Yin.Methods The syndrome distribution and baseline data of 2836 patients with psoriasis vulgaris treated with Wugong Baidu Yin in recent 5 years were analyzed by HIS system and EMR system,the patients were classified from six syndromes of blood heat,blood dryness,blood stasis,blood deficiency,blood cold and blood toxin,then,the study of syndrome differentiation was carried out at the baseline level of demographic characteristics,severity characteristics of psoriasis and TCM symptom characteristics.Results Wugong Baidu Yin was most commonly used in patients with blood heat syndrome,followed by blood stasis syndrome and blood toxin syndrome in the aspect of syndrome distribution.In terms of demographic baseline characteristics,the treatment targets of Wugong Baidu Yin were mainly middleaged people who were fat or overweight,the disease often occured in winter,especially in Harbin and the cold area in the north of Heilongjiang,the skin lesions were mostly in the lower limbs or body cadres,of which the age of blood heat syndrome was the lowest(P<0.01),and the age of blood stasis syndrome was the highest(P<0.05);Meanwhile,most of them were male,especially the proportion of blood toxin syndrome was the highest;And the patients with blood stasis syndrome may have alcohol history;Some patients with blood heat syndrome,blood cold syndrome and blood toxin syndrome could be induced by infection.In terms of baseline characteristics of psoriasis severity,patients with severe psoriasis vulgaris were treated with PASI>10,BSA>10%and DLQI>10,the order of severity was blood toxin syndrome,blood stasis syndrome and blood heat syndrome(P<0.05 or P<0.01).In terms of baseline characteristics of TCM symptoms,most of them were accompanied by pruritus and dry stool,and blood heat syndrome and blood toxin syndrome were the most significant(P<0.05 or P<0.01).Conclusions Wugong Baidu Yin can be used in the treatment of psoriasis vulgaris with blood heat,blood stasis,blood toxin and other syndromes,obesity,cold,infection,middle and lower part,severe,pruritus and dry stool are the main application reference signs.