中西医结合治疗口腔扁平苔藓44例临床观察

Clinical Research of Integrated Chinese and Western Medicine Therapy for Oral Lichen Planus:A Report of 44 Cases

目的:观察清心导赤汤配合西医常规疗法治疗口腔扁平苔藓(OLP)的近期疗效及对远期复发的影响。方法:将88例患者随机分为2组各44例,2组均采用醋酸曲安奈德1 m L加2%利多卡因于糜烂区黏膜下局部注射,每周1次,共4次;对照组加用白芍总苷胶囊,连续服用12周;中西医结合组采用清心导赤汤内服,连续服用12周。治疗后进行客观指标体征、主观症状评价;检测血清肿瘤坏死因子α(TNF-α)、白细胞介素-4(IL-4)、白细胞介素-6(IL-6)水平;并记录6月后患者复发情况。结果:2组临床疗效经Ridit分析,中西医结合组优于对照组,差异有显著性意义(P<0.05)。治疗后2组客观指标和疼痛评分均较治疗前下降(P<0.01);中西医结合组上述指标评分降低较对照组更显著(P<0.01)。治疗后2组血清TNF-α、IL-4和IL-6水平均较治疗前下降(P<0.01);中西医结合组TNF-α、IL-4和IL-6水平降低较对照组更显著(P<0.01)。复发率中西医结合组为20.45%,对照组为43.18%,2组比较,差异有显著性意义(P<0.05)。结论:在西医常规治疗的基础上加用清心导赤汤治疗OLP近期和远期疗效均显著,其作用机制可能降低血清炎症因子水平有关。

Abstract： Objective： To explore the short-term effect of Qingxin Daoehi decoction combined with conventional western medicine therapy for oral lichen planus and to observe the long-term recurrence. Methods： Eighty-eight patients were randomly divided into the control group（44 cases） and the combination group（44 cases）. Both groups received one mL of triamcinolone acetonide with one mL of 2% lidocaine for local injection under erosive mucosa, once per week, lasting for 4 weeks. Additionally, patients in the control group received Total Glucosides of Paeony Capsules, and patients in the combination group were given Qingxin Daochi decoction orally for 12 continuous weeks. The scores of signs and symptoms were evaluated. Serum levels of tumor necrosis factor-alpha （TNF-a）, interleukin-6 （IL-6）, interleukin-4 （IL-4） were detected. The incidence of recurrence was recorded after 6 mouths. Results： The results of Ridit analysis showed that clinical effect of the combination group was superior to that of the control group（P 〈 0.05）. After treatment for 4 weeks, the scores of signs and pain scores were decreased in both groups（P 〈 0.01compared with those before treatment）, and the scores of the combination group were lower than those of the control group（P 〈 0.01）. After treatment, the serum levels of TNF-a, IL-4 and IL-6 were decreased in both groups（P 〈 0.01compared with before treatment）, and the levels of the combination group were lower than those in the control group（P 〈 0.01）. Recurrence rate was 20.45% in the combination group, and was 43.18% in the control group（P 〈 0.05）, the difference being significant（P 〈 0.05）. Conclusion： On the basis of conventional western medicine treatment, Qingxin Daochi decoction has both short-term and long-term effect for treatment of oral lichen planus, and the possible therapeutic mechanism is associated with the decrease of serum inflammatory factors levels.