综合疗法治疗原发性肛门瘙痒症的临床研究

Comprehensive Therapy for Primary Pruritus Ani.Clinical Study

为比较3种综合疗法治疗原发性肛门瘙痒症（PA）的效果,探讨一种理想的治疗原发性PA的方法,本研究将90例原发性PA患者随机分为A、B、C组,各30例,A组予氯雷他定胶囊口服＋派瑞松软膏外用治疗,B组予亚甲蓝局部注射＋派瑞松软膏外用治疗,C组予曲安萘德局部注射＋派瑞松软膏外用治疗.对比3组患者近远期临床疗效.结果显示,1）近期临床疗效：B组总有效率明显高于A组,P〈0.05;A组与C组、B组与C组比较差异均无统计学意义,P〉0.05.B组治愈率明显高于A组和C组,P〈0.0001或P〈0.05;A组与C组比较差异无统计学意义,P〉0.05.2）远期临床疗效：3组治疗后6个月和12个月总有效率比较差异均无统计学意义,P〉0.05.3）并发症：A组急性期治疗无明显并发症,B组与C组均有一定并发症,B组并发症发生率明显高于C组,P〈0.05.4）有效控制致病因素与1年后总有效率间的关系：能有效控制致病因素的病例组1年后的总有效率明显高于未能有效控制致病因素的病例组,P〈00.001.结果表明,亚甲蓝局部注射联合派瑞松软膏外用治疗原发性PA的效果优于氯雷他定胶囊口服或曲安萘德局部注射联合派瑞松软膏外用治疗,但是亚甲蓝局部注射联合派瑞松软膏外用治疗并发症较多.因此,笔者认为对于症状较重的急性期原发性PA可采用亚甲蓝局部注射配合外用派瑞松软膏的方法治疗,对于轻症及慢性期原发性PA可采取口服抗组织胺类药物配合外用派瑞松软膏的方法治疗.原发性PA的治疗重在针对病因病机,关键是去除可能的致病因素.

This study was to search for a ideal therapy for primary pruritus ani（PA） through comparing the efficacies of three comprehensive therapies for primary PA,randomly divided 90 primary PA patients into group A,B,C,30 cases for each,which group A was treated with oral administration of loratadine cap- sule and pevisone cream externally used（short name： LP）,group B with locally injecting methylene blue plus pevisone cream externally used （short name： MP）,group C with locally injecting Azmacort plus pevi- sone cream externally used（short name：AP）;then compared the short- and long-term efficacy among the 3 groups.As results, 1）short-term effect：in total effective rate group B was significantly higher than group A （ P〈0.05） ,there was no statistical difference between group A and group C,so too between group B and group C（ P 〉0.05）;in curative rate group B was significantly higher than group A and group C（ P d0. 0001 or P〈0.05）,there was no statistical difference between group A and group C（ P ）0.05）.2）long- term effect：in total effective rate of 6 and 12 months after treatment there was no statistical difference a- mong the 3 groups（ P ）0.05）. 3）complication： in acute phase no appearant complication was found in group A,but certain complication was all found in group B and group C,and its incidence of group B was significantly higher than that of group C（ P〈0.05）.4）the relationship of effectively controlled pathgenesis factors and total effective rate 1 year after treatment：in the case-group（pathgenesis factors were effectively controlled） total effective rate 1 year after treatment was significantly higher than that in the case-group （non-controlled effectively）（ P〈0.0001）.Results show that the efficacy of MP on primary PA is superior to that of LP and AP,merely MP has more complication, so for beverer acute primary PA, MP should be used,but for lighter and chronic patients it could be used that oral antihistaminics are combined with externally used ointment.It is noticed that the treatment of primary PA should be focus on its etiology and pathogenesis,removing inducing factor is the key.