调肝理脾养血法治疗银屑病血燥证的临床疗效观察

Clinical efficacy of regulating liver and spleen nourishing blood in blood dryness syndrome of psoriasis vulgaris

目的:评价调肝养血解毒汤治疗寻常型银屑病(白疕)血燥证的临床疗效、安全性及心理情绪状况,探讨调肝理脾养血法在寻常型银屑病血燥证的应用。方法:96例寻常型银屑病血燥证患者按2∶1的比例随机分为治疗组和对照组,治疗组给予调肝养血解毒汤口服,对照组给予养血解毒汤口服。疗程8周,采用银屑病临床体征面积和疾病严重程度评分(PASI)积分和中医证候积分改善率、综合医院焦虑/抑郁情绪测定表做为评价标准。结果:统计病例88例,治疗组60例,对照组28例。其中血燥证兼有肝郁脾虚证患者47例,治疗组31例,对照组16例。88例患者中,因情志因素诱发本病或加重者占总人数的30.68%,居各类诱因之首。同时,部分患者可能存在心理疾患。治疗组PASI积分总有效率为76.7%,对照组PASI积分总有效率为71.4%;治疗组中医证候积分总有效率63.3%,对照组中医证候积分总有效率60.7%,两组间无显著差异。进一步分析47例血燥证兼有肝郁脾虚证患者,治疗组PASI积分总有效率为87.1%,对照组PASI积分总有效率为62.5%,两组间有显著差异(P<0.05);在改善中医证候积分方面,治疗组显著优于对照组(P<0.05)。结论:肝与寻常型银屑病血燥证密切相关,肝郁脾虚是银屑病血燥证常见的兼夹证型,应用调肝理脾养血法治疗寻常型银屑病血燥证兼有肝郁脾虚证具有更良好的临床疗效。

Objective： To evaluate the clinical curative effect, safety and psychological state of Regulating Liver, Nourishing Blood and Detoxifying Decoction in patients with psoriasis vulgaris syndrome, and to discuss the application of regulating liver and spleen nourishing blood method in syndrome of blood dryness of psoriasis vulgaris. Methods： According to a 2 ： 1 ratio, 96 cases of psoriasis patients with blood dryness syndrome were randomly divided into treatment group and control group. The treatment group was given Regulating Liver, Nourishing Blood and Detoxifying Decoction and the control group was given Nourishing Blood and Detoxifying Decoction only. The whole treatment has lasted for eight weeks, using the improvement rate of PASI score and TCM treatment score as evaluation criteria. Results： There were 88 cases of statistical cases, 60 cases of them belonging to the treatment group and 28 cases belonging to the control group. Among all of them, there were 47 patients with liver depression and spleen deficiency syndrome, among which 31 were in the treatment group while 16 belonged to the control group. In the cases of 88 patients, 30.68% of the total number of people are inflicted or aggravated by emotional factors, ranking first in all types of incentives. At the same time, some patients may have mental disorders. About the improvement rate of PASI score-the total effective rate in the treatment group was 76.7%, and the total effective rate in the control group was 71.4%. The improvement rate of the efficacy score in the TCM： the total effective rate in the treatment group was 63.3%, and the total effective rate in the control group was 60.7%. There was no statistical difference between the two groups. Further analysis was performed on 47 patients with hepatic depression and spleen deficiency syndrome. The improvement rate of PASI scores-the total effective rate was 87.1% in the treatment group and 62.5% in the control group. There was a statistical difference between the two groups （P〈0.05）. The improvement rate of the efficacy score in the treatment group was better than the control group （P〈0.05）. Conclusion： Liver is closely related to the psoriasis syndrome of blood dryness. The deficiency of liver stagnation and spleen deficiency is a common type of pneumoconiosis syndrome and the treatment of psoriasis syndrome with regulating liver and soleen noufishinz blood method have better clinical efficacy.