以清颜汤湿敷联合中西药口服为治疗模式探讨多种疗法联合治疗玫瑰痤疮的有效性和必要性

A study on the effectiveness and necessity of multiple therapies in the treatment of rosacea:taking an example of Qingyan decoction wet compressed combined with oral Chinese and Western medicine

目的:探讨清颜汤湿敷联合自拟中药、米诺环素胶囊口服治疗玫瑰痤疮的有效性,并以此明确多种疗法联合治疗玫瑰痤疮的必要性。方法:运用随机数字表法,将60例符合条件、于2020年7月―9月就诊于德阳市中西医结合医院皮肤科门诊的受试者随机分为三组。试验组给予清颜汤(组成:寒水石、石膏、野菊花、马齿苋、白及、地骨皮、黄柏、甘草、地榆、槐花)3%浓度湿敷每天1次,每次0.5 h;中药免煎颗粒(组成:青蒿、鳖甲、生地黄、知母、牡丹皮、赤芍、桑白皮、地骨皮、黄柏、玄参、夏枯草)口服,每天3次;米诺环素胶囊50 mg,口服,每天2次。对照1组:中药免煎颗粒、米诺环素胶囊,口服,用量和次数同试验组,0.9%氯化钠溶液,湿敷,每天1次,每次0.5 h。对照2组:米诺环素胶囊,口服,用量和次数同前,0.9%氯化钠溶液,湿敷,次数和时间同对照1组。所有患者均给予清颜霜(由清颜汤去掉寒水石、石膏,加入牡丹皮、赤芍组成)外用。结果:组内对比分析,试验组在第3周,有8种临床表现较治疗前差异有统计学意义(P<0.05);第6周,10种临床表现均较治疗前差异有统计学意义(P<0.05)。对照1组在第3周,有9种临床表现较治疗前差异有统计学意义(P<0.05);第6周,有9种临床表现较治疗前差异有统计学意义(P<0.05)。对照2组:第3周,有8种临床表现较治疗前差异有统计学意义(P<0.05);第6周,有9种临床表现较治疗前差异有统计学意义(P<0.05)。三组组间对比,治疗前入组时的基线及治疗第3周、第6周差异均无统计学意义(P>0.05)。治疗过程中,共发生了14例轻度的不良反应,其中8例患者因不良反应自行出组,组间的不良反应发生率差异没有统计学意义(P>0.05);有1例患者因不愿坚持用药出组。结论:清颜汤湿敷联合自拟中药、米诺环素胶囊口服治疗玫瑰痤疮具有更全面的潜在疗效优势,多种疗法联合治疗玫瑰痤疮是必要的。

Objective:To explore the effectiveness of Qingyan decoction(清颜汤)wet compressed combined with self-made oral Chinese medicine and minocycline capsules in the treatment of rosacea,and to clarify the necessity of multiple therapies for the treatment of rosacea.Methods:A total of 60 eligible subjects who attended the Dermatology Clinic of Deyang Hospital of Integrated Traditional Chinese and Western Medicine from July 2020 to September 2020 were randomly divided into 3 groups,using the method of random number table.The test group members were given the Qingyan decoction[composition:Hanshuishi(gypsum rubrum),Shigao(gypsum),Yejuhua(chrysanthemum indicum),Machixian(purslane),Baiji(Bletilla striata),Digupi(cortex rehmanniae),Huangbo(Cortex Phellodendri),Gancao(licorice),Diyu(Sanguisorba officinalis),Huaihua(Sophora japonica)]wet compressed with 3%concentration for half an hour once a day.Decoction-free granules of traditional Chinese medicine[composition:Qinghao(artemisia annua),Biejia(trionyx sinensis),Shengdihuang(rehmannia),Zhimu(anemarrhena asphodeloides),Mudanpi(cortex moutan),Chishao(radix paeoniae rubra),Sangbaipi(cortex mori),Digupi,Huangbo,Xuanshen(radix scrophulariae),Xiakucao(prunella vulgaris)]orally three times a day,minocycline capsule 50 mg orally twice a day.The control group 1:TCM decoction-free granules and minocycline capsules were taken orally,the dosage and frequency were the same as those in the test group,and normal saline wet compressed once a day for half an hour each time.The control group 2:oral minocycline capsules,with the same dosage and frequency as before;normal saline wet compress with the same frequency and time as the control group 1.All patients were given the Qingyan cream(清颜霜)(consisting of Qingyan decoction,removing Hanshuishi and Shigao,adding Mudanpi and Chishao)for external use.Results:In the comparative analysis within the group,at the third week in the test group,there were 8 sorts of clinical manifestations that were significantly different from those before treatment(P<0.05),at the 6th week,all 10 sorts of clinical manifestations were significantly different from those before the treatment(P<0.05).In the control group 1,at the 3rd week,there were 9 sorts of clinical manifestations that were significantly different from those before the treatment(P<0.05),at the 6th week,there were 9 sorts of clinical manifestations that were significantly different from those before the treatment(P<0.05).In the control group 2:at the third week,there were 8 sorts of clinical manifestations that were significantly different from those before treatment(P<0.05).At the 6th week,there were 9 sorts of clinical manifestations that were significantly different from those before treatment(P<0.05).There was no statistical difference among the three groups in the baseline at the time of enrollment before treatment and the 3rd and 6th weeks of treatment(P>0.05).During the periods of treatment,a total number of 14 cases of mild adverse reactions occurred,of which 8 patients were discharged from the group due to adverse reactions,and there was no statistical difference in the incidence of adverse reactions among the groups(P>0.05).And 1 patient was discharged due to unwillingness to insist on medication.Conclusion:The Qingyan decoction wet compressed combined with self-made TCM medicine and oral minocycline capsules has more comprehensive potential therapeutic advantages in the treatment of rosacea,and it is necessary to take combine multiple therapies to treat rosacea.