孙妍 方芳 弭澜 曹岩

[摘要]目的：探讨寻常痤疮（风热证）患者应用耳穴贴压法联合拔罐治疗前后症状改善及血清Th1/Th2类细胞因子的变化。方法：选取2017年6月-2018年8月笔者医院收治的132例寻常痤疮患者（风热证），按随机数字表法分为三组，每组44例。三组均给予常规西药治疗，在此基础上，对照A组联合拔罐，对照B组给予耳穴贴压法，观察组给予拔罐+耳穴贴压法，共治疗4周。比较三组治疗效果、不良反应及治疗前后症状改善（红肿、脓疱、脱屑、疼痛）、血清Th1/Th2类细胞因子[干扰素γ（INF-γ）、肿瘤坏死因子-α（TNF-α）、白细胞介素-8（IL-8）]及激素水平[雌二醇（E2）、雄激素（T）、黄体生成素（LH）]的变化，并于治疗后随访3～6个月，统计复发率。结果：观察组治疗后总有效率（95.45%）高于对照A组（70.45%）和对照B组（72.73%）（均P<0.05）;治療后，观察组脓疱、疼痛、红肿及脱屑评分低于对照A组和对照B组（P<0.05）;治疗后，观察组血清INF-γ水平高于对照A组和对照B组，TNF-α、IL-8水平低于对照A组、对照B组（P<0.05）;治疗后，观察组E2、LH高于对照A组、对照B组，T水平低于对照A组和对照B组（P<0.05）;观察组不良反应发生率13.64%，与对照A组11.36%、对照B组9.09%比较，无显著性差异（P>0.05）;治疗后随访3个月、6个月，观察组复发率（2.38%、7.14%）与对照A组（7.32%、12.20%）、对照B组（5.00%、10.00%）比较，无显著性差异（P>0.05）。结论：耳穴贴压法联合拔罐治疗寻常痤疮（风热证），可有效改善患者临床症状体征，疗效显著、安全可靠，其机制可能与调控Th1/Th2、性激素有关。

[关键词]寻常痤疮;风热证;耳穴贴压法;拔罐;症状改善;Th1/Th2

[中图分类号]R758.73+3    [文献标志码]A    [文章编号]1008-6455（2021）01-0137-05

Study on Symptoms Improvement of Acne Vulgaris （Wind-heat Syndrome） Patients Before and After Auricular Point Sticking and Cupping Therapy and the Changes of Th1/Th2 Cytokines in Serum

SUN Yan， FANG Fang， MI Lan， CAO Yan

（Tangshan Hospital of Traditional Chinese Medicine，Tangshan  063000， Hebei，China）

Abstract： Objective  To investigate the improvement of symptoms before and after applying auricular point pressure combined with cupping in patients with acne vulgaris （wind-heat syndrome） and the changes of Th1/Th2 cytokines in serum. Methods  A total of 132 patients with acne vulgaris （wind-heat syndrome） treated in our hospital from June 2017 to August 2018 were selected，random number table method was used to divide into three groups， with 44 cases in each group.All three groups were treated with conventional western medicine，on this basis， the control group A was given cupping，the control group B was given auricular point pressure method， the observation group was given cupping plus auricular point pressure method，the treatment lasted for four weeks.The therapeutic effects， adverse reactions， improvement in symptoms （redness， pustule， desquamation， pain）， serum Th1/Th2 cytokines [interferon gamma （INF-γ）， tumor necrosis factor-α （TNF-α）， interleukin-8 （IL-8）] and hormone levels [estradiol （E2）， androgen （T）， luteinizing hormone （LH）] before and after treatment were compared among the three groups，the patients were followed up for three months and six months to calculate the recurrence rate. Results  After treatment，the total effective rate in the observation group （95.45%） was higher than that in the control group A （70.45%） and the control group B （72.73%） （P<0.05）.The scores of pustules， pain， redness， and desquamation in the observation group after treatment were lower than those in the control A and B groups （P<0.05）.After treatment， the serum INF-γ levels in the observation group were higher than those in the control A and B groups， and the levels of TNF-α and IL-8 were lower than those in the control A and B groups （P<0.05）;After treatment， E2 and LH in observation group were higher than those in control group A and control group B， and T levels were lower than those in control group A and control group B （P<0.05）.The incidence of adverse reactions in the observation group was 13.64% （6/44） compared with 11.36% （5/44） in the control group A and 9.09% （4/44） in the control group B， with no significant difference （P>0.05）.The recurrence rates in the observation group （2.38%， 7.14%） followed up for three months and six months after treatment were compared with those in control group A （7.32%， 12.20%） and control group B （5.00%， 10.00%），there was no significant difference （P>0.05）. Conclusion  Auricular point sticking combined with cupping for acne vulgaris （wind-heat syndrome） can effectively improve the clinical symptoms and signs，the effect is remarkable， safe and reliable， and its mechanism may be related to the regulation of Th1/Th2 and sex hormones.

Key words： acne vulgaris; wind-heat syndrome; auricular acupressure method; cupping; symptom improvement; Th1/Th2

寻常痤疮具有病情缠绵难愈、迁延反复等特点，严重影响患者外形美观、正常生活与工作[1-2]。现阶段西医治疗寻常痤疮，主要采取抗生素、维A酸等治疗，但复发率较高，且可能引发不良反应[3]。中医学治疗疾病重视辨证论治，具有疗效确切、安全性高的优点，近年来在寻常痤疮领域受到关注。耳穴贴压法是用胶布将药豆准确地粘贴于耳穴处，并给予一定刺激，以实现治疗疾病的目的，既往研究指出，其治疗寻常痤疮可改善患者皮损情况[4]。拔罐……