| Objective: To investigate the RCM characteristics of various TCM syndromes of advanced vitiligo and evaluate the efficacy of different glucocorticoids in the treatment of advanced vitiligo.Methods: A total of 70 outpatients with vitiligo who met the diagnostic criteria and had VIDA score ? 3 in our hospital(affiliated hospital of tianjin academy of traditional Chinese medicine)from June 2019 to December 2019 were selected.The patients were informed to complete the vitiligo questionnaire and record their general conditions and medical history.Patients were randomly divided into 2 groups: acesson group: yuqu anxilong tablet(brand name: acesson,tianjin tianyao pharmaceutical co.,LTD.),with an average of 0.25 mg/kg·d,taken orally,halved every week or every 2 weeks,and discontinued for 3 months;Debaosone group: compound betamethasone injection(trade name: debaosone,Shanghai schering-bao pharmaceutical co.,LTD.)was administered with 1.0ml intramuscular injection for 1 time/month and 3 times in a row.At the same time,according to patients' clinical symptoms and skin lesions of syndrome differentiation and treatment,oral indicated in our college particle number ? in white spot words Z20070008(tianjin medicine system)on the basis of add and subtract,2 times/day.Return to the clinic every 2 weeks,observe and record the change of curative effect,and follow up every month.Before treatment,skin CT was used to observe the infiltration of inflammatory cells in leukoplakia and the degree of hypochromia,and the RCM characteristics of different TCM syndromes were recorded in combination with TCM syndromes.After treatment,visual observation and skin CT monitoring were used to evaluate and record the recoloration.Relevant indicators were input into the computer and SPSS24.0 was used to establish a database.The measurement data in line with normal distribution were expressed as mean ± standard deviation.Independent sample T test was used for comparison between the two groups.Mann-whitneyu test was used to compare the measurement data of skewness distribution between the two groups.The count data were expressed in terms of frequency and percentage.The comparison between groups was conducted by chi-square test of four-lattice table data or chi-square test of row × list data.Results: 1.TCM syndromes of patients in the advanced stage were mostly the syndrome of qi and blood disharmony,liver stagnation and qi stagnation.The syndrome of meridians stasis,liver and kidney deficiency,spleen and stomach weakness were less.2.RCM observation results 2.1 analysis of clear boundary of leucorrhea: both qi and blood disorders and qi stagnation syndrome were dominated by skin lesions with less clear edge of leucorrhea(P > 0.05).2.2 analysis of the degree of hypochromia in the basal layer of leukoplica: most of the lesions in the syndrome of qi and blood disharmony and qi stagnation in liver depression showed focal loss of pigment in the basal layer,while a few lesions showed complete loss of pigment in the basal layer(P > 0.05).2.3 analysis of focal or complete absence of pigment ring in basal layer of leuconia: focal absence of basal cell ring was common in both qi and blood disharmony syndrome and qi stagnation syndrome of liver depression.Partial complete absence was observed in some cases,and most of the ring of a few dermal cells was present,and the local area was unclear(P > 0.05).2.4 analysis of inflammatory cell infiltration: the proportion of inflammatory cell infiltration in the skin lesions of patients with qi and blood disharmony was higher than that of liver stagnation and qi stagnation(P < 0.05).2.5 analysis on the deposition of phagocytes and pigment particles in the superficial dermis: most of the patients with qi and blood disharmony syndrome and qi stagnation syndrome could see the deposition of phagocytes and pigment particles in the superficial dermis at the skin lesions,but the proportion of the patients with qi and blood disharmony syndrome was relatively high(P < 0.05).2.6 analysis of the distribution of dendritic melanocytes or granular pigment: fewer dendritic melanocytes were found in the skin lesions of patients with qi and blood disorder and qi stagnation syndrome(P >0.05).2.7 analysis of basal cell ring integrity: incomplete basal cell ring was observed in the skin lesions of patients with qi and blood disorder and qi stagnation syndrome(P >0.05).2.8 analysis of intercellular edema: the proportion of intercellular edema in the skin lesions of patients with qi and blood disharmony was higher than that of liver stagnation and qi stagnation(P < 0.05).3.Efficacy evaluation: the total effective rate of treatment in the acesson group(93.55%)was higher than that in the depot pine group(74.29%),and the difference was statistically significant(P < 0.05).3.1 efficacy evaluation based on VASI score: VASI score in both the assesone group and the deposone group was lower than that before the treatment 3 months later;After 3 months of treatment,the total VASI score of patients in the acesson group was significantly lower than that of the depot pine group,and the difference was statistically significant(P < 0.05).3.2 evaluation of onset time based on RCM observation: the mean onset time in the acesson group under RCM was earlier than that in the debaosong group,and the difference was statistically significant(P < 0.05).The onset time of RCM at different time periods and that observed by naked eyes were different.The observed onset time under microscope was earlier than that observed by naked eyes,and the difference was statistically significant(P < 0.05).4.Safety evaluation: among the 66 patients included in the study,there were a total of 34 patients with adverse reactions,with a total incidence of 51.52%,65.52% in the acesson group,and 40.00% in the deposone group,with statistically significant differences(P < 0.05).Conclusion: 1.The syndrome of qi and blood disharmony and qi stagnation of liver depression were observed in patients with advanced vitiligo.2.The differences between qi and blood disaccord syndrome under RCM and qi stagnation syndrome under RCM were mainly due to the different degrees of inflammatory cell infiltration,the deposition of pigment macrophages and pigment particles in the superficial dermis,and the presence or absence of intercellular edema.No significant differences were observed in other indicators.This may be because the sample size is too small,the observation time is concentrated,and the judgment of TCM syndrome type lacks professional evaluation.The sample size should be enlarged,the observation time should be broadened,and the syndrome diagnosis should be more standardized.3.The characteristic features of RCM syndrome of qi and blood disaccord are as follows: the edge of white spot is not clear,the pigment in basal layer is obviously decreased,the ring of basal cells is missing,the real epidermis is often infiltrated by inflammatory cells,the dermal papilla and the superficial layer of dermis are often seen with a large number of pigmented cells or pigment particles deposition,and the intercellular edema is often seen.4.The characteristics of liver stagnation syndrome under RCM are as follows: the margins of the white spots are not clear,the pigment in the basal layer is significantly decreased,the basal cell ring is missing,inflammatory cell infiltration can be seen in the surface dermis,and the deposits of phagocytes and pigment particles can be seen in the superficial dermis,or the intercellular edema can be seen.5.The effect of glucocorticoid on the control of advanced vitiligo was definite.6.Rapid progression of vitiligo patients oral trianxilon tablets can be quickly controlled in a short time.7.In the treatment of advanced vitiligo with oral glucocorticoid according to systematic rules,patients should take drugs strictly according to the doctor's advice and reduce the dosage.The compliance of oral corticosteroids in a long period of time may be hindered by the psychological effect and the high incidence of side effects.Timely revisit and strict follow-up are particularly important.For patients with poor compliance and convenient and quick requirements,the method of muscle injection can be used.8.RCM can observe early rechromatism earlier than the naked eye,which is conducive to timely adjusting the treatment plan and can be used as an effective means for clinical efficacy evaluation. |
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