慢性手部湿疹接触性变应原及皮损部位菌群的测定与治疗  

Detection and treatment of contact allergens and flora at the skin lesion site in chronic hand eczema

作　　者：汪瀚瀛 王海英[1] WANG Hanying;WANG Haiying(Department of Dermatology,Peking University Shougang Hospital,Beijing 100144,China)

机构地区：[1]北京大学首钢医院皮肤科,北京100144

出　　处：《中国医药科学》2025年第5期89-93,共5页China Medicine And Pharmacy

基　　金：北京大学首钢医院临床重点项目建设课题(2017-院-临床-09)。

摘　　要：目的探讨慢性手部湿疹患者的接触性变应原、皮肤表面定植细菌种类、单用激素药膏和联用抗生素药膏对治疗结局的影响。方法选择北京大学首钢医院皮肤科门诊94例慢性手部湿疹患者,分别进行手部湿疹严重指数(HECSI)评分、斑贴试验检测、皮损部位菌种测定。所有患者以随机数表法分为两组,单药组47例予卤米松乳膏治疗,联合用药组47例予卤米松乳膏联合复方多黏菌素B软膏治疗,观察两组HECSI评分及治疗1、2周后的疗效。结果94例患者中斑贴试验阳性率为71.28%,排名前5位为对苯二胺、硫酸镍、纺织染料混合物、甲醛、氯化钴,女性患者斑贴试验阳性率高于男性患者,差异有统计学意义(P<0.05)。患者皮损部位金黄色葡萄球菌检出率为17.02%,高于健康人群检出率。治疗1、2周后,联合用药组HECSI评分均较单药组降低更多,差异有统计学意义(P<0.05);治疗1周后,联合用药组有效率高于单药组,差异有统计学意义(P<0.05);治疗2周后两组有效率比较,差异无统计学意义(P>0.05),但联合用药组的治愈率更高。结论对苯二胺、硫酸镍、纺织染料混合物、甲醛、氯化钴是慢性手部湿疹主要变应原,患者皮损处金黄色葡萄球菌定植率高于健康人,卤米松乳膏与复方多黏菌素B软膏联用起效快、疗效确切。Objective To investigate the effects of contact allergens,bacterial species colonizing the skin surface,hormonal ointment alone and in combination with antibiotic ointment on the treatment outcome in patients with chronic hand eczema.Methods A total of 94 patients with chronic hand eczema in the outpatient clinic of our hospital were selected and subjected to hand eczema severity index(HECSI)scoring,patch test,and detection of bacterial species at the skin lesion site,respectively.All patients were divided into two groups using the randomized numerical table method.47 patients in the monotherapy group were treated with halomethasone ointment.47 patients in the combination group were treated with halomethasone ointment combined with compound polymyxin B ointment.The HECSI score and efficacy after 1 week and 2 weeks of treatment were observed in the two groups.Results The positive rate of patch test among 94 patients was 71.28%,with the top five being p-phenylenediamine,nickel sulfate,textile dye mixtures,formaldehyde,and cobalt chloride.The positive rate of patch test was higher in female patients than that in male patients,with a statistically significant difference(P<0.05).The detection rate of Staphylococcus aureus at the skin lesion site of the patients was 17.02%,which was higher than the detection rate in the healthy population.After 1 week and 2 weeks of treatment,the HECSI score decreased more in the combination group than that in the monotherapy group,with a statistically significant difference(P<0.05).After 1 week of treatment,the effective rate was higher in the combination group than that in the monotherapy group,with a statistically significant difference(P<0.05).The difference in the effective rate of the two groups after 2 weeks of treatment was not statistically significant(P>0.05).However,the cure rate was higher in the combination group.Conclusion P-phenylenediamine,nickel sulfate,textile dye mixtures,formaldehyde,cobalt chloride are the main allergens of chronic hand eczema.The colonization rate

关 键 词：手部湿疹 变应原 菌群 卤米松 复方多黏菌素B 

分 类 号：R752.1[医药卫生—皮肤病学与性病学]