成教中医学本科皮肤及性传播疾病教学--81124红蝴蝶疮

,*,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,南方医科大学中医外科学教研室,南方医科大学中医外科学教研室 赖梅生,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,第,十一章第,24节,红蝴蝶疮,2021年6月6日星期六,大纲要求,熟悉本病的概念、病因病机及实验室检查,掌握诊断和辨证论治。,DLE,What is Lupus,Autoimmune disease that affect various organs such as skin, kidney, liver, joints, and blood,红蝴蝶疮是一种累及皮肤和全身多脏器的自身免疫性结缔组织病,Latin for wolf,Types of Lupus,Discoid LE(盘状),Systemic LE系统性,Drug-induced LE药物诱导,Neonatal LE新生儿,Who is at risk?,90% are women,临床特点,盘状红蝴蝶疮(DLE)：皮肤损害为主，面部常发生蝶形红斑，病变呈慢性局限性，预后较好。,系统性红蝴蝶疮SLE：皮肤损害多系统多脏器损害，呈进行性经过，预后较差。,本病女性患者占绝大多数，男女之比为1：10。发病年龄多在1545岁。,病因病机,肝肾亏损,热毒入里,六淫浸袭,暴晒,禀赋缺乏,药毒内浸,+,阴阳失调,脉络瘀阻,脏腑受损,急性期,热毒炽盛,后期/稳定期,Diagnosis,Criterion（标准）,Definition（定义）,1.,Malar Rash,Rash over the cheeks,2.,Discoid Rash,Red raised patches,3.,Photosensitivity,Reaction to sunlight, resul-ting in the development of or increase in skin rash,4.,Oral Ulcers,Ulcers in the nose or mouth,usually painless,面颊疹,Diagnosis,Criterion,Definition,5.,Arthritis,Nonerosive arthritis involving two or more peripheral joints (arthritis in which the bones around the joints do not become destroyed),6.,Serositis,Pleuritis or pericarditis (inflammation of the lining of the lung or heart),Diagnosis,Criterion,Definition,7.,Renal Disorder,Excessive protein in the urine and/or cellular casts,8.,NeurologicDisorder,Seizures and/or psychosis in the absence of drugs or metabolic disturbances which are known to cause such effects,Diagnosis,Criterion,Definition,9.,HematologicDisorder,Hemolytic anemia or leukopenia ( 4,000) or lymphopenia ( 1,500) or thrombocytopenia ( 100,000).,10.,AntinuclearAntibody,Positive test for antinuclear antibodies (ANA) in the absence of drugs known to induce it.,Diagnosis,Criterion,Definition,11.,ImmunologicDisorder,Positive anti-double stranded anti-DNA test, positive anti-Sm test, positive antiphospholipid antibody such as anticardiolipin, or false positive syphilis test (VDRL).,SLE诊断标准(1982年美国),面颊疹；,盘状红斑；,光敏感/光过敏；,口腔溃疡；,关节炎；,浆膜炎；,肾损害,精神神经病症；,血液学异常,抗核抗体阳性,免疫学异常,辨证论治内治,热毒炽盛 相当于系统性红蝴蝶疮急性活动期。面部蝶形、红斑鲜艳，皮肤紫斑。伴有高热，烦躁口渴，神昏谵语，抽搐，关节肌肉疼痛，大便干结，小便短赤。舌红绛，苔黄腻，脉洪数或细数。,治那么：清热凉血，化斑解毒，,方药：犀角地黄汤合黄连解毒汤加减。高热神昏者，加安宫牛黄丸或紫雪丹等。,辨证论治内治,阴虚火旺 斑疹暗红，伴有不规那么发热或持续低热，手足心热，心烦无力，自汗盗汗，面浮红，关节痛，足跟痛，月经量少或闭经。舌红，苔薄，脉细数。,治那么：滋阴降火,方药：六味地黄丸合大补阴丸、清骨散,辨证论治内治,脾肾阳虚 面色无华，眼睑、下肢浮肿，胸胁胀满，腰膝痠软，面热肢冷，口干不渴，尿少或尿闭。舌淡胖，苔少，脉沉细。,治那么：温肾壮阳，健脾利水,方药：附桂八味丸合真武汤加减，重者用参附汤,辨证论治内治,脾虚肝旺 皮肤紫斑，胸胁胀满，腹胀纳呆，头昏头痛，耳鸣失眠，月经不调或闭经。舌紫黯或有瘀斑，脉细弦。,治那么：健脾清肝,方药：四君子汤合丹栀逍遥散加减,辨证论治内治,气滞血瘀 多见于盘状局限型及亚急性皮肤型红蝴蝶疮。红斑暗滞，角栓形成及皮肤萎缩。伴倦怠乏力。舌黯红，苔白或光面舌，脉沉细。,治那么：疏肝理气，活血化瘀,方药：逍遥散合血府逐瘀汤加减,辨证论治外治,皮损外治以保护、避光、润肤为原那么。可用40%氧化锌油、或15%氧化锌软膏局部涂搽每日23次，外出前应在患处涂搽药膏以避光。,其他疗法,雷公藤制剂,关节病症严重者，可加用雷公藤多甙片，1mg/kg/d，分23次饭后服。主要副作用有消化道反响，肝肾功能损害、月经失调等。,西医疗法,急性发作或重证病例，应中西医结合治疗抢救，可选用肾上腺皮质激素及免疫抑制剂。,Drugs for SLE,Corticosteroids(糖皮质激素):,most commonly used. It can suppress inflammation and are commonly used in controlling SLE.,Immunosuppressive Drugs(免疫抑制剂): CTX(环磷酰胺), AZA(硫唑嘌呤),免疫抑制剂,死因,1.感染:肺部感染,预防与调摄,防止阳光照射。外出要注意防晒避光。,冬季注意防寒保暖，预防感冒。,生活规律，勿操劳过度，急性活动期的患者应卧床休息。,调畅情志，不急躁，戒烦恼，对疾病既重视又不背思想包袱。,坚持治疗，遵医嘱用药，不可擅自增减药量。,病例分析,患者女，38岁，患系统性红斑狼疮7年，服用强的松治疗，用量递减，现每日服30mg，仍有午后低热37.5度左右，自觉心烦乏力、手足心热、关节痛、脱发。检查：颜面有浸润性红斑，舌质红少苔，脉细数。,中医辨证：红蝴蝶疮气阴两伤证。,治法：益气滋阴，清热降火。,方药：生脉散合大补阴丸加减。,病例分析,太子参20 麦冬30 生地15,龟板15 黄柏15 知母15,女贞子15 旱莲草15,小 结,自身免疫性疾病,临床表现复杂多样,诊断:满足11条中的4条,治疗:中西医结合辨证长期规律治疗,参考学习资源,陈顺乐主编?系统性红斑狼疮?，上海科学技术出版社，2004年12。ISBN 7-5323-7813-6,卢君健主编?红斑狼疮中西医结合诊治?，人民卫生出版社，2007年。ISBN 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