痤疮伴排便不畅患者面部与肠道微生态特征分析

Exploration of facial and intestinal microbiota characteristics in acne patients with defecation difficulty

关键词:  排便不畅  痤疮  中医辨证分型  微生态

Key words:  defecation difficulty  acne  traditional Chinese medicine syndrome differentiation  microbiota

摘要:

[目的] 探讨伴排便不畅的痤疮患者不同中医证型的面部及肠道微生态特征。[方法] 采用回顾性研究方法，对痤疮伴排便不畅患者进行中医辨证，分别为肺经风热证、脾胃湿热证、冲任不调证和痰瘀凝结证。依据Pillsbury国际改良痤疮分级法评估患者皮损严重程度，运用皮肤镜伍德灯联合VISIA皮肤图像分析系统定量检测面部痤疮丙酸杆菌分布，采用粪便中革兰阳性杆菌（G+B）及革兰阴性杆菌（G-B）比例，评估肠道微生态。结合痤疮患者的排便不畅情况，比较不同中医证型患者的皮损严重程度、面部痤疮丙酸杆菌数值及肠道菌群异常比例。[结果] 研究共纳入101例伴排便不畅的痤疮患者。不同证型患者排便情况差异存在统计学意义（P<0.05），肺经风热证以大便干结为主，脾胃湿热证大便黏腻更为突出；肠道菌群分布异常比例以脾胃湿热证最高（51.52%），但和其他证型比较，差异无统计学意义（P>0.05）；面部痤疮丙酸杆菌分析，肺经风热证、脾胃湿热证患者面部痤疮丙酸杆菌数值高于冲任不调证、痰瘀凝结证（P<0.01）；皮损方面，痰瘀凝结证患者痤疮严重程度高于肺经风热证、脾胃湿热证及冲任不调证（P<0.01）。[结论] 不同中医证型的痤疮伴排便不畅患者，面部及肠道微生态特征存在差异。

Abstract:

[Objective] To explore the facial and intestinal microecological characteristics in acne patients with defecation difficulty across different traditional Chinese medicine（TCM） syndrome types. [Methods] A retrospective study was conducted. Acne patients with defecation disorders were classified into four TCM syndrome types via TCM syndrome differentiation：Lung Meridian Wind-Heat Syndrome，Spleen-Stomach Damp-Heat Syndrome，Chong-Ren Disharmony Syndrome，and Phlegm-Stasis Coagulation Syndrome. The severity of skin lesions was evaluated according to the modified Pillsbury International Acne Grading System. The distribution of Cutibacterium acnes（formerly Propionibacterium acnes） on the face was quantitatively detected using a combination of dermoscope，Wood’s lamp，and VISIA skin image analysis system. Intestinal microecology was assessed by determining the ratio of gram-positive bacilli（G+B） to gram-negative bacilli（G-B） in feces. By integrating the defecation disorder status of acne patients，comparisons were made among patients with different TCM syndrome types in terms of skin lesion severity，quantitative value of facial C. acnes，and abnormal ratio of intestinal flora. [Results] A total of 101 acne patients with defecation disorders were enrolled. There was a statistically significant difference in defecation status among patients with different TCM syndrome types（P<0.05）. Specifically，dry and hard stools were the main manifestation in patients with Lung Meridian Wind-Heat Syndrome，while sticky stools were more prominent in those with Spleen-Stomach Damp-Heat Syndrome. The Spleen-Stomach Damp-Heat Syndrome group had the highest abnormal ratio of intestinal flora（51.52%），but this difference was not statistically significant compared with other syndrome types（P>0.05）. The quantitative values of facial C. acnes in patients with Lung Meridian Wind-Heat Syndrome and Spleen-Stomach Damp-Heat Syndrome were significantly higher than those in patients with Chong-Ren Disharmony Syndrome and Phlegm-Stasis Coagulation Syndrome（P<0.01）. The acne severity in patients with Phlegm-Stasis Coagulation Syndrome was significantly higher than that in patients with the other three syndrome types（P<0.01）. [Conclusion] Patients with acne and defecation disorders of different TCM syndrome types exhibit differences in facial and intestinal microecological characteristics.