内科

目的探讨异维A酸和阿奇霉素联合治疗青春期后中重度痤疮的效果及对患者性激素水平的影响。方法选取2013年5月至2018年2月在我院治疗的青春期后中重度痤疮患者100例为研究对象，按照随机数字表法分为观察组与对照组，每组50例。对照组患者给予0.1%阿达帕林凝胶治疗，观察组患者在此基础上给予异维A酸以及阿奇霉素治疗。两组患者的疗程均为1个月。比较两组患者的临床疗效；检测比较两组患者血清睾酮、孕酮、雌二醇、催乳素（PRL）、促卵泡激素（FSH）、黄体生成素（LH）水平；比较两组患者的皮脂分泌率及异常反应发生率。结果观察组患者的治疗总有效率（96.0%）高于对照组（72.0%），临床疗效显著优于对照组，差异有统计学意义（P＜0.05）。治疗1个月后，两组患者的睾酮、孕酮和PRL水平均显著降低，两组患者的雌二醇、LH水平以及观察组患者的FSH 及LH/FSH水平显著增高，差异有统计学意义（P＜0.05）；观察组患者睾酮、孕酮和PRL水平显著低于对照组，雌二醇、LH、FSH及LH/FSH水平显著高于对照组，差异有统计学意义（P＜0.05）。治疗后两组患者的皮脂分泌率均显著降低，观察组患者的水平显著低于对照组，差异有统计学意义（P＜0.05）。治疗过程中两组患者用药异常反应发生率比较差异无统计学意义。结论异维A酸联合阿奇霉素治疗青春期后中重度痤疮患者临床疗效显著，能有效改善患者的性激素水平，降低皮脂分泌率，治疗安全性高。

ObjectiveTo explore the efficacy of isotretinoin combined with azithromycin on moderate to severe acne after adolescence and their effects on sex hormone levels. MethodsA total of 100 patients with moderate to severe acne after adolescence treated in our hospital from May 2013 to February 2018 were selected as the study objects, and randomly divided into observation group and control group, with 50 cases in each group. The control group was treated with adapalene gel in 0.1%, whereas the observation group was treated with isotretinoin and azithromycin based on the treatment of the control group. The course of treatment for both groups was 1 month. The clinical efficacy, serum testosterone, progesterone, estradiol, prolactin (PRL), follicle stimulating hormone (FSH), luteinizing hormone (LH) levels, sebum secretion rate, and abnormal reaction rate were compared between the two groups. ResultsThe effective rate of the observation group (96.0%) was higher than the control group (72.0%), and the clinical efficacy was significantly better than the control group, with statistically significant difference (P＜0.05). After 1 month of treatment, the levels of testosterone, progesterone and PRL were significantly decreased in the two groups, whereas the levels of estradiol and LH in the two groups were significantly increased. The levels of FSH and LH/FSH in the observation group were significantly increased, with statistically significant difference (P＜0.05). The levels of testosterone, progesterone and PRL in the observation group were significantly lower than the control group, while the levels of estradiol, LH, FSH and LH/FSH were significantly higher than the control group, with statistically significant difference (P＜0.05). After treatment, the sebum secretion rate in the two groups was significantly decreased, and the level in the observation group was significantly lower than the control group,with statistically significant difference (P＜0.05). There was no statistically significant difference in the abnormal drug reaction rate in the two groups during the treatment. ConclusionIsotretinoin combined with azithromycin in the treatment of patients with moderate to severe acne after adolescence has a significant clinical efficacy, which can effectively improve the patients′ sex hormone levels, and reduce sebum secretion rate. In addition, it has high treatment safety.