瘢痕疙瘩评分在激素封闭治疗中的应用  

Using Vancouver score to deduce the effect of corticosteroid injections on keloids

作　　者：潘靖[1] 张凡[1] 吕艳伟[2] 李静[1] 邝捷[1] 

机构地区：[1]北京积水潭医院皮肤科,100035 [2]北京市创伤骨科研究所临床统计与流行病学研究室

出　　处：《中国医药》2012年第8期1033-1035,共3页China Medicine

基　　金：基金项目：北京市积水潭医院院内基金（2011）

摘　　要：目的从瘢痕疙瘩患者治疗前温哥华瘢痕量表（VSS）评分推断激素封闭治疗的效果，进一步为患者制定合理的治疗方案。方法选取2011年1—3月于我院皮肤科就诊的瘢痕疙瘩患者46例，在没有禁忌证的情况下均采取复方倍他米松注射液（得宝松）封闭治疗作为一线治疗，每位患者选取≤2cm2瘢痕面积作为观察面积。在患者初诊时按VSS评分方法记录患者的总分及各分项分数。予以复方倍他米松注射液1ml局部封闭治疗，每4周注射1次，最多注射4次，每次治疗结束后记录患者总分及各分项分数。治疗结束后随访12个月，进行疗效评价。结果复方倍他米松注射液治疗瘢痕疙瘩有效28例，无效18例，总有效率为60．9％（28／46）。疗效与治疗前VSS总分、厚度评分、血管分布评分及柔软度评分相关性有统计学意义（Z=2．008、1．537、1．550、1．471，P=0．001、0．018、0．016、0．026），而与治疗前色泽相关性无统计学意义（Z=0．236，P=1．000）。通过对选定的治疗前各项指标的界值点进行ROC检验发现，当VSS总分为12，或厚度评分、血管分布评分及柔软度评分的总和为9时曲线下面积最大，为0．815。结论在推断激素封闭治疗瘢痕疙瘩的效果时以VSS总分作为标准较以各分项评分作为标准更准确，治疗前瘢痕疙瘩VSS总评分≥12，或厚度评分、血管分布评分及柔软度评分的总和≥9时选用激素封闭治疗效果不好，需选用综合治疗方法。Objective To investigate the treatment program for keloid patients and to judge the effect of corticosteroid injections by Vancouver score （VSS）. Methods The clinical manifestations and VSS data on 46 keloid patients from January 2011 to March 2011 were analyzed. Each patient with no contraindieations had Diprospan as a first-line treatment, and scar≤2 cm2 was as the observation area. Diprospan lml injection was given once 4 weeks. All patients were observed by the Vancouver score before injection therapies and were followed up for 12 months with a reference to the CAI Jinglong method for efficacy evaluation. Results Total effective rate was 61%. Efficacy was related with VSS scores, thickness scores, vascular distribution scores and softness scores. All data demonstrated statistically significant （Z = 2. 008, 1. 537, 1. 550, 1. 471, P = 0. 001, 0. 018, 0. 016, 0. 026）. Pre-treatment color scores had no correlation with efficacy （Z = 0.236, P = 1. 000）. We introduced the receiver operating characteristic （ROC） analysis with the cutoff point of the indicators on selected pre-treatment. The ROC diagnostic curve had the largest area with the VSS total score of 12, or with the sum of thickness, vascular distribution and softness scores of 9. Conclusions VSS score can be used as one more accurate marker than sub-score in the corticosteroid injections. With pre-treatment VSS total score ≥ 12, or the sum of thickness, vascular distribution and softness ≥ 9, patients should be treated with cortieosteroid injections.

关 键 词：瘢痕疙瘩 激素治疗 温哥华评分 

分 类 号：R751[医药卫生—皮肤病学与性病学]