超脉冲CO2点阵激光治疗甲真菌病疗效观察  

Efficacy of a superpulse-mode fractional carbon dioxide laser for the treatment of onychomycosis：a clinical observational study

作　　者：杨阳[1] 刘涵[1] 杨蓉娅[1] 黄昕欣[2] 景东云[2] 王玲[2] 刘维达[3] 吕雪莲[1] 

机构地区：[1]北京军区总医院皮肤科,100700 [2]大连医科大学大连市皮肤病医院真菌科 [3]中国医学科学院北京协和医学院皮肤病研究所

出　　处：《中华皮肤科杂志》2015年第8期526-530,共5页Chinese Journal of Dermatology

摘　　要：目的：评估超脉冲 CO2点阵激光治疗甲真菌病的疗效及安全性。方法收集临床具有甲真菌病典型临床表现且真菌真接镜检阳性病例，给予超脉冲 CO2点阵激光治疗8次，根据患者年龄、病甲感染类型、甲板厚度、感染面积、甲板感染长度等进行临床甲真菌病临床评分指数（SCIO）和甲真菌病严重度指数（OSI）评估，比较治疗前、治疗结束、疗后1个月和疗后3个月的临床评分变化，计算真菌学清除率，记录观察激光治疗的不良反应。结果共入组20例甲真菌病患者共75个病甲，完成治疗及随访18例71个病甲。治疗前、治疗结束、疗后1个月及3个月 SCIO 分别为13.07±6.47、9.03±6.14、8.51±6.99、7.89±7.26，OSI 分别为21.11±11.94、13.63±12.10、14.18±13.65、13.70±13.93，疗后3个时间点真菌学清除率分别为57.75%（41/71）、59.15%（42/71）、61.97%（44/71），SCIO、OSI 与治疗前相比差异均有统计学意义（均 P 〈0.05）。其中远端侧位甲下型SCIO 和 OSI 治疗前分别为12.48±5.41和16.44±9.89，疗后3个月降至5.01±5.56和6.44±8.26；而全甲营养不良型 SCIO 和 OSI 治疗前分别为17.86±3.98和34.05±2.56，疗后3个月分别为15.88±4.10和31.00±7.28。治疗过程中偶有一过性轻微疼痛，未发生甲下出血等其他不良反应。结论超脉冲 CO2点阵激光治疗远端侧位甲下型等轻中度甲真菌病，尤其甲板侵入较浅且甲板生长速度较快时疗效可靠。超脉冲 CO2激光对真菌仅表现为直接的抑制和杀伤作用，治疗时应根据病情适当延长疗程。Objective To evaluate the efficacy and safety of a superpulse-mode fractional carbon dioxide（CO2） laser for the treatment of onychomycosis. Methods Patients with typical clinical manifestations of onychomycosis and positive for direct microscopic examinations of fungi were enrolled into this study, and treated with a superpulse-mode fractional CO2 laser for eight sessions. The scoring clinical index for onychomycosis （SCIO）and onychomycosis severity index （OSI）were calculated according to patients′ age, clinical type of onychomycosis, thickness of nails, area and length of nail involvement before the treatment, at the end of treatment, 1 month and 3 months after completion of treatment. Mycological clearance was also evaluated according to direct microscopy and fungal culture results. Adverse reactions to laser therapy were recorded. Statistical analysis was carried out by using the chi-square test and Wilcoxon signed-rank sum test with the SPSS 17.0 software. Results Totally, 20 patients with onychomycosis were enrolled into this study, and 75 affected nails were treated. Finally, 18 patients with 71 target nails completed the treatment and follow-up. The SCIO and OSI were 13.07 ± 6.47 and 21.11 ± 11.94 in these patients at baseline respectively, both significantly different from those at the end of treatment（9.03 ± 6.14 and 13.63 ± 12.10, respectively, both P 〈 0.05）, 1 month（（8.51 ± 6.99 and 14.18 ± 13.65, respectively, both P 〈 0.05）and 3 months（7.89 ± 7.26 and 13.70 ± 13.93 respectively, both P 〈0.05）after completion of treatment. No significant differences were observed in mycological clearance rates between the posttreatment time points（57.75%（41/71）at the end of treatment vs. 59.15%（42/71）at 1 month vs. 61.97%（44/71） at 3 months after completion of treatment, P 〉 0.05）. The SCIO and OSI decreased from 12.48 ± 5.41 and 16.44 ± 9.89 at the baseline to 5.01 ± 5.56 and 6.44 ± 8.26 at 3 months after the treatment, respectively, in patients with di

关 键 词：激光疗法 甲癣 治疗结果 安全性 治疗 临床研究性 

分 类 号：R756.4[医药卫生—皮肤病学与性病学]