皮秒翠绿宝石激光与超脉冲CO2点阵激光治疗面部萎缩性痤疮瘢痕的疗效与安全性比较  

A comparison of efficacy and safety of picosecond alexandrite laser versus ultrapulsed fractional CO2 laser for the treatment of facial atrophic acne scars

作　　者：张孟丽 房静 吴秋菊 林彤 Zhang Mengli;Fang Jing;Wu Qiuju;Lin Tong(Department of Cosmetic Laser Surgery,Hospital for Skin Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Nanjing 210042,China)

机构地区：[1]中国医学科学院,北京协和医学院,皮肤病医院激光科,南京210042

出　　处：《中华皮肤科杂志》2020年第8期602-606,共5页Chinese Journal of Dermatology

基　　金：中国医学科学院医学与健康科技创新工程项目(CIFMS-2018-I2M-AI-018、CIFMS-2017-I2M-1-017)。

摘　　要：目的通过前瞻性、半脸对照研究,比较皮秒翠绿宝石激光与超脉冲CO2点阵激光治疗面部萎缩性痤疮瘢痕的疗效与安全性。方法2015年10月至2017年10月在中国医学科学院皮肤病医院激光科收集面部对称性萎缩性痤疮瘢痕患者,左侧面部痤疮瘢痕采用超脉冲CO2点阵激光治疗,右侧采用皮秒翠绿宝石激光点阵模式治疗,治疗间隔为2个月,共治疗3次。治疗前后由皮肤科医生根据ECCA评价表对瘢痕进行评分,患者根据四分法自评临床疗效。记录治疗时疼痛程度和不良反应。两侧间、治疗前后ECCA评分及疼痛程度评分比较采用配对t检验,组间四分法评分比较采用Wilcoxon秩和检验。结果治疗前皮秒激光侧和点阵激光侧间ECCA评分差异无统计学意义(t=1.06,P=0.300),治疗3次后差异有统计学意义[(70.98±21.48)分比(58.04±17.63)分,t=3.76,P=0.001]。与治疗前相比,皮秒激光侧瘢痕改善评分(2.21±1.09)分,CO2点阵激光侧(2.83±1.11)分,两组差异有统计学意义(z=2.70,P=0.007)。与CO2点阵激光侧相比,皮秒激光侧不良反应更少,表现为一过性红斑、水肿,治疗疼痛评分亦明显降低[(3.71±0.62)分比(6.23±1.06)分,t=11.93,P<0.001]。结论皮秒翠绿宝石激光与超脉冲CO2点阵激光均能有效改善萎缩性痤疮瘢痕,CO2点阵激光疗效更显著,而皮秒激光不良反应更少。Objective To compare the efficacy and safety of picosecond alexandrite laser and ultrapulsed fractional CO2 laser for the treatment of facial atrophic acne scars in a prospective,split-face clinical trial.Methods From October 2015 to October 2017,patients with facial symmetrical atrophic acne scars were enrolled from Department of Cosmetic Laser Surgery,Hospital for Skin Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College.The left side of the face of the patients was treated with ultrapulsed fractional CO2 laser,and the right side of the face was treated with a 755-nm picosecond alexandrite laser with a diffractive lens array.All patients received 3 sessions of laser treatment at a 2-month interval.The severity of scars was evaluated by 2 dermatologists before and after the treatment according to the ECCA grading scale(échelle d′évaluation clinique des cicatrices d′acné),and clinical efficacy was self-assessed by the patients according to a 4-point scale.Pain scores and adverse reactions were recorded.Paired t test was used to compare ECCA scores and pain scores between the 2 sides of the face,as well as between pre-and post-treatment values,and Wilcoxon rank sum test was used to compare the 4-point scores between the 2 groups.Results There was no significant difference in the ECCA score between the picosecond laser side and the fractional laser side before the treatment(t=1.06,P=0.300),while the ECCA score was significantly higher in the picosecond laser side than in the fractional laser side after 3 sessions of treatment(70.98±21.48 vs.58.04±17.63,t=3.76,P=0.001).Compared with the pre-treatment severity score of scars,the improvement in severity score was significantly less in the picosecond laser side than in the fractional laser side(2.21±1.09 vs.2.83±1.11,z=2.70,P=0.007).Compared with the fractional laser side,the picosecond laser side showed significantly lower pain scores(3.71±0.62 vs.6.23±1.06,t=11.93,P<0.001)and less adverse reactions,which mainly manifested as tran

关 键 词：痤疮 瘢痕 激光 皮秒激光 CO2点阵激光 

分 类 号：R758.733[医药卫生—皮肤病学与性病学]