Q开关1064nm点阵激光联合氨甲环酸治疗中重度黄褐斑临床疗效分析  

Efficacy analysis of Q-switched 1064nm fractional laser combined with oral tranexamic acid in the treatment of moderate to severe melasma

作　　者：屈欢欢[1] 高妮[1] 鲁美恒 景焕 李凯[1] 高琳[1] QU Huan-huan;GAO Ni;LU Mei-heng(Department of Dermatology,Xijing Hospital,the Fourth Military Medical University,Xi'an 710032,China)

机构地区：[1]第四军医大学西京皮肤医院,西安710032

出　　处：《实用皮肤病学杂志》2021年第4期206-210,共5页Journal of Practical Dermatology

基　　金：陕西省自然科学基础研究计划(2020JM-320)。

摘　　要：目的评价Q开关1064nm点阵激光联合氨甲环酸口服治疗中重度黄褐斑的有效性及安全性。方法收集中重度黄褐斑患者60例,分为口服氨甲环酸联合Q开关1064nm FS20激光组、口服氨甲环酸联合Q开关1064nm R28激光组、Q开关1064nm FS20激光组、Q开关1064nm R28激光组,各15例。口服氨甲环酸剂量为250 mg每日2次;激光治疗每月1次,共5次。比较治疗前后黄褐斑面积和严重指数(melasma area and severity index,MASI)评分、VISIA检测仪检测紫外线色斑值及棕色斑值、Antera 3D检测黑色素差异、色素影响区域等指标,并观察不良反应。结果 4组患者治疗后MASI评分均较治疗前明显下降(t=29.869,25.551,12.545,5.506,P <0.001),其中口服氨甲环酸联合Q开关1064nm FS20激光组治疗前、治疗后MASI评分为(28.08±2.64)分、(2.05±1.96)分,口服氨甲环酸联合Q开关1064nm R28激光组治疗前、治疗后MASI评分为(27.99±3.42)分、(2.93±2.70)分,两组组间比较差异有统计学意义(P <0.01),且均优于单纯Q开关1064nm FS20激光组及单纯Q开关1064nm R28激光组(Z=–3.408、–2.832,–1.165、–2.272,P <0.01);治疗中均未发生严重不良反应。结论 Q开关1064nm点阵激光联合氨甲环酸口服治疗中重度黄褐斑安全有效。Objective To evaluate the efficacy and safety of Q-switched 1064 nm fractional laser combined with oral tranexamic acid in the treatment of moderate to severe melasma. Methods A total of 60 patients collected from January 2019 to December 2019 in the dermatology department of the Fourth Military Medical University affiliated Xijing Hospital with moderate to severe melasma were divided into four groups, with 15 cases in each group. The oral dose of tranexamic acid was 250 mg bid(stopped during menstruation). Laser treatment was performed once a month for 5 times in total. MASI score, ultraviolet and brown spot value were detected by VISIA, difference of melanin and area affected by pigment were detected by Antera 3 D and compared before and after treatment, and the adverse reactions were observed. Results The MASI scores of the four groups after treatment were significantly lower than those before treatment(t=29.869, 25.551, 12.545, 5.506, P<0.001);for the group of tranexamic acid tablets combined with Q-switched 1064 nm FS20, the MASI score before and after treatment were(28.08±2.64) and(2.05±1.96), as for the group of tranexamic acid tablets combined with Q-switched 1064 nm R28, the MASI score before and after treatment were(27.99±3.42) and(2.93±2.70), there were statistically significant differences between the two groups(P<0.01), meanwhile the improvement of MASI score of the both groups were superior to the Q-switched 1064 nm FS20 laser group and the Q-switched 1064 nm R28 laser group(Z=-3.408,-2.832,-1.165,-2.272, P<0.01). No serious adverse reactions occurred during the treatment. Conclusion Q-switched 1064 nm fractional laser combined with oral tranexamic acid is safe and effective in the treatment of moderate to severe melasma.

关 键 词：黄褐斑 激光 Q开关1064nm 氨甲环酸 联合治疗 

分 类 号：R758.42[医药卫生—皮肤病学与性病学]