调Q开关755nm紫翠宝石激光联合外用氨甲环酸治疗黄褐斑随机半侧面部对照研究  

Q-switched 755nm alexandrite laser combined with topical tranexamic acid in the treatment of melasma:a hemifacial randomized controlled study

作　　者：张玲玲 钱晓莺 金艺[2] 刘楠楠 Zhang Lingling;Qian Xiaoying;Jin Yi;Liu Nannan(Department of Dermatology,Zhejiang Rongjun Hospital,Jiaxing 314000,China;Department of Dermatology,Zhejiang Jiaxing Maternal and Child Health Hospital,Jiaxing 314000,China)

机构地区：[1]浙江省荣军医院皮肤科,嘉兴314000 [2]浙江省嘉兴市妇幼保健院皮肤科,嘉兴314000

出　　处：《中华整形外科杂志》2022年第9期970-977,共8页Chinese Journal of Plastic Surgery

基　　金：嘉兴市级科技计划项目(2019AD32152)。

摘　　要：目的探讨调Q开关755 nm紫翠宝石激光联合外用氨甲环酸治疗面部黄褐斑的临床效果。方法按照纳入和排除标准从浙江省荣军医院皮肤科2020年6至12月期间就诊的女性黄褐斑患者中选取研究对象,并按照随机数字表法分为A、B、C 3组。采用半侧面部自身对照的方法进行研究。A组左侧面部黄褐斑采用调Q开关755 nm紫翠宝石激光大光斑(直径5 mm)、低能量密度(1.6 J/cm^(2))、短脉宽(70 ns)模式(简称A模式)治疗,2周1次,共6次,术后即刻外涂氨甲环酸精华液,早晚各1次,连续6个月;右侧面部黄褐斑单纯外涂氨甲环酸精华液,早晚各1次,连续6个月。B组左侧面部采用调Q开关755 nm紫翠宝石激光小光斑(直径3 mm)、中等能量密度(5.0 J/cm^(2))、长脉宽(150μs)模式(简称B模式)治疗,2周1次,共6次,术后即刻外涂氨甲环酸精华液,早晚各1次,连续6个月;右侧面部单纯外涂氨甲环酸精华液,早晚各1次,连续6个月。C组左侧面部治疗方法及术后处理同A组左侧面部;右侧面部治疗方法及术后处理同B组左侧面部。激光治疗结束后12周对治疗效果进行评价:(1)评估黄褐斑面积及严重指数(MASI),分值为0~48分,分数越高,皮损越严重;(2)医生整体评价(PGA),分值为0~6分,分数越高黄褐斑残留越多;(3)患者自我评价,即患者满意率,为非常满意与满意例数之和占总例数的百分率。计量资料以x±s表示,MASI评分及PGA评分比较采用配对样本t检验;患者满意率比较采用χ^(2)检验,P<0.05为差异有统计学意义。结果共纳入90例患者,A、B、C 3组各30例,患者年龄分别为(33.0±5.8)岁、(32.3±7.2)岁、(32.9±6.5)岁(P>0.05),病程分别为(3.5±2.3)年、(3.3±1.9)年、(3.5±1.5)年(P>0.05)。激光治疗结束后12周效果评价:(1)MASI评分。A组两侧面部治疗后评分均低于治疗前(P<0.01或<0.05),且治疗后左侧评分[(9.67±4.10)分]明显低于右侧[(18.13±7.67)分](P<0.01);B组两侧面部治疗后�Objective To evaluate the efficacy of Q-switched 755 nm alexandrite laser combined with tranexamic acid in the treatment of facial melasma.Methods According to the inclusion and exclusion criteria,the subjects were selected from female patients with melasma who visited the Department of Dermatology of Zhejiang Rongjun Hospital from June to December 2020,the patients were divided into group A,B and C according to the random number table.The study was conducted by half face self contrast method.Group A,lesions on the left side of the face were irradiated by Q-switched 755 nm alexandrite laser with the mode of 5 mm spot,1.6 J/cm^(2) energy,70 ns pulse width(mode A)with an interval of two weeks for 6 sessions.Meanwhile,tranexamic acid serum was applied topically on the lesions twice a day for six months.Lesions on the right side of the face,as control side,tranexamic acid serum was used in the same way as above described.Group B,lesions on the left side of the face were irradiated by Q-switched 755 nm alexandrite laser for 6 sessions with the mode of 3 mm spot,5.0 J/cm^(2) energy,150μs pulse width(mode B)with an interval of two weeks for 6 sessions.Meanwhile,tranexamic acid serum was applied topically on the lesions twice a day for six months.The treatment of right side of face as control side was the same as group A.The treatment method and postoperative treatment of the left face in group C were the same as those in group A left face.The treatment method and postoperative treatment of the right side face were the same as those of the left side face of group B.The treatment effect was evaluated 12 weeks after the end of laser treatment.(1)Assessment of Melasma Area and Severity Index(MASI),the score ranges from 0 to 48,with higher scores indicating more severe lesions.(2)Physician Global Assessment(PGA),the score ranged from 0 to 6,and the higher the score,the more melasma remained.(3)The patient satisfaction rate was the percentage of the total number of patients with very satisfied and satisfied cases.Measurement

关 键 词：激光治疗 氨甲环酸 黄褐斑 调Q开关 755nm紫翠宝石激光器 

分 类 号：R758.42[医药卫生—皮肤病学与性病学]