染料激光联合A型肉毒毒素治疗早期红色增生性瘢痕的前瞻性随机对照研究  

Prospective randomized controlled study of dye laser combined with botulinum toxin type A in the treatment of early red hyperplastic scar

作　　者：丁菲 杜红霞 张道军[3] 尹光文[4] 巴西 张瑞 程晓曼 艾静 DING Fei;DU Hong-xia;ZHANG Dao-jun;YIN Guang-wen;BA Xi;ZHANG Rui;CHENG Xiao-man;AI Jing(Department of Dermatology,Zhoukou Central Hospital,Zhoukou 466000,Henan,CHINA;Department of Dermatology,Xinyang Central Hospital,Xinyang 464000,Henan,CHINA;Department of Dermatology,the Third Affiliated Hospital of Chongqing Medical University,Chongqing 400000,CHINA;Department of Dermatology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,Henan,CHINA)

机构地区：[1]周口中心医院皮肤科,河南周口466000 [2]信阳中心医院皮肤科,河南信阳464000 [3]重庆医科大学第三附属医院皮肤科,重庆400000 [4]郑州大学第一附属医院皮肤科,河南郑州450000

出　　处：《海南医学》2024年第11期1611-1617,共7页Hainan Medical Journal

基　　金：2021年度河南省医学科技攻关计划联合共建项目(编号:LHGJ20213008)。

摘　　要：目的探讨染料激光联合A型肉毒毒素(BTXA)治疗早期红色增生性瘢痕的临床效果。方法选取2019年1月至2023年1月周口中心医院收治的98例早期红色增生性瘢痕患者纳入研究,按随机数表法分为观察组和对照组,每组49例。对照组患者予以BTXA治疗,观察组患者予以染料激光联合BTXA治疗。比较两组患者治疗6个月后的临床疗效以及治疗前、治疗3个月后、6个月后的瘢痕面积、瘙痒感[数字评估量表(NRS)]、疼痛程度[视觉模拟评估量表(VAS)]、瘢痕情况[温哥华瘢痕量表(VSS)]、瘢痕血清指标[转化生长因子-β1(TGF-β1)、表皮生长因子(EGF)、血管内皮生长因子(VEGF)和骨形态发生蛋白-7(BMP-7)]水平,同时比较两组患者治疗期间的不良反应发生情况。结果观察组患者的治疗总有效率为93.88%,明显高于对照组的77.55%,差异有统计学意义(P<0.05);治疗3个月和6个月后,观察组患者的瘢痕面积分别为(4.25±1.23)cm^(2)、(2.16±0.58)cm^(2),明显小于对照组的(5.34±1.16)cm^(2)、(2.87±0.89)cm^(2),瘙痒感NRS评分分别为(3.48±1.06)分、(1.80±0.51)分,明显低于对照组的(4.65±0.97)分、(2.64±0.67)分,疼痛VAS评分分别为(3.76±0.95)分、(1.72±0.63)分,明显低于对照组的(4.61±0.89)分、(2.29±0.74)分,瘢痕血管分布评分分别为(2.01±0.52)分、(1.54±0.33)分,明显低于对照组的(2.68±0.54)分、(1.92±0.40)分,瘢痕厚度分别为(2.27±0.48)分、(1.41±0.30)分,明显低于对照组的(2.85±0.51)分、(1.76±0.28)分,瘢痕色泽评分分别为(1.84±0.48)分、(1.21±0.27)分,明显低于对照组的(2.33±0.42)分、(1.49±0.29)分,瘢痕柔软度分别为(2.52±0.51)分、(1.78±0.35)分,明显低于对照组的(3.08±0.47)分、(2.21±0.48)分,VSS总评分分别为(8.64±2.14)分、(5.94±1.46)分,明显低于对照组的(10.94±1.98)分、(7.38±1.53)分,差异均有统计学意义(P<0.05);观察组患者治疗3个月和6个月后的血清TGF-β1分别为(336.84±41.37)ng/L,Objective To investigate the clinical effect of dye laser combined with botulinum toxin type A(BTXA)in the treatment of early red hypertrophic scar.Methods A total of 98 patients with early red hypertrophic scars admitted to Zhoukou Central Hospital from January 2019 to January 2023 were selected for inclusion in the study.They were randomly divided into an observation group and a control group according to a random number table method,with 49 patients in each group.Patients in the control group were treated with BTXA,while those in the observation group were treated with dye laser combined with BTXA.The clinical efficacy of the two groups of patients was compared after 6 months of treatment,as well as the scar area,itching sensation[numerical rating scale(NRS)],pain level[Visual Analogue Scale(VAS)],scar condition[Vancouver Scar Scale(VSS)],and scar serum indicators[transforming growth factor-β1(TGF-β1),epidermal growth factor(EGF),vascular endothelial growth factor(VEGF),and bone morphogenetic protein-7(BMP-7)]levels before treatment,after 3 months of treatment,and after 6 months of treatment.The adverse reactions during treatment were also compared between the two groups of patients.Results The total effective rate of treatment for patients in the observation group was 93.88%,which was significantly higher than 77.55%in the control group(P<0.05).After 3 months and 6 months of treatment,the scar area of the observation group was(4.25±1.23)cm^(2) and(2.16±0.58)cm^(2),respectively,which were significantly lower than(5.34±1.16)cm^(2) and(2.87±0.89)cm^(2) of the control group;the NRS scores of pruritus sensation were(3.48±1.06)points and(1.80±0.51)points,which were significantly lower than(4.65±0.97)points and(2.64±0.67)points of the control group;the pain VAS scores were(3.76±0.95)points and(1.72±0.63)points,respectively,significantly lower than(4.61±0.89)points and(2.29±0.74)points of the control group;the scar blood vessel distribution scores were(2.01±0.52)points and(1.54±0.33)points,respectivel

关 键 词：增生性瘢痕 A型肉毒毒素 染料激光 视觉模拟量表 温哥华瘢痕量表 临床疗效 不良反应 

分 类 号：R62[医药卫生—整形外科]