皮秒激光与Q开关Nd:YAG激光治疗顽固性黄褐斑疗效比较

2020-01-13 05:06王羿婷
中国美容医学 2020年12期
关键词:黄褐斑临床疗效

[摘要]目的:比較皮秒激光和Q开关Nd:YAG激光治疗顽固性黄褐斑患者的临床疗效,对两种激光的疗效和安全性进行评估。方法:收集2017年9月-2018年9月在笔者医院美容皮肤科就诊的140例黄褐斑患者资料,随机分为皮秒激光组和Q开关Nd:YAG激光两组,分别采用波长为755nm的皮秒激光和波长为1 064nm的Q开关Nd:YAG激光进行治疗。1次/月,共治疗6次。分别在治疗前、治疗后6个月观察两组患者的疗效、MASI评分及不良反应,并由患者进行满意度测评。结果:治疗后,两组患者均有明显的好转,患者面部色斑变浅、面积变小;Q开关Nd:YAG激光组的治疗有效率低于皮秒激光组(P<0.05);Q开关Nd:YAG组和皮秒激光组患者的MASI评分均明显低于治疗前(P<0.001),Q开关Nd:YAG组治疗后MASI评分明显高于皮秒激光组MASI评分(P=0.001);两组患者的满意度和不良反应发生率比价无显著性差异。结论:与1 064nm Q开关Nd:YAG激光治疗相比,用755nm皮秒激光治疗有更好疗效,有效率显著高于Q开关Nd:YAG激光组,医师的MASI评估分数也低于Q开关Nd:YAG激光组。

[关键词]皮秒激光;Q开关Nd:YAG激光;黄褐斑;临床疗效

[中图分类号]R758.4+2    [文献标志码]A    [文章编号]1008-6455(2020)12-0019-03

Clinical Efficiency Analysis on the Treatment of Regractory Melasma Using Picosecond Laser and Nd:YAG Laser

WANG Yi-ting

(Department of Dermatology, Suzhou Mebel Cosmetology Hospital,Suzhou 215000,Jiangsu,China)

Abstract: Objective  To compare the data of patients with melasma treated by picosecond laser and 1 064 nm QS-Nd: YAG laser to evaluate the efficacy and safety of the two lasers. Methods  The data of 140 patients with melasma who were treated in the Department of Aesthetic Dermatology in our hospital from September 2017 to September 2018 were collected. It was divided into two groups and treated with picosecond laser with a wavelength of 755nm and QS-Nd:YAG laser with a wavelength of 1 064nm. 1 time /month, a total of 6 treatments. The efficacy, MASI score, and adverse reactions of the two groups of patients were observed before treatment and after 6 months of treatment, and the patients were evaluated for satisfaction. Results  The two groups of patients showed significant improvement after treatment,and the patients' facial spots became lighter and the area became smaller. QS-Nd:YAG group: the treatment efficiency of the QS-Nd:YAG group was lower than that of the picosecond laser group (P<0.05).The MASI scores of patients in the QS-Nd:YAG group and the picosecond laser group were significantly lower than before treatment (P<0.001), and the MASI scores after treatment in the QS-Nd:YAG group were significantly higher than those in the picosecond laser group (P=0.001) There was no difference in the satisfaction and adverse reaction rates between the two groups. Conclusion  Compared with treatment with 1 064 nm QS-Nd:YAG laser, treatment with 755 nm picosecond laser has better efficacy, and the effective rate is significantly higher than that of QS-Nd: YAG laser treatment group. The physician s MASI evaluation score Also lower than QS-Nd:YAG laser treatment group.

Key words: picosecond laser; QS-Nd: YAG laser; melasma; clinical efficacy

黄褐斑是顽固性色素沉着症,在亚洲地区,特别在育龄妇女中有很高发病率[1]。其主要临床表现为浅棕色至深棕色斑块,皮损常发生于脸颊和前额,边界较不清楚。尽管对黄褐斑的研究不断开展[2],但没有发现彻底治愈该疾病的有效方法。Q开关Nd:YAG激光低能量密度治疗黄褐斑已经被广泛应用[3-6]。近年来,皮秒激光治疗在临床上应用越来越广泛,皮秒激光与Q开关Nd:YAG激光纳秒级脉宽相比,皮秒激光脉宽更短,降至皮秒级,增强了对色素的爆破能力,同时提高了治疗的安全性[7-10]。本研究比较皮秒激光和Q开关Nd:YAG激光治疗黄褐斑的临床疗效,对两种激光的疗效和安全性进行评估,现报道如下。

1  资料和方法

1.1 一般资料:选择2017年9月-2018年9月在笔者医院美容皮肤科就诊的140例黄褐斑患者为研究对象。患者均为女性,Q开关Nd:YAG激光组:年龄(38.66±7.38)岁,病程(6.54±2.69)年;皮秒激光组:年龄(36.79±6.94)岁,病程(7.13±3.05)年,两组患者一般资料比较无统计学差异(P>0.05),具有可比性。

1.2 纳入和排除标准:纳入标准:明确诊断为黄褐斑,分布于面部双颊,所有患者均知情同意本研究;排除标准:合并其他严重器质性疾病者,正在接受激光治疗或口服药物治疗者。

1.3 方法:Q开关Nd:YAG激光组:采用Naturalase飞顿大QTM皮肤色素激光仪,频率10Hz,波长1 064nm,光斑直径为6mm,能量密度为4J/cm2,在黄褐斑区进行均匀照射,1次/月;皮秒激光组:采用美国赛诺秀皮秒激光仪治疗,波长755nm,光斑直径6~8mm,能量密度0.4~0.7J/cm2,在黄褐斑区进行均匀照射,1次/月。治疗完成后均给予冷喷,并嘱患者注意防晒。

1.4 疗效评价

1.4.1 黄褐斑评分(MASI)[11]:治疗前、后由两名医师单独对患者进行黄褐斑评分,见表1。

1.4.2 疗效判定标准[12]:基本痊愈:色斑面积消退>90%,皮肤基本恢复正常;显效:色斑面积消退61%~90%,颜色明显变淡;好转:色斑面积消退31%~60%,颜色淡化,但皮损仍有边界;无效:色斑面积<30%,颜色淡化不明显,皮损变化不大。有效率=(基本痊愈+显效)例数/总例数×100%。

1.4.3 患者满意度:采用笔者医院自制的满意度调查表评估两组患者的治疗满意度,由患者对自身面部美观情况进行打分,经预调查本量表的内部一致性信度系数为0.87,效度系数为0.88。满分100分,得分<60分即不满意,60~69分即为一般,70~89分即为较满意,90~100分即非常满意。满意度以较满意+非常满意计。

1.5 统计学分析:用SPSS 20.0软件进行统计学分析,计量资料用x?±s进行统计学描述,用t检验进行组间比较,计数资料用率和百分比进行统计学描述,用χ2检验进行组间比较,P<0.05表示差异有统计学意义。

2  结果

2.1 临床疗效:所有患者均接受6次治疗,治疗6个月后对疗效进行评估。两组患者治疗后均有明显好转,患者面部色斑变浅、面积变小。在临床疗效方面,Q开关Nd:YAG激光组治疗有效率85.71%,皮秒激光组治疗有效率95.71%,两组比较差异有统计学意义(χ2=7.375,P=0.046),见表2。典型病例见图1~3。

2.2 黄褐斑评分:治疗前后有相同医生对患者脸部进行MASI评分,治疗前Q开关Nd:YAG激光组为(10.03±3.11)分,皮秒激光组为(10.55±3.36)分,两组比较无统计学差异(t=-0.950,P=0.345);治疗结束后,Q开关Nd:YAG组和皮秒激光组患者的MASI评分均明显低于治疗前(P<0.001);治疗后,Q开关Nd:YAG激光组MASI评分(6.37±1.89)分,明显高于皮秒激光组的(5.20±1.65)分,两组比较有统计学差异(t=-3.901,P=0.001),见表3。

2.3 患者满意度比较:治疗结束后,对所有患者进行满意度测评,Q开关Nd:YAG激光组患者满意度为84.29%,皮秒激光组满意度为91.43%,两组比较无统计学差异(χ2=1.674,P=0.196),见表4。

2.4 不良反应事件发生率:两组患者治疗后均出现轻中度红斑,经过冷敷1~2h后红斑均消退。所有患者无感染、色素沉着和瘢痕等不良反应发生。

3  讨论

黄褐斑是在亚洲人群中很常见的色素沉着性疾病,特别是在中年女性中有很高的发病率[13]。通常表现为面部对称,不规则的黑色素沉着症,主要表现在双侧中央颊部[7,14]。黄褐斑的发病机制尚不清楚,可能与遗传,紫外线照射,激素水平变化和炎症等因素有关[15]。黄褐斑治疗方法主要有激光治疗、药物治疗以及联合治疗。目前,最常用的治疗黄褐斑的方法包括强脉冲光(IPL)[16-17]、Q开关红宝石激光器(694nm)[18-19],以及Q开关Nd:YAG激光(1 064nm)[20-21]已经被用于治疗黄褐斑,然而,这些治疗手段的疗效并不理想,患者治疗后容易反复发作。以往治疗中,有学者报道了Q开关Nd:YAG激光(1 064nm)平顶光束治疗黄褐斑的方法[22-25]。盡管有较好的临床疗效,但可能会增加斑点性色素沉着的风险[26-27]。

用激光治疗黄褐斑的目的是将色素沉着减少到正常的色素沉着水平。皮秒激光的机制主要依靠光机械效应来破坏目标组织,同时伴随着减弱的光热效应(相对于纳秒或毫秒脉冲)[9]。极短的皮秒脉冲首次为医师提供了一种选择性控制黑素和黑素细胞的新方法[8]。与Q开关Nd:YAG激光治疗仪相比,皮秒激光由于光热效应减少而具有更高的安全性。现今市场上有532nm、755nm和1 064nm皮秒激光设备可用。尽管532nm对黑色素的吸收系数比755nm高得多,但是532nm对铁血黄素的吸收也相对较高。此外,与755nm相比,1 064nm对黑色素的吸收系数较低,对铁血黄素的吸收系数较高[28]。因此,在532nm和1 064nm上,755nm对黑色素具有更好的选择性。

本研究結果显示,与1 064nm Q开关Nd:YAG激光1 064nm治疗相比,用755nm皮秒激光治疗有更好的疗效,有效率显著高于Q开关Nd:YAG激光组,医师的MASI评估分数也低于Q开关Nd:YAG激光组。但是两组患者的满意度没有差异,不良反应发生率也没有显著性差异。但本研究因样本量小和随访时间短,有一定的局限性,未来可能需要更大样本量和更长随访时间的研究。

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[收稿日期]2020-03-25

本文引用格式:王羿婷.皮秒激光与Q开关Nd:YAG激光治疗顽固性黄褐斑疗效比较[J].中国美容医学,2020,29(12):19-22.

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