曲安奈德联合点阵激光及乳膏外涂序贯治疗增生性瘢痕的近远期疗效观察
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摘要
目的:探讨曲安奈德联合点阵激光及乳膏外涂序贯治疗增生性瘢痕近远期的治疗效果。方法:选取笔者医院2014年5月-2017年5月收治的90例增生性瘢痕患者,根据随机数字表法分成A组、B组、C组,每组30例。A组:采用曲安奈德序贯点阵激光治疗;B组:采用点阵激光联合乳膏外涂治疗;C组:采用曲安奈德联合点阵激光及乳膏外涂序贯治疗。比较三组治疗后3、6个月的临床疗效,分别在患者治疗前及治疗后3、6个月测定瘢痕体积与血红素、黑色素含量,并取瘢痕组织检测转录因子63(Protein63,P63)、角蛋白19(Cytokeratin19,CK19)在其中的强阳性表达率。结果:C组治疗后3个月的总有效率为93.33%,高于A、B组的73.33%,差异有统计学意义(P<0.05),A、B、C组治疗后6个月的总有效率分别为93.33%、96.67%、100.00%,组间比较无统计学意义(P>0.05)。三组治疗后3、6个月,瘢痕体积及血红素、黑色素含量均低于治疗前,且C组治疗后3个月的瘢痕体积、黑色素含量低于A、B组,差异有统计学意义(P<0.05)。三组治疗后3、6个月的P63、CK19强阳性表达率高于治疗前,且C组治疗后3个月两者强阳性表达率高于A、B组,差异有统计学意义(P<0.05)。A、B组患者均未出现不良反应,C组不良反应发生率为6.67%,三组不良反应发生率比较无统计学意义(P>0.05)。结论:曲安奈德联合点阵激光与乳膏外涂序贯治疗能促进增生性瘢痕患者病情的改善,近远期效果均比较理想,不良反应少,安全性高。
Objective To investigate the short-term and long-term effects of triamcinolone acetonide, dot laser and cream on sequential treatment of scar hyperplasia. Methods 90 cases of scar hyperplasia admitted to our hospital from May 2014 to May2017 were selected and divided into A group, B group and C group according to random number table.30 cases in each group.In group A, Cu Ann Ned sequential laser therapy was used.In group A, Cu Ann Ned sequential dot matrix laser was used, group B was treated with dot matrix laser combined with cream, and group C was treated with Cu Ann Ned, dot matrix laser and cream.The clinical ef? cacy of three groups was compared between 3 and 6 months after treatment.Scar volume and hemoglobin and melanin content were measured before and 3 and 6 months after treatment respectively.The scar tissue was used to detect the strong positive expression rate of Protein63(P63) and Cytokeratin19(CK19). Results The total effective rate of group C in 3 months after treatment was 93.33%, higher than 73.33% of group A and B.The difference was statistically signi? cant(P<0.05).The total effective rates in group A, B and C 6 months after treatment were 93.33%, 96.67% and 100%, respectively, and there was no signi? cant difference between the two groups(P>0.05).The volume of scar and hemoglobin and melanin in the three groups were lower than those before treatment for 3 and 6 months, and the volume of scar and melanin in group C were lower than that of group A and B after 3 months of treatment(P<0.05).The strong positive expression rates of P63 and CK19 in the three groups were higher than those before treatment in 3 and 6 months after treatment, and the positive expression rate of two in group C was higher than that in group A and B at 3 months after treatment.The difference was statistically signi? cant(P<0.05).No adverse reactions were found in group A and B. The incidence of adverse reactions in group C was 6.67%, and there was no signi? cant difference in the incidence of adverse reactions between the three groups(P>0.05). Conclusion The sequential therapy of triamcinolone acetonide,dot matrix laser and cream can promote the improvement of the condition of patients with hypertrophic scar. In the near and long term, the effect is ideal,less adverse reaction and high safety.
Objective To investigate the short-term and long-term effects of triamcinolone acetonide, dot laser and cream on sequential treatment of scar hyperplasia. Methods 90 cases of scar hyperplasia admitted to our hospital from May 2014 to May2017 were selected and divided into A group, B group and C group according to random number table.30 cases in each group.In group A, Cu Ann Ned sequential laser therapy was used.In group A, Cu Ann Ned sequential dot matrix laser was used, group B was treated with dot matrix laser combined with cream, and group C was treated with Cu Ann Ned, dot matrix laser and cream.The clinical ef? cacy of three groups was compared between 3 and 6 months after treatment.Scar volume and hemoglobin and melanin content were measured before and 3 and 6 months after treatment respectively.The scar tissue was used to detect the strong positive expression rate of Protein63(P63) and Cytokeratin19(CK19). Results The total effective rate of group C in 3 months after treatment was 93.33%, higher than 73.33% of group A and B.The difference was statistically signi? cant(P<0.05).The total effective rates in group A, B and C 6 months after treatment were 93.33%, 96.67% and 100%, respectively, and there was no signi? cant difference between the two groups(P>0.05).The volume of scar and hemoglobin and melanin in the three groups were lower than those before treatment for 3 and 6 months, and the volume of scar and melanin in group C were lower than that of group A and B after 3 months of treatment(P<0.05).The strong positive expression rates of P63 and CK19 in the three groups were higher than those before treatment in 3 and 6 months after treatment, and the positive expression rate of two in group C was higher than that in group A and B at 3 months after treatment.The difference was statistically signi? cant(P<0.05).No adverse reactions were found in group A and B. The incidence of adverse reactions in group C was 6.67%, and there was no signi? cant difference in the incidence of adverse reactions between the three groups(P>0.05). Conclusion The sequential therapy of triamcinolone acetonide,dot matrix laser and cream can promote the improvement of the condition of patients with hypertrophic scar. In the near and long term, the effect is ideal,less adverse reaction and high safety.
引文
[1]闫艺之,姜佳霖,张国林,等.瘢痕疙瘩的临床治疗最新探索[J].中国美容医学,2016,25(6):34-37.
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[4]杨少蝶,叶庭路,马刚.点阵激光在瘢痕防治中的应用进展[J].国际皮肤性病学杂志,2016,42(1):40-42.
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[8]Poetschke J,Dornseifer U,Clementoni MT,et al.Ultrapulsed fractional ablative carbon dioxide laser treatment of hypertrophic burn scars:evaluation of an in-patient controlled,standardized treatment approach[J].Laser Med Sci,2017,32(602):1-10.
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[10]姜涛,张林霞,王雨,等.曲安奈德联合γ干扰素在临床瘢痕疙瘩治疗中应用[J].徐州医学院学报,2016,36(8):507-508.
[11]吴泽勇,王绥江,黄海华,等.手术切除联合不同浓度曲安奈德注射治疗耳廓瘢痕疙瘩的临床观察[J].山东医药,2016,56(17):94-95.
[12]Ren YM,Zhou XH,Wei ZJ,et al.Effi cacy and safety of triamcinolone acetonide alone and in combination with 5afl uorouracil for treating hypertrophic scars and keloids:a systematic review and meta analysis[J].Int Wound J,2016,14(3):480-487.
[13]宗宪磊,宋国栋,都乐,等.曲安奈德联合得宝松注射治疗瘢痕疙瘩的效果[J].中国医药导报,2016,13(6):157-160.
[14]李雅琴,杨帆,刘孝兵.卤米松乳膏联合青鹏软膏治疗局限性湿疹的近远期疗效分析[J].药物评价研究,2016,39(2):286-288.
[15]王万伟.润燥止痒胶囊联合卤米松治疗原发性皮肤淀粉样变病68例疗效观察[J].中国皮肤性病学杂志,2017,31(9):1054-1056.
[16]郭敏,刘宏,季可非,等.曲安奈德局部给药制剂的研究进展[J].中国药师,2016,19(3):559-562.
[2]周游,王婷,于尔特.增生性瘢痕形成的病理机制和当代治疗现状[J].解剖科学进展,2016,22(4):432-435.
[3]郑庆桂,程代薇,彭德飞.手部瘢痕功能重建手术与康复治疗[J].重庆医学,2016,45(10):1391-1393.
[4]杨少蝶,叶庭路,马刚.点阵激光在瘢痕防治中的应用进展[J].国际皮肤性病学杂志,2016,42(1):40-42.
[5]蔡景龙.现代瘢痕学[M].北京:人民卫生出版社,2008:333.
[6]Tejiram S,Zhang J,Travis TE,et al.Compression the rapy affects collagen type balance in hypertrophic scar[J].J Surg Res,2016,201(2):299-305.
[7]Finnerty CC,Jeschke MG,Branski LK,et al.Hypertrophic scarring:the greatest unmet challenge following burn injury[J].Lancet,2016,388(10052):1427-1436.
[8]Poetschke J,Dornseifer U,Clementoni MT,et al.Ultrapulsed fractional ablative carbon dioxide laser treatment of hypertrophic burn scars:evaluation of an in-patient controlled,standardized treatment approach[J].Laser Med Sci,2017,32(602):1-10.
[9]Azzam OA,Bassiouny DA,El-Hawary MS,et al.Treatment of hypertrophic scars and keloids by fractional carbon dioxide laser:a clinical,histological,and immunohistochemical study[J].Laser Med Sci,2016,31(1):9-18.
[10]姜涛,张林霞,王雨,等.曲安奈德联合γ干扰素在临床瘢痕疙瘩治疗中应用[J].徐州医学院学报,2016,36(8):507-508.
[11]吴泽勇,王绥江,黄海华,等.手术切除联合不同浓度曲安奈德注射治疗耳廓瘢痕疙瘩的临床观察[J].山东医药,2016,56(17):94-95.
[12]Ren YM,Zhou XH,Wei ZJ,et al.Effi cacy and safety of triamcinolone acetonide alone and in combination with 5afl uorouracil for treating hypertrophic scars and keloids:a systematic review and meta analysis[J].Int Wound J,2016,14(3):480-487.
[13]宗宪磊,宋国栋,都乐,等.曲安奈德联合得宝松注射治疗瘢痕疙瘩的效果[J].中国医药导报,2016,13(6):157-160.
[14]李雅琴,杨帆,刘孝兵.卤米松乳膏联合青鹏软膏治疗局限性湿疹的近远期疗效分析[J].药物评价研究,2016,39(2):286-288.
[15]王万伟.润燥止痒胶囊联合卤米松治疗原发性皮肤淀粉样变病68例疗效观察[J].中国皮肤性病学杂志,2017,31(9):1054-1056.
[16]郭敏,刘宏,季可非,等.曲安奈德局部给药制剂的研究进展[J].中国药师,2016,19(3):559-562.