基于OCT技术的非消融性光子嫩肤研究
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摘要
非消融性光子嫩肤是治疗皮肤老化的一项最新技术。因为不破坏皮肤的表皮层,所以该技术具有并发症少、对患者的正常工作与生活影响小的优点。但是,和激光换肤等消融性治疗技术相比,非消融性光子嫩肤的治疗效果较差,而且治疗效果难以预测。其中主要的原因是缺乏有效技术来预测或实时监控个性化光剂量。目前,选择个性化光剂量已成为限制非消融性光子嫩肤发展的主要瓶颈之一。本文以个性化光剂量的选择为研究核心,重点阐述了用于确定个性化光剂量的热损伤动态监控系统的开发及其在基础研究中的应用。首先,总结了非消融性光子嫩肤的研究进展,分析了确定个性化光剂量的重要性,并提出确定个性化光剂量的新技术。其次,分析了皮肤的解剖学结构及细胞层面的微观结构,为选择适当的检测系统作充分的理论铺垫。再次,设计了基于OCT技术的热损伤动态监控系统。其中,热损伤动态监控系统的设计包含硬件设计和软件设计两部分。最后,利用热损伤动态监控系统测试不同光剂量对光衰减系数变化量的影响,并利用该系统评估强风冷却和接触冷却的差异以及不同冷却时机对冷却效果的影响。实验结果表明:热损伤动态监控系统能够较为准确地测试出组织的热损伤情况,通过后续研究有望应用于非消融性光子嫩肤中个性化光剂量的确定。
Non-ablative photorejuvenation is the latest technique for therapy of aged skin featuring low risk of complication and minimum downtime due to the reservation of the epidermis during the operation. Compared with the ablative techniques, such as laser resurfacing, however, the non-ablative method has some shortcoming. Due to the lack of characteristic measuring of light dose, the efficiency of the non-ablative photorejuvenation is less satisfactory and the prediction is difficult, according to previous reports. In this paper an innovative new system to determine the characteristic light dose will be introduced. First, the progress of non-ablative photorejuvenation was reviewed and the importance of characteristic light dose illustrated. Second, the structures of skin were divided into epidermis, dermis and subcutaneous tissue. The cellular level structures were analyzed for better understanding of the photon activity in skin tissue. Third, we developed a dynamical monitoring system based on OCT technique for heat damage evaluation. Last, the attenuation coefficients of skin irradiated by different light dose were measured by the system and the different cooling techniques were assessed by the system. The experiment results show that the system could monitor dynamically the degree of the heat damage during laser irradiation in the non-ablative photorejuvenation and the method is promising to be an effective tool to apply in clinic in the future.
Non-ablative photorejuvenation is the latest technique for therapy of aged skin featuring low risk of complication and minimum downtime due to the reservation of the epidermis during the operation. Compared with the ablative techniques, such as laser resurfacing, however, the non-ablative method has some shortcoming. Due to the lack of characteristic measuring of light dose, the efficiency of the non-ablative photorejuvenation is less satisfactory and the prediction is difficult, according to previous reports. In this paper an innovative new system to determine the characteristic light dose will be introduced. First, the progress of non-ablative photorejuvenation was reviewed and the importance of characteristic light dose illustrated. Second, the structures of skin were divided into epidermis, dermis and subcutaneous tissue. The cellular level structures were analyzed for better understanding of the photon activity in skin tissue. Third, we developed a dynamical monitoring system based on OCT technique for heat damage evaluation. Last, the attenuation coefficients of skin irradiated by different light dose were measured by the system and the different cooling techniques were assessed by the system. The experiment results show that the system could monitor dynamically the degree of the heat damage during laser irradiation in the non-ablative photorejuvenation and the method is promising to be an effective tool to apply in clinic in the future.
引文
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2.Patrick H.Bitter.Noninvasive rejuvenation of photodamaged skin using serial,full-face intense pulsed light treatments.Dermatologic Surgery,2000,26(9):835-842.
3.高天文,孙林潮.美容激光医学.北京.人民军医出版社.2004.
4.Goldman L,Rockwell R.J.,Naprstek Z,et al.Some parameters of high output CO_2 laser experimental surgery.Nature,1970,228:1344-1345.
5.Anderson,R.R.,Parrish J.A.Selective photothermolysis:precise microsurgery by selective absorption of pulsed radiation.Science,1983,220:524-527.
6.Thomas E.Milner,Babman Anvari,Kurosh Keikhanzadeh,et al.Analysis of nonablative skin resurfacing.Proc.of SPIE,1997,2970:367-373.
7.Gary Lask,Patrick K.Lee,Manouchehr Seyfzadeh,et al.Nonablative laser treatment of facial rhytides.Proc.of SPIE,1997,2970:338-349.
8.Nelson,J.S.,B.Majaron,and K.M.Kelly.What is nonablative photorejuvenation of human skin? Seminars in Cutaneous Medicine and Surgery,2002,21(4):238-250.
9.Longo L.,Lubart R.,Friedman H.,et al.A possible mechanism for visible light-induced skin rejuvenated.Proc.of SPIE,2004,5610:158-164.
10.Shusen Xie,Wei Gong,Hui Li.Analysis of the photorejuvenation mechanisms for health care and treatment.Proc.of SPIE,2005,5630:205-208.
11.DeHoratius D.M.and Dover J.S.Nonablative tissue remodeling and photorejuvenation.Clinics in Dermatology,2007,25:474-479.
12.王明利,刘大烈,袁强.强脉冲光对皮肤热休克蛋白70表达的影响.第一军 医大学报, 2005, 25(1): 109-110.
13. Lubart R, Friedmann H, Lavie R, et al. A reasonable mechanism for visible light-induced skin rejuvenation. Lasers in Medical Science, 2007, 22(1): 1-3.
14. Wenrou Wong, Wenling Shyu, Kuanghung Hsu, et al. Intense pulsed light modulates the expressions of MMP-2, MMP-14 and TIMP-2 in skin dermal fibroblasts cultured within contracted collagen lattices. Journal of Dermatological Science, 2008, 51(1): 70-73.
15. Negishi K., Tezuka Y., Kushikata N., et al. Photorejuvenation for Asian skin by intense pulsed light. Dermatologic Surgery, 2001, 27(7): 627-632.
16. Trelles M. A., Allones I., Velez M. Non-ablative facial skin photorejuvenation with an intense pulsed light system and adjunctive epidermal care. Lasers in Medical Science, 2003, 18(2): 104-111.
17. Bjerring P., Christiansen K., Troilius A., et al. Facial photo rejuvenation using two different intense pulsed light (IPL) wavelength bands. Lasers in Surgery and Medicine, 2004, 34(2): 120-126.
18. Butler E.G., McClellan S. D., Ross E. V. Split treatment of photodamaged skin with KTP 532 nm laser with 10 mm handpiece versus IPL: A cheek-to-cheek comparison. Lasers in Surgery and Medicine, 2006, 38(2): 124-128.
19. Trelles M. A., Allones I., Velez M., et al. Nd:YAG laser combined with IPL treatment improves clinical results in non-ablative photorejuvenation. J Cosmet Laser Ther, 2004, 6(2): 69-78.
20. Park J. M., Tsao H., Tsao S. Combined use of intense pulsed light and Q-switched ruby laser for complex dyspigmentation among Asian patients. Lasers in Surgery and Medicine, 2008, 40(2): 128-133.
21. Goldberg D. J. Full-Face Nonablative Dermal Remodeling with a 1320 nm Nd:YAG Laser. Dermatologic Surgery, 2000, 26(10): 915-918.
22. Dayan S. H., Vartanian A. J., Menaker G, et al. Nonablative laser resurfacing using the long-pulse (1064-nm) Nd:YAG laser. Arch Facial Plast Surg, 2003, 5(4): 310-5.
23. Min-Wei Christine Lee. Combination 532-nm and 1064-nm lasers for noninvasive skin rejuvenation and toning. Archives of Dermatology, 2003, 139(10): 1265-1276.
24. Fulchiero J. F., Pamela C.P., Suzan O. Subcision and 1320-nm Nd:YAG nonablative laser resurfacing for the treatment of acne scars: a simultaneous split-face single patient trial. Dermatologic Surgery, 2004, 30(10): 1356-1360.
25. Ruiz-Rodriguez R., Sanz-Sanchez T., and Cordoba S. Photodynamic photorejuvenation. Dermatologic Surgery, 2002, 28(8): 742-744.
26. Gold M. H. Intense pulsed light therapy for photorejuvenation enhanced with 20% aminolevulinic acid photodynamic therapy. Lasers in Surgery and Medicine, 2003, 15 (Suppl) : 47.
27. Alster T. S., Tanzi E. L., and Welsh E. C. Photorejuvenation of facial skin with topical 20% 5-aminolevulinic acid and intense pulsed light treatment: a split-face comparison study. J Drugs Dermatol, 2005, 4(1): 35-38.
28. Dover J.S., Bhatia A.C., Stewart b., et al. Topical 5-aminolevulinic acid combined with intense pulsed light in the treatment of photoaging. Archives of Dermatology, 2005, 141(10): 1247-1252.
29. Gold M. ALA-PDT plus blue light or intense pulsed light for the treatment of sebaceous gland hyperplasia. Journal of the American Academy of Dermatology, 2005, 52 (3): 208-208.
30. Christiansen K., Bjerring P., and Troilius A. 5-ALA for photodynamic photorejuvenation- Optimization of treatment regime based on normal-skin fluorescence measurements. Lasers in Surgery and Medicine, 2007, 39(4): 302-310.
31. Kristen M. K., Nelson J. S., Gary P. L., et al. Cryogen Spray Cooling in Combination With Nonablative Laser Treatment of Facial Rhytides. Arch Dermatologic, 1999, 135(6): 691-694.
32. Basinger, B., Aguilar G., and Nelson J. S. Effect of skin indentation on heat transfer during cryogen spray cooling. Lasers in Surgery and Medicine, 2004, 34(2): 155-163.
33. Svaasand L. O., Nelson J. S. On the physics of laser-induced selective photothermolysis of hair follicles: Influence of wavelength, pulse duration, and epidermal cooling. Journal of Biomedical Optics, 2004, 9(2): 353-361.
34. Brown S. A., Farkas J. P., Arnold C., et al. Heat shock proteins 47 and 70 expression in rodent skin model as a function of contact cooling temperature: Are we overcooling our target? Lasers in Surgery and Medicine, 2007, 39(6): 504-512.
35. Goldberg J. D., Silipunt S. Histologic evaluation of a Qswitched Nd:YAG laser in the non-ablative treatment of wrinkles. Dermatologic Surgery, 2001, 27(8): 744-746.
36. Fatemi A., Weiss M.A., and Weiss R.A. Short-term histologic effects of nonablative resurfacing: results with a dynamically cooled millisecond-domain 1320 nm Nd:YAG laser. Dermatologic Surgery, 2002, 28(2): 172-176.
37. Dahan S., Lagarde J. M., Turlier V., et al. Treatment of neck lines and forehead rhytids with a nonablative 1540-nm Er : Glass laser: A controlled clinical study combined with the measurement of the thickness and the mechanical properties of the skin. Dermatologic Surgery, 2004, 30(6): 872-880.
38. Negishi K., Kushikata N., Takeuchi K., et al. Photorejuvenation by intense pulsed light with objective measurement of skin color in Japanese patients. Dermatologic Surgery, 2006, 32(11): 1380-1387.
39. Yueyun W., Rong C., Xiaohua L., et al. Discussion of evaluating methods for photorejuvenation. Proc. of SPIE, 2007, 6534: 65342C.
40. Woonggyu J., Bunsho K., Kristen M. K. Optical Coherence Tomography for In Vitro Monitoring of Wound Healing After Laser Irradiation.IEEE journal of selected topics in quantum electronics,2003,9(2):222-226.
41.何友武,李雪芳,吴淑莲等.基于OCT技术的鼠皮肤激光热损伤修复过程的监测.激光生物学报,2007,16(2):163-166.
42.Williams A.C.Transdermal and topical drug delivery,Pharmaceutical Press.2003:London.
43.Alberts B.,Bray D.,Johnson A.,et al.Essential Cell Biology,Garland Science Publishing.1998:Garland.
44.Tsukahara K.,Takema Y.,Fujimura T.,et al.Quantitative twodimensional analysis of facial wrinkles of japanese women at various ages.International Journal of Cosmetic Science,2002,24(2):71-80.
45.Batisse D.,Bazin R.,Baldeweck T.,et al.Influence of age on the wrinkling capacities of skin.Skin Research and Technology,2002,8(3):148-154.
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