复方倍他米松联合CO_(2)点阵激光、PDL激光治疗瘢痕疙瘩疗效分析

Efficacy of Compound Betamethasone combined with CO_(2) lattice laser and PDL in treatment of keloid

目的观察分析复方倍他米松(商品名得宝松)联合CO_(2)点阵激光、PDL激光治疗瘢痕疙瘩的临床疗效。方法选取2018-04至2019-12武警辽宁总队医院接受治疗的111例瘢痕疙瘩患者作为研究对象,随机分为A组、B组、C组,每组37例。A组采用CO_(2)点阵激光+PDL激光治疗,B组采用CO_(2)点阵激光+得宝松治疗,C组采用得宝松联合CO_(2)点阵激光+PDL激光治疗,每4周为1疗程,共3个疗程。所有患者在治疗6个月后进行观察,观察3组治疗前后瘢痕各维度评分(VSS)、转化生长因子β_(1)(TGF-β_(1))、基质金属蛋白酶9(MMP-9)含量变化,以及临床疗效、不良反应及复发率情况。结果治疗6个月后,三组色泽、血管分布、瘢痕柔软度、厚度、VSS总分较治疗前显著降低,其中C组显著优于A组、B组(P<0.05),但B组和C组未见统计学差异;A组、B组、C组总有效率分别为86.49%、83.78%、94.60%,C组疗效显著优于A组和B组(P<0.05);治疗1个月后,三组TGF-β_(1)、MMP-9表达含量较治疗前显著改善(P<0.05),C组TGF-β_(1)、MMP-9表达显著低于A组和B组(P<0.05),而A组和B组比较,未见统计学差异;在治疗后1个月时,A组2例瘢痕疙瘩治疗区域出现部分色素沉着,B组3例出现颜色发红、血管丰富情况,其余患者均未出现疼痛、血肿、瘙痒、皮肤感染、色素沉着及皮肤萎缩等不良反应,且未见复发;在治疗6个月时,患者色素沉着及颜色发红等不良反应基本消退,但三组均出现部分瘢痕疙瘩复发情况,复发率分别为8.11%(3例,A组)、5.41%(2例,B组)及2.70%(1例,C组)(χ^(2)=0.24,P=0.98)。结论得宝松联合CO_(2)点阵激光、PDL治疗瘢痕疙瘩疗效确切,安全性高,有效促进瘢痕组织恢复,值得临床推广。

Objective To observe and analyze the clinical efficacy of Compound Betamethasone(Debaosong)combined with CO_(2)lattice laser and PDL laser in the treatment of keloid.Methods A total of 111 patients with keloid treated in our department from April 2018 to December 2019 were randomly divided into group A,group B and group C,with 37 patients in each group.Group A was treated with CO_(2)dot array laser+PDL laser,group B was treated with CO_(2)dot array laser+Debaosong,and group C was treated with Debaosong combined with CO_(2)dot array laser+PDL laser every 4 weeks(a course of treatment)for 3 courses.All patients were observed within six months of treatment,and the changes of scar score(VSS),transforming growth factorβ_(1)(TGF-β_(1)),matrix metalloproteinase-9(MMP-9)expression levels,clinical efficacy,adverse reactions and recurrence rate were observed before and after treatment in the three groups.Results After 6 months of treatment,the color,vascular distribution,scar softness,thickness and VSS scores of the three groups significantly decreased,and group C was significantly better than group A and B(P<0.05),but there was no statistical difference between group B and group C(P>0.05).The total effective rate of group A,B and C was 86.49%,83.78%and 94.60%,respectively.The curative effect of group C was significantly better than that of group A and B(P<0.05).After 1 month of treatment,the expression levels of TGF-β_(1)and MMP-9 in the three groups were significantly improved(P<0.05).The expression levels of TGF-β_(1)and MMP-9 in group C were significantly lower than those in groups A and B(P<0.05),while there was no statistical difference between group A and B.At the end of the first month after treatment,2 patients in Group A showed partial pigmentation in the treated area of keloid,and 3 patients in Group B showed redness and abundant blood vessels.No pain,hematoma,pruritus,skin infection,pigmentation and skin atrophy or other adverse reactions were found in the other patients,and no recurrence was observed.At the end of the 6th months,the adverse reactions such as pigmentation and color redness were basically subsided,but partial keloid appeared in all the three groups,and the recurrence rates were 8.11%(3 cases,group A),5.41%(2 cases,group B)and 2.70%(1 case,group C)(χ^(2)=0.24,P=0.98)respectively.Conclusions Debaosong combined with CO_(2)dot-matrix laser and PDL in the treatment of keloid is characterized by definite efficacy,high safety,low recurrence rate,and can effectively promote the recovery of scar tissues,which is worthy of clinical promotion.