A型肉毒素注射治疗瘢痕疙瘩顽固性痛痒的临床研究

Botulinum Toxin Type A for the Treatment of Keloid with Obstinate Pain and Itch

目的探索治疗瘢痕疙瘩患者顽固性痛痒的新疗法。方法经常规激素治疗(1～2mL/次·月,平均5.2次)后痛痒无明显改善的瘢痕疙瘩患者35例,年龄18～55岁。随机单盲法分为A型肉毒素注射组(T组)16例,得宝松注射组(C组)19例。随访1次/月,共6个月。采用VAS量表评估痛痒症状的变化,记为V随访次数,统计分析V值,评价疗效。免疫组化检测疗程结束后,两组瘢痕内切除组织的SP表达(T组9例,C组11例)。结果除V0外,两组间各观察点V值的差异有统计学意义(P<0.01)。C组各观察点的VAS值差异无统计学意义;T组各观察点的VAS值逐步缓慢下降,其中V1vsV0,V6vsV5有显著差异。与C组相比,T组切除的瘢痕组织内SP阳性染色较少。结论肉毒素A注射治疗瘢痕疙瘩患者的顽固性痛痒疗效明显并具有时间依赖性;肉毒素A可能是通过减少瘢痕内的SP含量达到治疗效果的。肉毒素注射可作为治疗瘢痕疙瘩顽固性痛痒的有效手段。

Objective To explore the effects of Botulinum toxin type A for keloid patients with obstinate pain and itch. Methods Thirty five patients of keloid with obstinate pain and itch, aging 18-55 years, undergone an average 5.2 times injection of steroid hormone. But the symptoms were not be relieved. All patients were randomly divided into T group （Botox injeetive, n=16） and C group （Diprospan injection, n=19）. The change of pain and itch were evaluated by visual analogy scale （VAS） for every month. Immunological histochemistry technique was used to detect the expression of substance P （SP） in excised tissue after the whole therapy was finished. There were T group and 11 from C group respectively. Results All cases were followed up for 6 months. There were significant difference between the VAS in T and C group. There was no difference in VAS at C group. In T group, V1 vs V0, V6 vs V5 there was significant difference between VAS1 vs VAS0 and VAS6 vs VAS5. In addition, the positive expression of SP in excised tissue in T group is less than in C group. Conclusion Botulinum toxin type A can reduce the pain or itching in keloid patients and its effect was time-dependent. The distinguished effect was achieved probably by decreasing the expression of SP in keloid with botulinum toxin type A injection. So botulinum toxin type A injection is an effective treatment for obstinate pain and itching in keloid.