两种A型肉毒毒素在前额的弥散性比较

Diffuseness comparison of two kinds of botulinum toxins type A on the forehead

目的探讨两种注射用A型肉毒毒素（保妥适和衡力）在前额的弥散性，以及皮内注射和皮下注射对药物弥散性的影响。方法选取健康志愿者20名，在前额4个部位分别注射0.05ml（2U）的A型肉毒毒素。随机选择在一侧前额的中部和颞侧注射保妥适，而在另一侧前额的中部和颞侧注射衡力；其中前额中部行皮下注射，颞侧行皮内注射。注射后第14天进行微碘一淀粉试验，拍摄前额照片，计算每块无汗晕环的面积，最大垂直和水平弥散距离。结果皮内注射时，保妥适的无汗晕面积（144±14）mm^2、垂直弥散距离（14．4±1．1）mm和水平弥散距离（10．8±0．6）mm，均显著小于衡力的无汗晕面积（180±15）mm^2、垂直弥散距离（15．8±1．0）mm和水平弥散距离（12．5±0.7）mm，差异有统计学意义（P〈0.05）。皮下注射时，保妥适的无汗晕面积（183±18）mm^2显著小于衡力的无汗晕面积（207±17）mm^2，差异有统计学意义（P〈0.05）；保妥适的水平弥散距离（12．2±0．7）mm稍小于衡力的水平弥散距离（13．2±0．6）mm（P=0．06）。保妥适的水平弥散距离，皮内注射小于皮下注射，差异有统计学意义（P〈0.05）；而衡力皮内注射和皮下注射的弥散距离差异无统计学意义（P〉0.05）。结论保妥适弥散性小于衡力，临床药效更加可控。相对于皮下注射，皮内注射可以减少A型肉毒毒素的弥散性。

Objective To evaluate the diffuse characteristics of two types of botulinum toxin type A （BOTOX and CBTX-A） in the forehead and the effect of intradermal （ID） and subcutanous （SC） infections on their diffusion. Methods Healthy volunteers （n =20） were recruited to receive a 0.05 ml （2 U） injection of botulinum toxin type A at four forehead sites [both sides of medial forehead （SC） and temporal forehead （ID）], one side for BOTOX and another for CBTX-A. On day 14, the Minors＇ iodine starch test was performed and photographs were taken for calculating the area and dimensions of anhydrotic area. Results The areas of anhidrosis ID were significantly greater with CBTX A （180±15） mm^2 than that of BOTOX （144±14） mm^2. The same conditions occurred in vertical dimensions （14.4±1.1） mm vs. （15.8±1.0） mm and horizontal dimensions （10.8±0.6） mm vs. （12.5±0.7） mm. There was significant variation between the both for diffuseness in the two anhidrotic halos observed after ID injection （P〈0.05）. The areas of anhidrosis by SC were significantly greater with CBTX-A （207±17） mm^2 than that in BOTOX （183±18） mm^2. The mean horizontal dimension was greater with CBTX-A by SC （13.2±0.6） mm than that of BOTOX by SC （12.2±0.7） mm, but not statistically significant （P = 0.06）. The mean horizontal dimension in BOTOX was significantly greater with SC than that with ID （P〈0.05）. There was no statistically significant difference between SC and ID administration of CBTX-A. Conclusions BOTOX diffuses less than CBTX-A. ID injection technique may result in less diffusion than SC.