复方甘草酸苷注射液治疗黄褐斑疗效评估

Efficacy evaluation of compound glycyrrhizin injection in the treatment of melasma

目的 观察复方甘草酸苷注射液治疗黄褐斑的疗效。方法 2015年5月至2016年7月在杭州市第三人民医院皮肤科门诊收集皮肤镜血管评分为＋＋或＋＋＋以及反射式共聚焦显微镜（RCM）黑素评分为＋＋或＋＋＋的黄褐斑患者30例。所有患者按照抽签法随机分为两组：实验组静脉滴注复方甘草酸苷注射液40 ml/次，每3天1次，连续使用8次；同时口服维生素C片每日3次每次0.2 g；维生素E片每日1次，每次0.1 g；对照组仅口服维生素C片和维生素E片，剂量同试验组。治疗前及治疗开始3个月后使用黄褐斑面积和严重指数（MASI）评估疗效，同时用RCM、皮肤镜和VISIA皮肤检测仪评估皮损，计算黑素评分、血管评分以及棕色斑和红色区指数。结果 实验组治疗开始3个月后与治疗前相比，RCM黑素评分分布（z = 2.773，P = 0.006）、皮肤镜血管评分分布（z = 3.135，P = 0.002）差异有统计学意义， VISIA棕色斑指数下降（38.3 ± 3.1比43.9 ± 5.8，z = 3.091，P = 0.002），VISIA红色区指数亦下降（26.5 ± 5.6比33.3 ± 7.7，t = 2.752，P = 0.010）。治疗开始3个月后，对照组RCM黑素评分较治疗前明显下降（P = 0.023），而皮肤镜血管评分和VISIA指数与治疗前相比差异均无统计学意义（P＞0.05）。治疗开始3个月后，实验组显效9例，好转6例；对照组显效3例，好转11例，无效1例，实验组疗效显著优于对照组（z = 2.276，P = 0.029）。结论 复方甘草酸苷注射液治疗黄褐斑有效，RCM、皮肤镜和VISIA皮肤检测仪可辅助黄褐斑疗效评估。

Objective To evaluate the clinical efficacy of compound glycyrrhizin injection in the treatment of melasma. Methods A total of 30 melasma patients with blood vessel scores of ＋＋ or ＋＋＋ and melanin scores of ＋＋ or ＋＋＋, which were evaluated by dermoscopy and reflectance confocal microscopy （RCM） respectively, were collected from the Department of Dermatology of Hangzhou Third Hospital between May 2015 and July 2016. All the patients were randomly divided into 2 groups by drawing lots： treatment group treated with intravenous drips of compound glycyrrhizin injection at a dose of 40 ml once every three days for 8 sessions, oral vitamin C tablets at a dose of 0.2 g thrice a day, and oral vitamin E tablets at a dose of 0.1 g once a day, and control group treated with oral vitamin C and vitamin E tablets at the same dose as the treatment group. Three months after starting the treatment, the therapeutic effect was evaluated using melasma area and severity index（MASI）. Meanwhile, RCM, dermoscopy and VISIA skin detector were used to detect skin lesions, and the melanin score, blood vessel score and brown spot and erythema indices were calculated. Results For the treatment group, the melanin score and blood vessel score were both significantly decreased at 3 months after starting the treatment compared with those before the treatment （Z =2.773, 3.135, P = 0.006, 0.002, respectively）, so were the brown spot index （38.3 ± 3.1 vs. 43.9 ± 5.8, Z = 3.091, P = 0.002）and erythema index （26.5 ± 5.6 vs. 33.3 ± 7.7, t = 2.752, P = 0.010）. For the control group, the melanin score significantly decreased at 3 months after starting the treatment compared with those before the treatment （P = 0.023）, while no significant differences were observed in the blood vessel score or VISIA indices （P 〉 0.05）. Three months after starting the treatment, 9 cases showed marked improvement, and 6 showed improvement in the treatment group; 3 cases showed marked improvement, 11 improvement, and 1 showed no improvement in the control group. The therapeutic effect in the treatment group was significantly superior to that in the control group （Z = 2.276, P = 0.029）. Conclusion Compound glycyrrhizin injection is effective for the treatment of melasma, and RCM, dermoscopy and VISIA skin detector can be used to assist efficacy evaluation in melasma.