A型肉毒素与曲安奈德治疗瘢痕疙瘩的长期疗效对比

Comparison of Long-term Efficacy of Botulinum Toxin Type A and Triamcinolone Acetonide for Keloid

目的比较A型肉毒素与曲安奈德治疗瘢痕疙瘩的长期疗效。方法将30例瘢痕疙瘩患者随机分为A组和B组,各15例。A组瘢痕内注射A型肉毒素,总量不超过100 U/人,间隔8周注射1次,共治疗5次;B组行曲安奈德注射治疗,控制单次给药量<80 mg,每4周注射1次,共治疗5次;两组患者每次注射治疗后,再行局部X线照射治疗,4 Gy/次。应用温哥华瘢痕评分量表(VSS)与可视对比评分量表(VAS)对两组治疗前后瘢痕疙瘩的整体情况进行评分,将两个量表的评分相加得出瘢痕疙瘩总评分,比较两组患者治疗前后总评分差值与治疗后的显效程度。结果两组患者在治疗后,观察者随访24~36个月,平均(29.67±2.28)个月,均有较为理想的治疗效果。A组显效程度高于B组(P=0.01);A组治疗前后总评分差值为(8.47±0.92)分,B组治疗前后总评分差值为(5.27±1.44)分,两组差异有统计学意义(P<0.05)。其中,A组治疗后VAS评分均较治疗前有较大改善,VAS前后差值为(4.33±0.49)分,而B组治疗前后VAS评分差值变化不明显,VAS前后差值为(0.87±0.83)分,差异有统计学意义(P<0.05)。结论在改善患者的痛痒症状和瘢痕疙瘩外观方面,采用A型肉毒素联合X线治疗瘢痕疙瘩,整体来说优于曲安奈德联合X线,疗效较好。

Objective To compare the long-term efficacy of botulinum toxin type A ( BTA) and triamcinolone acetonide for keloid. Methods Thirty patients with keloids were randomly divided into groups A and B. Group A received BTA (≤100 U/person) once every 8 weeks and 5 times in total, while group B was given triamcinolone acetonide (≤80 mg/person) once every 4 weeks and 5 times in total. Following each treatment, skin lesion was irradiated with 4Gy of X ray. Vancouver scar score scale (VSS) and visual comparison score scale ( VAS) were used to evaluate the condition of keloid before and after treatment. The total keloid scores were obtained by adding the scores of the two scales. The difference in the total scores before and after treatment, and efficacy were compared between the two groups. Results Both groups achieved satisfactory outcome following 24 .36 months of follow-up ( average 29. 67 ± 2. 28 months of follow-up). Efficacy was higher in group A than in group B ( P =0. 01). The differences in total scores before and after treatment in group A were more significant than that in group B ( 8. 47 ±0. 92 vs. 5. 27 ± 1. 44, P < 0. 05). Following the treatments, the differences in VAS scores before and after treatments were also more significant in group A than in group B ( 4. 33 ± 0. 49 vs. 0. 87 ± 0. 83 , P < 0. 05). Conclusion Botulinum toxin type A combined with X-ray is superior to triamcinolone acetonide combined with X-ray for keloid in relieving pain and pruritus in addition to superior efficacy.