超脉冲二氧化碳点阵激光对凹陷痤疮瘢痕治疗机制探讨

Study on mechanism of ultra pulsed carbon dioxide laser in treatment of acne scars

目的探究凹陷痤疮瘢痕采用超脉冲二氧化碳点阵激光治疗的机制。方法选取2018年1月至2019年2月中山大学附属第七医院收治的凹陷痤疮瘢痕64例患者,将其作为观察组,随机分成Ⅰ和Ⅱ组;另选取健康体检患者45例,作为对照组;观察组患者在术前接受利多卡因乳膏进行治疗,Ⅰ组进行超脉冲二氧化碳点阵激光(设定参数:密度为10%,能量为10MT,工作光斑直径0.12mm,时间间隔0.5 s,频率300 Hz)进行治疗,Ⅱ组进行超脉冲二氧化碳点阵激光(设定参数:密度为20%,能量为20MT,工作光斑直径0.12 mm,时间间隔0.5s,频率300 Hz)进行治疗;观察比较两组患者的治疗效果及临床指标评分、血清中IL水平、TNF-α及TGF-β和CRP水平、MEK1、MEK2、ERK1、ERK2水平变化及不良反应。结果Ⅰ组脱痂时间、水肿及PIH持续时间、ECCA评分及VAS评分均高于Ⅱ组,差异有统计学意义(P<0.05);观察组患者血清中IL水平均明显降低,观察组Ⅱ组患者治疗后下降幅度高于观察组Ⅰ组,差异有统计学意义(P<0.05);TNF-α及TGF-β和CRP水平均明显降低,观察组Ⅱ组患者治疗后上述因子下降更明显,差异有统计学意义(P<0.05);MEKl、MEK2、ERKl、ERK2水平均明显降低,且观察组患者Ⅱ组患者治疗后MEKl、MEK2、ERKl、ERK2水平下降较为明显,差异有统计学意义(P<0.05);不良反应总发生率分别为9.38%、21.88%,两组数据差异具有统计学意义(P<0.05)。结论超脉冲二氧化碳点阵激光治疗凹陷痤疮瘢痕的疗效显著,治疗的机制可能与响p38MAPK信号通路及炎症反应相关。

Objective To investigate the mechanism of ultra short pulse carbon dioxide laser in the treatment of acne scar, and to provide the basis for clinical treatment of acne scar.Methods Totally 62 cases of acne scar depression patients were treated in our hospital were selected from July 2015 to October 2016 as the observation group, take the random number of patients in the observation group were randomly divided into Ⅰ group and Ⅱ group;another 45 cases of healthy patients were selected as control group;the observation group patients in the preoperative lidocaine cream party for treatment,Ⅰ group of ultra pulse CO2 laser treatment,Ⅱ group of ultra pulse CO2 laser treatment;and the clinical indicators were compared between the two treatment groups score, serum levels of IL, TNF-alpha and TGF-beta and CRP, MEK1, MEK2, ERK1 level, ERK2 level changes and adverse reactions.Results Ⅰ group of patients with PIH duration, VAS score, pain, effect of edema duration and decrustation is higher than that of Ⅱ group(P<0.05);after treatment, IL level of the observation group in serum were significantly decreased, the observation group decreased after treatment in group Ⅱ were higher than that of group Ⅰ(P<0.05) and alpha TNF-;TGF-beta and CRP levels were significantly lower in observation group,Ⅱ group of patients after treatment of the above factors decreased significantly(P<0.05);MEKl, MEK2, ERKl and ERK2 levels were significantly decreased, and the observation of MEKl, MEK2, ERKl and ERK2 levels in patients with Ⅱ after treatment decreased more significantly(P<0.05);total adverse reaction rates were 9.38% and 21.88%, with statistically significant differences between the two groups of data(P<0.05).Conclusion The curative effect of the treatment of acne scar with super pulsed carbon dioxide laser is significant, and the mechanism of treatment may be related to the p38 MAPK signaling pathway and inflammatory reaction.