长脉宽Nd:YAG 1064 nm激光治疗远端侧位甲下型甲真菌病的疗效观察及对真菌超微结构的影响

Efficacy of long pulsed Nd:YAG 1064nm laser for the treatment of distal lateral subungual onychomycosis and effect on the ultrastructural changes of fungi

目的探讨长脉宽Nd:YAG 1064 nm激光治疗远端侧位甲下型甲真菌病的疗效,观察其对真菌超微结构的影响。方法收集临床具有甲真菌病典型临床表现且真菌真接镜检阳性的远端侧位甲下型甲真菌病病例,给予长脉宽Nd:YAG 1064 nm激光治疗12周,计算临床有效率、真菌学清除率,记录不良反应。采用扫描电镜观察长脉宽Nd:YAG 1064 nm激光对红色毛癣菌、趾/指间毛癣菌、白念珠菌临床菌株超微结构的影响。结果入选远端侧位甲下型甲真菌病患者30例,共计病甲58个,其中22个累积甲母质。疗后半年临床有效率为58.62%。治疗结束未累积与累积甲母质病甲临床有效率分别为61.11%、9.09%,疗后半年两组临床有效率分别为80.56%、22.73%,差异均有显著的统计学意义(χ^2=15.234、18.825,P<0.001、0.001)。疗后半年真菌学清除率为58.62%。治疗结束时及疗后半年未累积与累积甲母质病甲真菌学清除率差异均有显著的统计学意义(χ^2=21.795、23.895,P<0.001、0.001)。激光照射后的临床菌株,在扫描电镜下显示菌体被破坏。结论长脉宽Nd:YAG1064 nm激光是治疗未累积甲母质的远端侧位甲下型甲真菌病的一种安全有效的方法,其可以改变菌体的超微结构。

Objective To evaluate the efficacy of long pulsed NdYAG 1064nm laser for the treatment of distal lateral subungual onychomycosis and to observe the effect on the ultrastructural changes of fungi.Methods Distal lateral subungual onychomycosis cases with typical clinical manifestations and positive fungal microscopy examination were enrolled into this study,and treated with long pulsed NdYAG 1064 nm laser for 12 weeks.Clinical efficacy and mycological clearance were evaluated.The ultrastructural changes of long pulsed NdYAG 1064 nm laser in Trichophyton rubrum,Trichophyton interdigitale and Candida albicans were exhibited by scanning electron micrograph(SEM).Results Totally,30 patients with distal lateral subungual onychomycosis(58 nails)were enrolled.There were 22 nails with nail matrix involvement.The clinical effective rate was 58.62%at 6 months after treatment.At the end of the treatment,the clinical effective rates of the nails without and with nail matrix involvement were 61.11%、9.09%,respectively.At 6 months after treatment,those were 80.56%、22.73%,respectively.There were significant differences,respectively(χ^2=15.234、18.825,P<0.001、0.001).The mycological clearance rate was 58.62%at 6 months after treatment.At the end of treatment and 6 months after treatment,there was significant difference in the mycological clearance rate between the nails without and with nail matrix involvement(χ^2=21.795、23.895,P<0.001、0.001).The results of SEM exhibited that the ultrastructure of the three strains after laser irradiation was damaged.Conclusion Long pulsed NdYAG 1064 nm laser was a safe and effective method for the treatment of distal lateral subungual onychomycosis without nail matrix involvement,and the laser could change the cellular ultrastructure of fungi.