曲安奈德联合玻璃酸酶注射辅助浅层X线放射治疗多发性瘢痕疙瘩的有效性研究

A study on the efficacy of triamcinolone acetonide combined with hyaluronidase injection and superficial X-ray in the treatment of multiple keloids

目的探讨曲安奈德联合玻璃酸酶注射辅助浅层X线放疗,在治疗多发性瘢痕疙瘩中的临床应用价值。方法回顾性分析南方医科大学皮肤病医院门诊2018年3月至2019年10月治疗的144例多发性瘢痕疙瘩患者资料,男性89例,女性55例,年龄16~68岁,平均28岁;病程1~20年,平均6年。根据治疗方法分为A组65例,采用曲安奈德联合玻璃酸酶局部注射辅助浅层X线放疗;B组79例,采用曲安奈德联合玻璃酸酶局部注射治疗。治疗后随访6~18个月,对2组患者进行温哥华瘢痕量表(VSS)评估和有效性评价。采用两独立样本t检验及卡方检验进行统计分析。结果 A组治疗前VSS评分为(11.9±0.9)分,治疗后为(6.5±1.1)分,51例好转、14例显效,显效率为21.54%(14/65),不良反应主要表现为一过性色素沉着。B组治疗前VSS评分为(12.1±1.0)分,治疗后为(8.3±1.0)分,74例好转、2例显效、3例无效,显效率为2.63%(2/76),不良反应主要包括毛细血管扩张、皮肤萎缩等,有部分女性患者出现月经周期异常(3例),毛发增多(2例)。2组患者治疗前VSS评分比较差异无统计学意义(t=-1.114,P=0.267),治疗后VSS评分比较差异有统计学意义(t=-10.208,P<0.001)。2组显效率比较差异有统计学意义(χ2=12.450,P<0.001)。结论曲安奈德联合玻璃酸酶注射辅助浅层X线治疗多发性瘢痕疙瘩效果理想,不良反应发生率低,是具有临床应用前景的干预方法。

Objective To investigate the clinical application value of triamcinolone acetonide combined with hyaluronidase injection and shallow X-ray in the treatment of multiple keloids.Methods From March 2018 to October 2019,144 cases of multiple keloids in outpatient department were analyzed retrospectively.There were 89 males and 55 females,aged from 16 to 68,with an average age of 28 years.The average duration was 6 years(ranged from 1 to 20 years).Among them,65 cases were treated with superficial X-ray radiotherapy combined with local injection(group A)and 79 cases were treated only with local injection(group B).The Vancouver Scar Scale(VSS),t-test and chi-square test were used to evaluate the validity of the two groups.The patients were followed up for 6-18 months.Results In group A,the VSS was changed from 11.9±0.9 to 6.5±1.1.51 cases were improved and 14 cases showed obviously effective.The significant effect rate was 21.54%(14/65).The main side effect of group A was transient pigmentation.In group B,the VSS was changed varied from 12.1±1.0 to 8.3±1.0.74 cases were improved,2 cases were markedly effective,but 3 cases were ineffective.The significant effective rate was 2.63%(2/76).The side effects include telangiectasia,skin atrophy,even arousing abnormal menstrual cycles and hair growth in several females.The comparability between the two groups was confirmed by the VSS scores before treatment(t=-1.114,P=0.267).Then,the difference of VSS scores became significant after treatment(t=-10.208,P<0.001),the same to apparent efficiency(χ2=12.450,P<0.001).Conclusions Triamcinolone acetonide combined with hyaluronidase injection and shallow X-ray radiation therapy for multiple keloids has ideal curative effect and low incidence of adverse reactions,which is a prospected clinical method.