Nd∶YAG皮秒激光治疗黄褐斑临床疗效及安全性研究

Clinical efficacy and safety of picosecond Nd∶ YAG laser in the treatment of melasma

目的探索1 064 nm Nd∶YAG皮秒激光治疗黄褐斑的有效性和安全性。方法前瞻性选取2019年9~10月首都医科大学附属北京友谊医院门诊招募的38例黄褐斑患者进行皮秒激光治疗,治疗共3次,每4周进行一次,随访6个月。对患者治疗前、治疗第4周、第8周、第12周及随访6个月后的改良黄褐斑面积和严重指数(m MASI)评分做出评估,记录治疗后医生整体评价(PGA)、患者疗效满意度,记录治疗及随访期间出现的不良反应情况。结果 35例患者完成本研究,Fitzpatrick皮肤分型Ⅲ型25例,FitzpatrickⅣ型10例。经过3次治疗后,治疗区域mMASI评分由治疗前的5.4(2.4,10.8)分降至2.4(0.9,4.2)分,差异有统计学意义(P <0.001)。总有效率为94.3%,显效20例(57.1%),好转13例(37.1%),无效2例(5.7%)。经过3次治疗后,FitzpatrickⅢ型患者mMASI评分由治疗前4.2(2.0,7.0)分降至1.5(0.9,2.6)分,FitzpatrickⅣ型患者m MASI评分由治疗前11.4(6.8,15.1)分降至4.8(3.6,6.3)分,治疗前后FitzpatrickⅢ与FitzpatrickⅣ型患者m MASI评分下降值比较,差异无统计学意义(P> 0.05)。FitzpatrickⅢ型患者有效率(96.0%)和FitzpatrickⅣ型患者(90.0%)比较,差异无统计学意义(P> 0.05)。33例(94.3%)患者PGA评分有不同程度改善,FitzpatrickⅢ型总改善率为96.0%,FitzpatrickⅣ型总改善率为90.0%。2组患者PGA评分值比较,差异无统计学意义(P> 0.05)。患者疗效满意率为85.7%。治疗期间未观察到严重不良反应。随访6个月后,9例(25.7%)出现复发。结论 1 064 nm Nd∶YAG皮秒激光治疗FitzpatrickⅢ型与Ⅳ型黄褐斑疗效均较好,不良反应小,值得临床推广应用。

Objective To explore the efficiency and safety of the 1 064 nm picosecond Nd∶ YAG laser in the treatment of melasma.Methods From September to October 2019,38 cases of melasma in Beijing Friendship Hospital,Capital Medical University were prospectiveely enrolled and received 1 064 nm picosecond Nd∶ YAG laser therapy for 3 times,once every 4 weeks,followed up for 6 months. The modified melasma area and severity index(m MASI) scores were evaluated at baseline,4 weeks,8 weeks,12 weeks and after 6 months of follow-up. The Physician’s Global Assessment(PGA) scores and the satisfaction rate of patients were calculated after treatment. All the adverse reactions during the treatment period and up to 6 months in the follow-up period were observed. Results Thirty-five cases completed the study,Fitzpatrick skin type classification: 25 cases of type Fitzpatrick Ⅲ and 10 cases of type Fitzpatrick Ⅳ. The average m MASI score of the laser-treated areas significantly reduced from 5. 4(2. 4,10. 8) pionts to 2. 4(0. 9,4. 2) pionts after accepting treatment for 3 times(P < 0. 001). The total effective rate was 94. 3%,20 cases(57. 1%) were markedly effective,13 cases(37. 1%) were improved,and 2 cases(5. 7%) were ineffective. After 3 treatments,Fitzpatrick Ⅲ score decreased from 4. 2(2. 0,7. 0) points before treatment to 1. 5(0. 9,2. 6) points,and Fitzpatrick Ⅳ patients dropped from 11. 4(6. 8,15. 1) points before treatment to 4. 8(3. 6,6. 3) points. There was no significant difference in m MASI score comparison between Fitzpatrick Ⅲ and Fitzpatrick Ⅳ patients before and after treatment(P > 0. 05). The PGA scores of 33 cases(94. 3%) were improved with different levels. The overall improvement rate of Fitzpatrick Ⅲ was 96. 0%,and that of Fitzpatrick Ⅳ was 90. 0%. There was no significant difference in PGA score between the two groups(P > 0. 05). The general satisfaction rate was 85. 7%. No serious adverse events have been observed during the treatment period. Nine cases(25. 7%) recurred after 6 months of follow-up. Conclusion The 1 064 nm picosecond Nd∶ YAG laser for the treatment of Fitzpatrick Ⅲ and Ⅳ melasma has reliable efficacy,less side effect,and is worthy of clinical application.