三种类型瘢痕患者瘢痕皮肤的经皮水分丢失情况及其与瘢痕严重程度的关系

Transepidermal water loss of scar skin in three types of scar patients and its correlation with scar severity

目的了解浅表性瘢痕患者、增生性瘢痕患者、萎缩性瘢痕患者瘢痕皮肤的经皮水分丢失(TEWL)情况,探讨TEWL与瘢痕严重程度的关系。方法采用回顾性观察性研究方法。2017年2月—2019年2月,吉林市化工医院收治符合入选标准的瘢痕患者120例,其中男78例、女42例,年龄(35±14)岁。根据入院时诊断情况,本组患者中浅表性瘢痕患者、增生性瘢痕患者、萎缩性瘢痕患者各40例。入院时,采用温哥华瘢痕量表(VSS)对每例患者瘢痕进行评分,应用水分流失测试仪测定每例患者的瘢痕皮肤和“瘢痕边缘约1 cm处或健侧相同部位正常皮肤”(下称正常皮肤)TEWL并计算瘢痕皮肤和正常皮肤TEWL的差值(下称TEWL差值)。对数据比较进行χ^(2)检验、Kruskal-Wallis秩和检验、配对样本t检验、单因素方差分析、Dunnett-t检验,对TEWL差值与瘢痕VSS评分的相关性进行一元线性回归分析。结果入院时,浅表性瘢痕患者瘢痕VSS评分明显低于增生性瘢痕患者、萎缩性瘢痕患者(t=4.403、4.768,P<0.01),萎缩性瘢痕患者瘢痕VSS评分明显低于增生性瘢痕患者(t=4.185,P<0.01)。入院时,浅表性瘢痕患者、增生性瘢痕患者、萎缩性瘢痕患者瘢痕皮肤TEWL分别为(18±4)、(20±4)、(20±5)g·m^(-2)·h^(-1),分别明显高于正常皮肤TEWL的(12±3)、(12±3)、(14±4)g·m^(-2)·h^(-1)(t=6.889、10.221、5.870,P<0.01)。浅表性瘢痕患者、增生性瘢痕患者、萎缩性瘢痕患者TEWL差值分别为(5.9±1.7)、(8.1±1.7)、(6.4±2.1)g·m^(-2)·h^(-1),各类型瘢痕患者比较,仅增生性瘢痕患者TEWL差值明显高于浅表性瘢痕患者(t=6.975,P<0.05)。浅表性瘢痕患者、增生性瘢痕患者、萎缩性瘢痕患者TEWL差值与瘢痕VSS评分均呈明显正相关(r=0.805、0.872、0.826,P<0.01)。结论浅表性瘢痕患者、增生性瘢痕患者、萎缩性瘢痕患者瘢痕皮肤TEWL均较正常皮肤增加,增加程度与瘢痕的严重程度呈正相关。

Objective To study the transepidermal water loss(TEWL)of scar skin in patients with superficial scars,hypertrophic scars,and atrophic scars,and to explore the correlation between TEWL and scar severity.Methods A retrospective observational study was conducted.From February 2017 to February 2019,120 scar patients who met the inclusion criteria were admitted to the General Hospital of Jilin Chemical Industry Group,including 78 males and 42 females,aged(35±14)years.According to the diagnosis on admission,there were 40 cases of superficial scar patients,40 cases of hypertrophic scar patients,and 40 cases of atrophic scar patients.On admission,the Vancouver Scar Scale(VSS)was used to score the scar of each patient;the TEWL of scar skin and normal skin 1 cm from the edge of scar or the same site of the healthy side(hereinafter referred to as normal skin)of each patient was measured by water loss tester,and the difference value of TEWL between scar skin and normal skin(hereinafter referred to as the TEWL difference)was calculated.Data were statistically analyzed with chi-square test,Kruskal-Wallis rank sum test,paired sample t test,one-way analysis of variance,and Dunnett-t test for comparison,and the correlation between the difference value of TEWL and scar VSS score was analyzed with univariate linear regression analysis.Results On admission,the scar VSS score of superficial scar patients was significantly lower than that of hypertrophic scar or atrophic scar patients(t=4.403,4.768,P<0.01),and the scar VSS score of atrophic scar patients was significantly lower than that of hypertrophic scar patients(t=4.185,P<0.01).On admission,the TEWL of scar skin of superficial scar,hypertrophic scar,and atrophic scar patients were(18±4),(20±4),and(20±5)g·m^(-2)·h^(-1)respectively,significantly higher than(12±3),(12±3),and(14±4)g·m^(-2)·h^(-1)of normal skin(t=6.889,10.221,5.870,P<0.01).The difference values of TEWL of superficial scar,hypertrophic scar,and atrophic scar patients were(5.9±1.7),(8.1±1.7),and(6.4±2.1)g·m^(-2)·h^(-1)respectively.In comparison among different types of scar patients,only the TEWL difference of hypertrophic scar patients was significantly higher than that of superficial scar patients(t=6.975,P<0.05).The TEWL difference and the scar VSS score in patients with superficial scars,hypertrophic scars,and atrophic scars were significantly positively correlated(r=0.805,0.872,0.826,P<0.01).Conclusions The TEWL of scar skin in patients with superficial scars,hypertrophic scars,and atrophic scars is increased compared with normal skin,and the degree of increase was positively correlated with the severity of scars.