595 nm脉冲染料激光治疗面颈部鲜红斑痣259例疗效及影响因素分析

Assessment of the Efficacy and Influencing Factors of Treating Facial and Neck Port-Wine Stains with 595 nm Pulsed Dye Laser

目的评价595 nm脉冲染料激光(pulsed dye laser,PDL)治疗面颈部鲜红斑痣的临床疗效,并探讨影响疗效的主要因素。方法回顾性分析259例经595 nm PDL治疗的面颈部鲜红斑痣的临床资料,采用自身前后对照的方式,对治疗前及治疗后的照片进行疗效评价,PDL治疗终点为轻度紫癜。纳入病例男82例,女177例;年龄1月~63岁。对影响疗效的因素进行单因素分析筛选后使用有序多分类logistic回归分析,探讨影响疗效的主要因素。并统计患者的不良反应。结果595 nm PDL治疗面颈部鲜红斑痣基愈病例57例(22.0%),显效病例106例(40.9%),有效病例68例(26.3%),总有效例数231例,总有效率为89.2%。无效病例28例(10.8%)。有序多分类logistic回归分析显示皮损颜色分型、皮损面积、皮损部位及治疗次数是影响疗效的因素,而皮损增厚与疗效无关。红型比紫红型疗效好〔比值比(OR)=2.748,P<0.05〕,面积≤10 cm2者疗效比面积>10 cm2的患者更好(OR=2.094,P<0.05),皮损位于面中部者疗效比位于颈部者差(OR=0.190,P<0.05)、面中及面周部者疗效比位于颈部者疗效差(OR=0.243,P<0.05);治疗3次以上者疗效优于治疗1~3次者(OR=0.508,P<0.05)。患者均未发生较严重的不良反应。结论皮损位于颈部、红型、面积≤10 cm2者适合使用595 nm PDL治疗,且宜治疗3次以上。性别、年龄、皮损增厚均不影响治疗效果。

Objective To assess the efficacy of 595 nm pulsed dye laser(PDL)in the treatment of facial and neck port-wine stains(PWSs),and to explore the main factors affecting the efficacy.Methods A total of 259 PWS cases who were treated with 595 nm PDL were retrospectively enrolled and their clinical information was analyzed in the study.Before-and after-treatment comparison of individual patient was done by comparing patient photographs taken before and after PDL treatment of the PWSs in order to assess the treatment efficacy,using mild purpura as the endpoint of the PDL treatment.A total of 82 male and 177 female cases were included,with patient age ranging between 1 month and 63 years.Univariate analysis was done to select factors influencing the treatment efficacy.Then,ordered multivariate logistic regression analysis was performed to evaluate the main factors affecting the efficacy.Statistics of adverse reaction of patients were also collected.Results Of the 259 patients covered in the study,57(22%)had achieved complete clearing of PWS,106(40.9%)showed significant improvement,and 68(26.3%)showed moderate improvement,amounting to a total of 231 effective treatment cases,indicating a 89.2%overall rate of effective treatment.There were 28 ineffective treatment cases(10.8%).Ordered multivariate logistic regression analysis showed that the color of PWS,the area of PWS,anatomical sites of PWS and the number of treatment sessions were the main factors affecting the therapeutic efficacy,while proliferation did not affect the therapeutic efficacy.Red-type PWS had better treatment efficacy than that of the purple-type PWS(odds ratio[OR]=2.748,P<0.05).Patients with PWS≤10 cm2 showed better treatment efficacy than those with PWS>10 cm2(OR=2.094,P<0.05).Treatment efficacy of PWS located in the central section of the face was not as good as those located on the neck(OR=0.190,P<0.05),and the treatment efficacy of PWS located in the central and lateral section of the face was not as good as those located on the neck(OR=0.243,P<0.05).Patients who had more than 3 treatment sessions showed better efficacy than those who had 1-3 sessions of treatment(OR=0.508,P<0.05).No patients incurred any serious adverse reactions.Conclusion Patients with PWS located on the neck,red-type PWS and area≤10 cm2 are suitable for treatment with 595 nm PDL and there should be more than three sessions of treatment.Patient sex,age,or proliferation do not affect the treatment effect.