755 nm皮秒激光联合氨甲环酸治疗黄褐斑的疗效及影响因素分析

Efficacy of 755 nm Pico-second Laser Combined with Tranexamic Acid on Patients with Melasma and Its Analysis of Influencing Factors

目的:观察波长755 nm皮秒激光联合氨甲环酸治疗黄褐斑的疗效,并分析影响疗效的相关因素。方法:选取2018年11月-2019年11月笔者医院收治的黄褐斑患者65例,分为对照组33例和观察组32例。对照组采用氨甲环酸治疗,观察组在对照组的基础上加用755 nm皮秒激光,疗程均为4个月。治疗后评价两组疗效,治疗前、治疗2个月后和治疗4个月后,两组均接受黄褐斑面积及严重程度(Melasma area severity index,MASI)评分,记录不良反应,采用单因素分析和多因素Logistic回归模型分析影响患者疗效的相关因素。结果:观察组有效率87.50%,高于对照组有效率63.64%(P<0.05);治疗2个月后,两组MASI评分均低于同组治疗前,且观察组低于对照组(P<0.05);治疗4个月后,两组MASI评分均低于治疗前和治疗2个月后,且观察组低于对照组(P<0.05)。两组不良反应发生率之间比较,差异无统计学意义(P>0.05)。单因素分析显示,病程、Wood灯下分型、临床分期、Fitzpatrick皮肤类型、防晒霜使用情况、POMS评分和治疗方案均与疗效有关(P<0.05);多因素Logistic回归分析显示,Wood灯下分型、临床分期、防晒霜使用情况和治疗方案是疗效的独立影响因素(P<0.05)。结论:755 nm皮秒激光联合氨甲环酸治疗黄褐斑,能够提高疗效,降低MASI评分,安全性高。Wood灯下分型、临床分期、防晒霜使用情况和治疗方案是疗效的独立影响因素。

Objective To investigate the efficacy of 755nm pico-second laser combined with tranexamic acid on patients with melasma,and to analyze the influencing factors of efficacy.Methods Total of 65 patients with chloasma admitted to our hospital from November 2018 to November 2019 were randomly divided into the observation group(n=32)and the control group(n=33).The control group was treated with tranexamic acid.The observation group was treated with 755nm pico-second laser on the basis of the control group.The course of treatment was 4 months.After treatment,the efficacy of the two groups was evaluated.Before treatment,2 months after the treatment and 4 months after the treatment,both groups received the melasma area severity index(MASI),and adverse reactions were recorded.Univariate analysis and multiple Logistic regression models were used to analyze the influencing factors of curative effect.Results The total effective rate of the observation group was 87.50%,which was higher than 63.64%of the control group(P<0.05).2 months after the treatment,MASI score in two groups was lower than that before treatment,and the observation group was lower than the control group(P<0.05).4 months after the treatment,MASI score in two groups was lower than that before treatment and 2 months after the treatment,and the observation group was lower than the control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Univariate analysis showed that the course of disease,pathological type of Wood lamp,clinical stage,Ⅲtypes of Fitzpatrick,use of sunscreen,score of POMS and the therapy treatment was related to efficacy(P<0.05).Multiple Logistic regression analysis showed that pathological type of Wood lamp,clinical stage,use of sunscreen and therapy treatment were independent influencing factors of efficacy(P<0.05).Conclusion The 755 nm pico-second laser combined with tranexamic acid on patients with melasma,can improve the efficacy and reduce the score of MASI with security.The pathological types of Wood lamp,clinical stage,use of sunscreen and therapy treatment are independent influencing factors of efficacy.