中药外敷联合A型肉毒毒素治疗早期增生性瘢痕疗效观察

Clinical Study on Efficacy of External Application of Chinese Medicinals Combined with Botulinum Toxin A in the Treatment of Early Hypertrophic Scar

目的:观察中药外敷联合A型肉毒毒素注射治疗早期增生性瘢痕的临床疗效。方法:选择2019年4月至2021年4月在开封市人民医院皮肤科就诊的早期增生性瘢痕患者98例,采用随机数字表法分为对照组和观察组,每组各49例。对照组给予A型肉毒毒素注射治疗,观察组在对照组治疗的基础上采用中药外敷治疗。观察两组患者治疗前后温哥华瘢痕量表(vancouverscarscale,VSS)评分、瘢痕处皮肤弹性、水分、红斑情况,检测两组患者治疗前后血清组胺、羟脯氨酸(hydroxy proline,HYP)、5-羟色胺(5-hydroxy tryptamine,5-HT)水平。结果:对照组有效率为73.47%,观察组有效率为91.84%,两组有效率比较,差异有统计学意义(P<0.05)。两组患者治疗后VSS评分均较治疗前降低,且组间比较,差异有统计学意义(P<0.05)。两组患者治疗后瘢痕处皮肤弹性、水分、红斑评分均较治疗前升高,且组间比较,差异有统计学意义(P<0.05)。两组患者治疗后血清组胺、HYP、5-HT水平均较治疗前降低,且组间比较,差异有统计学意义(P<0.05)。结论:中药外敷联合A型肉毒毒素注射治疗早期增生性瘢痕,能有效改善患者瘢痕症状,缓解疼痛感,其作用机制可能与调节血清组胺、HYP、5-HT水平有关。

Objective: To observe the clinical efficacy of external application of Chinese medicinals combined with botulinum toxin A on early hypertrophic scar.Methods: A total of 98 patients with hypertrophic scar treated in the dermatology department of Kaifeng People′s Hospital from April 2019 to April 2021 were randomly divided into the control group and the observation group, with 49 cases in each group.The control group was treated with botulinum toxin A injection, while the observation group was treated with external application of Chinese medicinals on the basis of the treatment of the control group.The clinical efficacy, Vancouver Scar Scale(VSS) score, skin elasticity, moisture and erythema at the scar were observed before and after treatment in the two groups.The levels of serum histamine, hydroxyproline(HYP) and 5-hydroxytryptamine(5-HT) were measured before and after treatment in the two groups.The effective rate was 73.47% in the control group and 91.84% in the observation group.There was significant difference between the two groups(P<0.05).Results: The effective rate was 73.47% in the control group and 91.84% in the observation group.There was significant difference between the two groups(P<0.05).The VSS score of the two groups after treatment was lower than that before treatment, and there was significant difference between the two groups(P<0.05).After treatment, the scores of skin elasticity, moisture and erythema in the scar of the two groups were higher than those before treatment, and there were significant differences between the two groups(P<0.05).The levels of serum histamine, HYP and 5-HT in the two groups after treatment were lower than those before treatment, and there were significant differences between the two groups(P<0.05).Conclusion: External application of Chinese medicinals combined with botulinum toxin A injection in the treatment of early hypertrophic scar can effectively improve scar symptoms and relieve pain.The mechanism may be related to the regulation of serum histamine, hydroxyproline and 5-HT levels.