点阵CO_(2)激光对不同程度痤疮瘢痕的疗效及影响因素分析

Analysis of the Influencing Factors and Treatment Effects of Fractional CO_(2) Laser in Patients with Various Degrees of Acne Scar

目的:探讨点阵CO_(2)激光治疗不同程度的痤疮瘢痕的疗效及影响因素。方法:采用病例对照及回顾性分析相结合的方法,收集笔者科室2017年8月-2020年12月就诊的痤疮瘢痕患者78例,根据Goodman&Baron痤疮瘢痕评价系统分为轻度组25例、中度组27例,重度组26例;采用点阵CO_(2)激光治疗痤疮瘢痕(1次/月,共3次),治疗结束后评估三组疗效、痤疮瘢痕评分及积分下降率、不良反应并分析其影响因素。结果:与治疗前比较,三组治疗后痤疮瘢痕评分均下降,差异具有统计学意义(均P<0.01);三组之间积分下降率比较,差异有统计学意义(P<0.05);轻、中度组总有效率分别为88.0%和88.89%,高于重度组57.69%(χ^(2)=5.88,P=0.015,χ^(2)=6.63,P=0.010);三组不良反应发生率分别为12.0%,14.81%,7.70%;组间比较差异无统计学意义(P>0.05),经对症处理后均消退。单因素分析发现皮肤分型、性别与疗效无关(P>0.05),而年龄、主观皮肤类型、病程均影响疗效(P<0.05);多因素Logistic回归显示年龄>30岁和干性皮肤是影响疗效的危险因素(P<0.05)。结论:点阵CO_(2)激光对轻中度痤疮瘢痕有明显的治疗效果,其治疗效果与年龄增长呈负相关,干性皮肤的疗效低于油性及混合性。

Objective To investigate the efficacy and influencing factors of fractional CO_(2) laser treatment of acne scars of diff erent degrees.Methods Using a case-control retrospective analysis method,78 patients with acne scars who camed to our department from August 2017 to December 2020 were collected.According to the Goodman&Baron acne scar evaluation system,acne scars were classifi ed into three categories include twenty-five mild cases,twenty-seven cases of moderate severity and twenty-six cases of severe severity.Fractional CO_(2) laser was used to treat acne scars(one time/month,three times in total),to evaluate its effi cacy,acne scar score and rate of point reduction,adverse reactions and analyze infl uencing factors.Results Compared with before treatment,the acne scar scores of the three groups decreased after treatment,and the diff erence was statistically signifi cant(P<0.01),comparison of integral degradation rates between the three groups,the diff erence was statistically signifi cant(P<0.05).The total eff ective rate of the mild and moderate group was 88.0%and 88.89%,respectively,which was higher than that of the severe group by 57.69%,the comparison was statistically signifi cant(P<0.05).The incidence of adverse reactions in the three groups was 12.0%,14.81%and 7.70%respectively;there was no signifi cant diff erence(P>0.05),and all subsided after symptomatic treatment.Univariate analysis found that skin type and gender had nothing to do with the curative eff ect of acne scars(P>0.05),while age,subjective skin type,and disease course all aff ected the curative eff ect(P<0.05),multivariate logistic regression showed that age>30 years and dry skin are risk factors that aff ect the effi cacy(P<0.05).Conclusion Fractional CO_(2) laser has obvious therapeutic eff ect on mild to moderate scar,and its therapeutic eff ect is negatively correlated with the increase of age.The curative eff ect of dry skin is lower than that of oily and mixed skin.