大光斑1064 nm调Q激光联合氨甲环酸治疗黄褐斑的临床疗效分析

Analysis of the Clinical Efficacy of Large Spot 1064 nm Q-switched Laser Combined with Tranexamic Acid in the Treatment of Chloasma

目的:探讨大光斑1064 nm调Q激光联合氨甲环酸治疗黄褐斑的疗效。方法:选择2019年5月-2020年5月笔者医院收治的93例黄褐斑患者为研究对象,予以随机数字表法分为药物组(氨甲环酸口服),激光组(1064 nm调Q激光)31例,联合组(1064 nm调Q激光联合氨甲环酸口服)31例,记录各组患者疗效,比较三组患者治疗前后血清中α-黑素细胞刺激素(α-MSH)、超氧化物歧化酶(SOD)、丙二醛(MDA)水平及皮损情况、MASI评分,随访2年,记录治疗后炎性反应色素沉着发生率及复发率。结果:药物组总有效率51.61%,激光组总有效74.19%,联合组总有效率93.55%,差异有统计学意义(P<0.05)。联合组治疗后血清MDA、α-MSH水平均低于激光组和药物组,SOD水平高于激光组和药物组(P<0.05)。治疗后联合组皮损面积、皮损颜色、MASI评分均低于激光组及药物组(P<0.05)。随访2年,联合组炎性反应色素沉着仅1例(3.23%),激光组炎性反应色素沉着3例(9.68%),药物组无炎性反应色素沉着情况,药物组黄褐斑复发率15例(48.38%),联合组和激光组黄褐斑复发率分别为5例(16.13%)和7例(22.58%,P<0.05)。结论:大光斑1064 nm调Q激光联合氨甲环酸治疗黄褐斑的疗效显著,有效预防激光术后炎症性色素沉着情况,降低其复发率。

Objective To investigate the efficacy of large spot 1064 Q-switched laser combined with tranexamic acid in the treatment of melasma.Methods 93 cases of chloasma patients in the hospital from May 2019 to May 2020 were selected as the research objects and randomly divided into drug group(oral tranexamic acid),laser group(1064 nm Q-switched laser)31 cases,combined group(1064 nm Q-switched laser combined with oral tranexamic acid)31 cases.α-Melanocyte stimulating hormone(α-MSH),superoxide dismutase(SOD),malondialdehyde(MDA)levels and skin lesions,MASI score.The patients were followed up for 2 years to record the incidence and recurrence rate of inflammatory reaction pigmentation.Results the total effective rate was 51.61%in the drug group,74.19%in the laser group and 93.55%in the combined group,with significant difference(P<0.05).After the combination group treatment,the serum MDA andα-MSH levels were lower than those in the laser group and the drug group,and the SOD level was higher than that in the laser group and the drug group(P<0.05).After treatment,the lesion area,color and Masi score of the combined group were lower than those of the laser group and the drug group,and the difference was statistically significant(P<0.05).After 2 years of follow-up,only 1 case(3.23%)had inflammatory reaction pigmentation in the combination group,3 cases(9.68%)in the laser group,and no inflammatory reaction pigmentation was found in the drug group.The recurrence rate of Chloasma in the drug group was 15 cases(48.38%),5 cases(16.13%)in the combination group and 7 cases(22.58%)in the laser group,and the difference was statistically significant(P<0.05).Conclusion Large spot Q-switched 1064nm Nd:YAG laser combined with tranexamic acid is effective in the treatment of chloasma,which can effectively prevent inflammatory pigmentation and reduce the recurrence rate.