长脉宽Nd:YAG1064nm激光治疗手、足甲真菌病临床疗效观察

发布时间：2018-07-09 22:31

本文选题：甲真菌病 + Nd:YAG1064-nm激光仪器　；参考：《首都医科大学》2013年硕士论文

【摘要】：背景：甲真菌病是真菌感染甲板及甲下组织所致的病变，如今常用的治疗方法有局部外用抗真菌药膏、口服抗真菌药物，但上述方法在一定程度上都存在疗程长、依从性差、疗效差、治疗痛苦等不足。近年来，医学激光技术发展迅猛，现已有经美国食品与药品管理局(foodanddrugadministration,FDA)批准的专业激光设备投入市场用于甲真菌病的治疗，效果肯定而且安全性好。激光治疗甲真菌病规范化疗程的建立尚不明确。回顾药物治疗甲真菌病，治疗足部甲真菌病口服用药的疗程较治疗手部甲真菌病相比更长，激光治疗甲真菌病的疗程中并无明确将治疗手、足病甲的疗程区分开。目的：为完善激光治疗甲真菌病疗程的建立，我们将针对激光治疗手、足甲真菌病的疗效进行比较，观察激光治疗甲真菌病是否有效，治疗手、足病甲的疗效是否存在差异。方法：分别收集手足病甲，每组病甲根据SCIO评分系统各分为不同严重程度的临床亚组，使用欧洲之星TM靓甲TM长脉宽Nd:YAG-1064nm激光治疗仪，波长为1064nm激光，能量密度为50~60J/cm2，光斑大小为2mm，脉宽35ms,频率1.5Hz，治疗病甲共两个疗程（8次）。根据第8周、16周、24周真菌学检查结果来评价有效率，对比手足甲激光治疗有效率的整体差异，并且对不同严重程度手足病甲之间的疗效进行比较。采用SPSS17.0统计软件对数据进行统计学分析，应用χ2检验、t检验，P值小于0.05认为有显著差异。结果：试验收集112枚病甲，指甲50枚，趾甲62枚。治疗24周时，真菌学治愈率指甲为74.0%，趾甲为83.9%。激光治疗第24周时，，手、足病甲治疗临床有效率有明显差异，趾甲激光治疗后临床有效率为71.0%，指甲为52.0%。相同严重程度，即III度病甲中，激光治疗趾甲疗效优于治疗指甲，趾甲激光治疗有效率为84.8%，指甲为52.0%。红色毛癣菌感染者对激光治疗的敏感度更高，红色毛癣菌组治疗有效率为68.7%，白色念珠菌组为58.8%。结论：1、激光治疗甲真菌病总体有效；2、治疗趾甲疗效优于治疗指甲；3、最终临床疗效除与感染部位（手/足）有关，还与感染菌种有关，红色毛癣菌感染者对激光治疗的敏感度更高；4、相同感染菌种，激光治疗手、足甲真菌病无明显差异。
[Abstract]:Background: onychomycosis is a disease caused by fungal infection deck and subnail tissue. Nowadays, the commonly used treatment methods include topical antifungal ointment and oral antifungal drugs. However, to some extent, these methods have long course of treatment and poor compliance. The curative effect is poor, the treatment pain and so on insufficient. In recent years, the medical laser technology has developed rapidly. Now, the specialized laser equipment approved by the Food and Drug Administration (FDA) has been put into the market for the treatment of onychomycosis. The establishment of a standardized course of laser treatment for onychomycosis is still unclear. The treatment course of oral treatment of foot onychomycosis was longer than that of hand onychomycosis. The course of laser treatment of onychomycosis did not distinguish the course of treatment of hand and foot nail. Objective: in order to improve the course of laser treatment for onychomycosis, we will compare the efficacy of laser in treating hand and foot onychomycosis, and observe whether the laser is effective in treating onychomycosis, whether there are differences in curative effect between hands and foot onychomycosis. Methods: hand and foot disease A were collected, and each group was divided into clinical subgroups with different severity according to the SCIO scoring system. The European star TM was treated with ND: YAG-1064nm laser, wavelength was 1064nm laser. The energy density was 50 ~ 60 J / cm ~ 2, the spot size was 2 mm, the pulse width was 35 Ms, the frequency was 1.5 Hz. According to the results of mycological examination at week 8, week 16 and week 24, the effective rate was evaluated, and the overall difference of the effective rate of laser treatment of hand and foot nail was compared, and the curative effect of different severity of hand and foot disease was compared. SPSS 17.0 statistical software was used for statistical analysis of the data. It was considered that there was significant difference by 蠂 2 test and t test (P < 0.05). Results: 112 diseased nails, 50 fingernails and 62 toenails were collected. After 24 weeks of treatment, the cure rate of mycology and toenail were 74.0 and 83.9 respectively. At the 24th week of laser treatment, there was significant difference in the clinical effective rate of hand and foot nail treatment. The clinical effective rate was 71.0 after laser treatment of toenail and 52.0 percent of nail. In the same degree of severity, the laser treatment of toenail is better than that of nail. The effective rate of laser treatment of toenail is 84.8%, and that of nail is 52.0%. The sensitivity to laser therapy was higher in infected patients with Trichophyton rubrum. The effective rate was 68.7 in the Trichophyton rubrum group and 58.8 in the Candida albicans group. ConclusionThe overall efficacy of laser treatment of onychomycosis is 2%, and the curative effect of treating toenail is better than that of nail trochanter. The final clinical efficacy is related not only to the infected site (hand / foot), but also to the species of infected bacteria. The sensitivity of Tinea rubrum infection to laser treatment was higher than that of other infected individuals. There was no significant difference between the same infection species and the treatment of hand and foot onychomycosis.
【学位授予单位】：首都医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R756

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