Q开关红宝石点阵激光联合氨甲环酸对UVB诱导豚鼠色素沉着的抑制作用

发布时间：2018-04-05 20:36

本文选题：紫外线　切入点：豚鼠　出处：《河北医科大学》2014年硕士论文

【摘要】：目的：点阵模式的Q开关红宝石激光（QSwitchRubyStarLaser，QSRL）已成功应用于治疗色素沉着性疾病，氨甲环酸治疗色素性疾病也得到了广泛应用，但二者联合应用在治疗色素性疾病鲜有报道，本研究采用Q开关红宝石激光的点阵模式联合外用氨甲环酸注射液对窄波紫外线诱导豚鼠皮肤色素沉着的影响，通过大体评估色素沉着变化、黑色素细胞数量、黑素颗粒表达，求证此法治疗色素沉着性疾病的有效性。方法：健康花色豚鼠10只（清洁级），雌性，年龄1月-2月,豚鼠棕黄色皮肤脱毛，接受窄波紫外线（narrowbandultravioletB,NB-UVB)照射，照射前调整焦距，使两个红色指示灯重合，照射剂量根据预实验结果最小红斑量(minimalerythemadose,MED)及定为2MED,即900mJ／cm2，每周照射1次，共3次，总剂量2700mJ／cm2.造模成功区域，平均分为4组： A组：无治疗处理。 B组：氨甲环酸外用治疗：将氨甲环酸注射液稀释后（5ml/50ml），与激光治疗同步湿敷于相应组别，连续湿敷3天。 C组：点阵QSRL照射联合氨甲环酸治疗：光斑直径7mm、能量密度2.5J/cm2，扫描一遍，激光治疗后立即将氨甲环酸注射液稀释后（5ml/50ml），连续湿敷3天，1周治疗1次，共2次。 D组：点阵QSRL治疗：光斑直径7mm、能量密度2.5J/cm2，扫描一遍。分别采用拍照大体评估色素沉着，各组同时取材，，分别进行黑素细胞染色(Imokawa法)以及黑素颗粒染色(Masson-Fontana法)，观察表皮色沉、黑色素细胞数量及黑素颗粒的改变，以明确其治疗效果及可能的机理。结果： 1色素沉着变化 NB-UVB照射完成后，照射区域色素沉着均匀，稳定。 A组：未治疗组：色素沉着较模型有所减少，但较正常皮肤组织，仍可见较多色素沉着。 B组：氨甲环酸外用治疗：色素沉着较模型有所减少，但较正常皮肤组织，仍可见较多色素沉着。 C组：点阵QSRL照射联合氨甲环酸治疗：色素沉着较模型明显减少，与正常皮肤组织相似。 D组：点阵QSRL治疗：色素沉着较模型明显减少，与正常皮肤相比较未见明显差异。 2黑色素细胞变化 2.1形态改变正常皮肤黑色素细胞呈两极状，少数呈多极树枝状突起，胞体狭长，经紫外线照射后，黑色素细胞胞体增大变圆，树枝状树突增多，点阵QSRL治疗后，胞体有所减小，树枝状树突减少，未治疗组及氨甲环酸治疗组黑色素细胞形态无明显变化 2.2数目改变 NB-UVB照射完成后，照射区域黑色素细胞数目较正常皮肤明显增多。 A组：未治疗组：黑色素细胞数目较模型有有所减少，但较正常皮肤组织，数目仍为增加。 B组：氨甲环酸外用治疗：黑色素细胞数目较模型有所减少，但较正常皮肤组织，数目仍增加。 C组：点阵QSRL照射联合氨甲环酸治疗：黑色素细胞数目较模型明显减少，较正常皮肤组织数目偏多。 D组：点阵QSRL治疗：黑色素细胞数目较模型明显减少，较正常皮肤组织数目偏多。2.3黑色素颗粒变化正常皮肤为表皮基底细胞和棘层偶见黑素颗粒，NB-UVB照射完成后，模型区域黑素颗粒显著增多，表皮全层密布黑素颗粒，并见较多黑素帽。 A组：未治疗组：黑色素颗粒较模型部分有所减少，基底细胞和棘层可见大量连续呈带状分布的黑素颗粒，部分仍为表皮全层密布黑素颗粒。 B组：氨甲环酸外用治疗：黑色素颗粒较模型部分有所减少，基底细胞和棘层可见大量连续呈带状分布的黑素颗粒，部分仍为表皮全层密布黑素颗粒。 C组：点阵QSRL照射联合氨甲环酸治疗：治疗2周后，黑色素颗粒较模型明显减少，较正常皮肤有所减少，但4周后，逐渐恢复，与正常皮肤接近。 D组：点阵QSRL治疗：治疗2周后，黑色素颗粒较模型明显减少，较正常皮肤有所减少，4周后，逐渐恢复，与正常皮肤接近。通过各组色素沉着评分、黑色素细胞数量、黑色素颗粒面积占表皮面积百分比统计分析，低能量密度点阵QSRL可减少黑色素细胞数量、黑色素颗粒，有效治疗色素沉着（P0.05）,氨甲环酸注射液外敷对减退色素沉着无显著作用（P0.05），两者联合治疗与单独点阵激光治疗差异无统计学意义（P0.05）。结论：（1）低能量密度点阵QSRL治疗NB-UVB诱导豚鼠色素沉着安全有效，其原理与减少部分黑色素细胞，靶向破坏部分黑色素小体有关，观察一个月，未见明显复发。（2）氨甲环酸注射液单独外敷治疗色素沉着无效，对改变黑色素细胞，黑色素小体无明显作用（3）两者联合作用有待进一步研究探索。
[Abstract]:Objective : The Q - switched ruby laser ( QSR ) in dot matrix mode has been successfully applied in the treatment of pigmentation diseases , and the treatment of pigmentary diseases has been widely used in the treatment of pigmentary diseases .

Methods : 10 healthy guinea pigs ( clean grade ) , female , age 1 month - February , guinea pig buffy skin were treated with ultraviolet ( NB - UVB ) irradiation , the focal length was adjusted before irradiation , and the two red indicators were coincident . The irradiation dose was 2 MED , i.e . 900 mJ / cm2 , once a week . The total dose was 2700 mJ / cm2 . The successful area of the mold was divided into 4 groups :

Group A : No treatment .

Group B : Treatment of external use of tranexamic acid : After diluted with ammonia A - ring acid injection ( 5 ml / 50 ml ) , it was applied to the corresponding group synchronously with laser treatment , and was continuously wet - applied for 3 days .

Group C : The laser irradiation combined with tranexamic acid treatment : The spot diameter was 7 mm , the energy density was 2.5 J / cm2 , the scanning was repeated , and immediately after the laser treatment , the ammonia A - ring acid injection was diluted ( 5 ml / 50 ml ) , followed by continuous wet application for 3 days and 1 week for 1 week .

Group D : The laser spot diameter was 7 mm , the energy density was 2.5 J / cm2 , and the scanning was repeated .

In order to clarify the therapeutic effect and possible mechanism , the pigmentation , the number of melanin cells and the changes of melanin particles were observed by the method of Imokawa staining ( Imokawa method ) and melanin particle staining respectively .

Results :

1 pigmentation change

After the irradiation of NB - UVB , the pigment of the irradiated region was more uniform and stable .

Group A : Untreated group : pigmentation was reduced compared with the model , but more pigmentation was still visible in the normal skin tissue .

Group B : The external use of tranexamic acid : The pigmentation of pigmentation was reduced , but more pigmentation was seen in the more normal skin tissue .

Group C : The combination of dot - dot - dot - dot irradiation combined with tranexamic acid treatment : pigmentation of pigmentation was significantly reduced compared with normal skin tissue .

Group D : The treatment of dot - dot matrix : The pigmentation was significantly reduced compared with the normal skin , and no significant difference was found in the comparison with the normal skin .

2 . Melanin cell change

2.1 Morphological changes

The normal skin melanin cells were in the form of bipolar , with a small number of dendritic protrusions . After irradiation with ultraviolet rays , the cells of the melanin cells increased , the dendritic dendritic cells increased , and the lattice of the cells decreased , the dendritic dendritic cells decreased , and the morphology of the melanin cells in the untreated group and the aminomethyl cyclic acid treatment group was not significantly changed .

2.2 Number of changes

After the NB - UVB irradiation , the number of melanin cells in the irradiated area was significantly increased than that of the normal skin .

Group A : There was a decrease in the number of melanin cells in the untreated group , but the number of normal skin tissues was still increased .

Group B : Topical treatment of tranexamic acid : The number of melanin cells decreased , but the number of normal skin tissues was still increased .

Group C : The number of melanin cells was significantly decreased and the number of normal skin tissues was more than that of normal skin tissue .

Group D : The number of melanin cells was significantly decreased and the number of normal skin tissues was more than that of normal skin tissue .

In normal skin , melanin granules were observed in epidermal basal cell and ratchet layer , and after NB - UVB irradiation , the melanin granules in the model area increased significantly , the whole layer of epidermis was densely covered with melanin granules , and more melanin hats were found .

Group A : There was a decrease in the number of melanin granules in the untreated group . The basal cells and the spinous layer showed a large number of melanin particles which were continuously in band - like distribution , and the part of the melanin granules was still the whole layer of the epidermis .

Group B : The external use of tranexamic acid : The smaller part of melanin granule , the basal cell and the ratchet layer can see a large number of melanin particles which are continuously in band - like distribution , and the part of the skin is still the whole layer of the epidermis .

Group C : The combination of dot - dot - dot - dot - dot - dot - dot irradiation combined with tranexamic acid treatment : After 2 weeks of treatment , the model of melanin granule decreased obviously , and the normal skin decreased , but after 4 weeks , it gradually recovered to close to the normal skin .

Group D : The treatment of dot - dot - dot - dot matrix : After 2 weeks of treatment , the model of melanin granule decreased obviously , the normal skin was decreased , and after 4 weeks , it gradually recovered and approached the normal skin .

The number of melanin cells and the area of melanin particles accounted for the percentage of epidermal area . The low - energy density dot - dot - dot matrix could reduce the number of melanin cells , melanin granules and treat pigmentation ( P0.05 ) . There was no significant difference in the external application of tranexamic acid injection ( P0.05 ) . There was no significant difference between the two treatments ( P0.05 ) .

Conclusion :

( 1 ) Treatment of NB - UVB induced pigmentation of guinea pig by low - energy density dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - matrix Q@@

( 2 ) There was no obvious effect on the change of melanin cells and melanin in the treatment of pigmentation .

( 3 ) The joint action of both should be further explored .

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R758.54

【参考文献】