咖啡斑激光治疗的长期疗效及相关影响因素的研究

发布时间：2018-06-04 15:53

本文选题：咖啡斑 + 长期疗效　；参考：《复旦大学》2014年博士论文

【摘要】：背景咖啡斑是常见的表皮色素异常性皮肤病,表现为形状、大小不一,表面光滑,颜色均一的淡褐色或咖啡色斑片。暴露部位的咖啡斑通常有治疗需求,目前报道的咖啡斑激光疗效的差异比较大,且存在观察的病例数少以及随访时间过短等问题,此外,影响咖啡斑激光治疗效果的相关因素目前仍不够明确。目的研究调Q紫翠玉宝石和调Q红宝石激光治疗咖啡斑的长期疗效和并发症,并且探讨影响咖啡斑激光治疗效果的相关因素。方法收集2006年10月至2011年5月至我院皮肤科激光中心就诊的80例咖啡斑患者,使用调Q紫翠玉,调Q红宝石激光或两者联合治疗,随访时间距末次治疗半年以上。通过就诊卡以及电话随访患者获取患者激光治疗的参数、治疗次数、疗效、复发情况、出现的并发症,患者的年龄、家族史、发病年龄、病程,以及咖啡斑的数目、大小、部位等基本信息,并通过照片评价皮损的边界形态。其中疗效根据皮损颜色改善的情况分为无效、好转、显效和痊愈四个等级。评价咖啡斑激光治疗的长期疗效,并通过两组独立样本或多组独立样本的秩和检验分析可能影响咖啡斑疗效的相关因素。采用SPSS22.0软件进行数据统计处理。结果本研究随访了80名咖啡斑患者,男女比例1：1.05,治疗次数为1-8次,平均随访时间27.9±11.6月(6-53月),有效率和显效率分别为61%和42.5%,复发率为12.2%,复发的时间多在末次治疗后1-3年内,均为部分复发。调Q紫翠玉激光,调Q红宝石激光和两种激光联合治疗在疗效上无统计学差异。即使治疗次数增加,仍有部分咖啡斑激光治疗效果不佳,提示疗效与治疗次数之间并非呈单纯的正相关关系。咖啡斑激光疗效与患者的性别、发病年龄、病程和咖啡斑的部位之间无明显的相关性。面积小的咖啡斑较面积大的治疗效果更好,锯齿状边界的咖啡斑较边界圆润光滑的疗效好。有3例患者(3.75%)治疗后出现了长期并发症,分别为局部永久性色素减退,皮肤质地改变和继发皮炎。结论1.调Q紫翠玉激光和红宝石激光可以较安全、有效地治疗咖啡斑,长期的复发率在12%左右,多为部分复发。2.咖啡斑调Q紫翠玉激光和红宝石激光疗效的个体差异较大。3.咖啡斑的激光疗效和咖啡斑的大小和边界有关,其具体的机制尚有待进一步研究。4.调Q紫翠玉和红宝石激光治疗咖啡斑长期并发症的发生率较低。
[Abstract]:Background Coffee spot is a common skin disease of epidermal pigmentation, which is characterized by a variety of shapes, sizes, smooth surfaces and uniform brown or brown patches. There is usually a need for treatment of coffee spots at exposed sites. There is a large difference in the efficacy of coffee spots reported at present, and there are problems such as the small number of cases observed and the short follow-up time, etc., in addition, The related factors affecting the effect of laser treatment of coffee spot are still not clear. Objective to study the long-term efficacy and complications of Q-switched emerald and Q-switched ruby laser in the treatment of coffee-spot, and to explore the related factors affecting the efficacy of Q-switched ruby laser in the treatment of coffee-spot. Methods from October 2006 to May 2011, 80 patients with coffee spots were treated with Q-switched purple emerald jade, Q-switched ruby laser or a combination of the two. The follow-up time was more than half a year after the last treatment. The parameters, times of treatment, curative effect, recurrence, complications, age, family history, onset age, course of disease, number and size of coffee spots were obtained by means of card and telephone follow-up. The basic information, such as location, was used to evaluate the boundary shape of skin lesions. According to the improvement of skin color, the curative effect can be divided into four grades: ineffective, improved, effective and cured. To evaluate the long-term efficacy of coffee-spot laser therapy, and to analyze the related factors that may affect the efficacy of coffee-spot by rank sum test of two groups of independent samples or groups of independent samples. SPSS22.0 software is used to process the data. Results 80 patients with coffee-spot were followed up. The ratio of male to female was 1: 1.05, the times of treatment was 1-8, the average follow-up time was 27.9 卤11.6 months from June to 53 months. The effective rate and effective rate were 61% and 42.5%, respectively. The recurrence rate was 12.2 and the time of recurrence was mostly within 1-3 years after the last treatment. All were partial recurrence. Q-switched purple jade laser, Q-switched ruby laser and two kinds of laser combined treatment have no statistical difference in curative effect. Even if the frequency of treatment increased, there were still some coffee spot laser treatment effect is not good, suggesting that there is not a simple positive correlation between the efficacy and the number of treatment. There was no significant correlation between the laser effect of coffee spot and sex, age, course of disease and site of coffee spot. Coffee spots with small area were better than those with large area, and coffee spots with serrated edges were better than those with smooth edges. There were long-term complications after treatment, including local permanent hypopigmentation, skin texture change and secondary dermatitis. Conclusion 1. Q-switched purple jade laser and ruby laser can be more safe, effective treatment of coffee spots, long-term recurrence rate of about 12%, mostly partial recurrence. 2. The individual difference between coffee spot Q-switched purple jade laser and ruby laser was significant. 3. The laser effect of coffee-spot is related to the size and boundary of coffee-spot, and its specific mechanism needs to be further studied. Q-switched purple jade and ruby laser treatment of coffee spot long-term complications were lower.
【学位授予单位】：复旦大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R758.4

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