308nm准分子激光治疗白癜风疗效及其对患者生活质量影响评价

发布时间：2018-06-16 11:32

本文选题：308nm准分子激光 + 白癜风　；参考：《南方医科大学》2010年硕士论文

【摘要】： 背景：虽然308nm准分子激光在临床上一经用于白癜风的治疗,就显示出其疗效好,见效快的优点,但是临床上对于其疗效的评估采取的仍然是传统的肉眼粗略估算评价方法,这种方法所得结果不仅难以令患者信服,而且也影响到学术交流,同时还不能充分反映治疗方法对患者精神心理的影响。因此,传统评价方法已不能满足现代生物—心理—社会医学模式的需求。对白癜风疗效进行客观评价的关键环节是实现对治疗前后皮损面积的定量。传统评价方法主要是依赖于医生按照自己的经验手工对皮损的外观进行测量和面积估算。该法仅适用于规则形状皮损的面积定量,而绝大多数白癜风皮损其不仅形状不规则,而且皮损中间还存有形状各异的色素小岛,对于这类外观的皮损,这种评价方法测量效率低、误差大,易受评估者主观因素的影响,存在肉眼粗略估计和个体评判误差的缺陷。在疗效判断上无法客观的进行分析对比。再则,目前流行的准分子激光治疗费用也常与白斑的面积有关,并且在治疗上要求分多次照射,相应的疗效评估也要分多次进行。所以,急需一种快速、客观、重复性好的评价方法来代替肉眼估算。随着计算机图像分析技术的发展,计算机图像分析软件已能实现对目标图像与背景图像的分割,并能根据需要给出目标图像特征参数。因此,我们可以利用图像处理软件提取接受准分子激光治疗的白癜风疗前疗后的皮损轮廓,计算白斑面积和复色率,进而实现对308nm准分子激光治疗白癜风进行客观的疗效评价。由于白癜风是一种身心疾病,其对患者精神心理的影响已远远超出皮损本身对患者躯体健康的影响,尤其是面颈部的白癜风,严重干扰患者精神心理和日常生活。所以在对308nm准分子激光治疗白癜风进行客观疗效评价的同时,为了满足现代医学模式的要求,体现“以人为本”的思想,我们试从患者的角度评价治疗方法的有效性或不足。为此,我们将借助对患者生活质量的测评来完善准分子激光治疗白癜风的疗效评价体系。研究目的： 1、利用图像分析软件对接受308nm准分子激光治疗的白癜风皮损进行轮廓提取、面积定量和复色率评定,分析所选图像分析软件进行图像处理和分析的效果,筛选最佳的图像分析方法。 2、采用最佳的图像分析方法对308nm准分子激光治疗白癜风进行客观的疗效评价,分析影响疗效的因素；同时对患者进行生活质量调查,探讨准分子激光治疗对患者生活质量的影响。研究方法： 1、以308nm准分子激光作为治疗手段,收集白癜风患者治疗前和治疗10次后的皮损图片,由3名皮肤科医师分别应用A法(皮肤色素斑痣图像分析软件及photoshop软件联合)和B法(单独使用皮肤色素斑痣图像分析软件)对治疗前后患者的皮损图片进行轮廓提取、面积定量及复色率评定,运用spssl3.0统计软件分析资料,比较两种方法在进行图像分析时的可重复性效果和效率。 2、采用皮肤病生活质量指数量表(DLQI),于治疗前及不同疗程后对接受满3个准分子激光治疗疗程(30次)皮损局限于面颈部寻常型白癜风患者进行生活质量调查,同时收集患者治疗前及不同疗程后的皮损图片,选用最佳的图像分析方法对疗效进行客观评价,探讨308nm准分子激光治疗对患者生活质量的影响。研究结果 1、在进行皮损轮廓提取、面积定量及复色率评定时A法的可重复性及效率优于B法,确立A法为疗效评价的方法。 2、疗效观察及影响疗效的因素分析 1)不同疗程间复色率的差异 1个疗程后、2个疗程后、3个疗程后复色率分别为：35.85%±1.43%、51.59%±1.96%、61.99%±2.15%。整体比较重复因素3个时间点间差异有统计学意义(P0.001)。两两比较前后差异有统计学意义(P0.001)。 2)不同疗程临床效果的比较不同疗程后复色效果的平均秩次分别197.79、152.34、105.87,不同疗程间复色效果也存在显著性差异(H=65.683,P＜0.001)。随着疗程增加,好转的比例在逐渐减少,显效及有效的比例在逐步增加。 3)性别、年龄、分期及病程对复色率的影响经逐步回归分析示,一般资料中分期及病程对复色率有显著性影响(P均0.001),相同治疗次数下处于进展期的患者其复色率高于稳定期患者；相同治疗次数及分期情况下复色率与病程呈负相关,病程越短者复色率越高。 3、治疗对患者生活质量的影响 1)对患者DLQI总评分的影响 DLQI总评分随疗程增加而逐步降低,治疗前、1个疗程后、2个疗程后、3个疗程后的DLQI总评分分别为(10.19±2.82)分、(9.06±2.42)分、(6.79±2.03)分、(5.80±2.23)分。重复因素4个时间水平间差异有统计学意义(F=134.77,P0.001)。两两比较示疗前及各疗程后的DLQI总分值均存在显著性差异(P0.001)。 2)第3个疗程后不同复色级别对DLQI分的影响比较第3个疗程后不同复色级别间DLQI评分的差异采用协方差分析,在平衡协变量(年龄、病程、疗前DLQI评分)影响后,不同复色级别间的DLQI评分存在显著性差异(P均0.05)。研究结论： 1、图像分析软件可以连续记录患者皮损面积、复色率的改善情况,在对准分子激光治疗白癜风进行客观评价时,所得结果比传统方法客观、科学。 2、308nm准分子激光治疗白癜风的效果受疾病分期和病程的影响。 3、308nm准分子激光治疗在改善皮损的同时能从日常生活的各方面提高患者的生活质量。
[Abstract]:Background:
Although the 308nm excimer laser is used in the treatment of vitiligo in clinical, it shows the advantages of good effect and quick effect, but the clinical evaluation of its curative effect is still the traditional method of estimating the crude eye rough estimate. The results of this method are not only difficult to convince the patient, but also affect the academic exchange. However, the traditional evaluation method can not meet the needs of modern biological psycho social medical model.
The key to the objective evaluation of the curative effect of vitiligo is to realize the quantification of skin lesions before and after treatment. The traditional evaluation method mainly depends on the doctors' manual measurement and area estimation of skin lesions according to their own experience. This method is only suitable for the quantitative surface product of regular shape lesions, but most of vitiligo skin lesions are damaged. It is not only irregular in shape, but also in the middle of the skin. For skin lesions of this kind of appearance, this evaluation method has low efficiency, large error, easy to be influenced by the subjective factors of the evaluator, and there is a defect of rough estimation of the naked eye and the error of individual judgment. At present, the popular excimer laser treatment costs are often related to the area of leukoplakia, and the treatment requires multiple exposure, and the corresponding evaluation of the curative effect should be carried out several times. Therefore, a rapid, objective and repeatable evaluation method is urgently needed to replace the naked eye estimation.
With the development of computer image analysis technology, the computer image analysis software has realized the segmentation of the target image and the background image, and can give the target image characteristic parameters according to the needs. Therefore, we can use the image processing software to extract the skin lesions of the vitiligo after the treatment of the excimer laser treatment, and calculate the white spot. Area and rate of color rendering, and then achieve an objective evaluation of 308nm excimer laser in the treatment of vitiligo.
As vitiligo is a physical and mental illness, its influence on the psycho psycho of the patient is far beyond the effect of the skin lesion itself on the physical health of the patient, especially the vitiligo in the face and neck, which seriously interferes with the mental and daily life of the patients. Therefore, the objective effect of the 308nm excimer laser treatment for the treatment of the white purpura wind is evaluated to satisfy the objective. The requirement of modern medical model embodies the idea of "people-oriented". We try to evaluate the effectiveness or deficiency of the treatment method from the point of view of the patient. To this end, we will use the assessment of the quality of life of the patients to improve the evaluation system of the therapeutic effect of excimer laser in the treatment of vitiligo.
The purpose of the study is:
1, using the image analysis software to extract the skin lesions of vitiligo treated by 308nm excimer laser, evaluate the area and color rate, analyze the effect of image processing and analysis by the selected image analysis software, and screen the best method of image analysis.
2, the best image analysis method was used to evaluate the effect of 308nm excimer laser in the treatment of vitiligo, and to analyze the factors that affect the curative effect. At the same time, the quality of life of the patients was investigated and the effect of excimer laser therapy on the quality of life of the patients was discussed.
Research methods:
1, using 308nm excimer laser as the treatment method, the skin lesions of patients with vitiligo before and after 10 times of treatment were collected, and 3 dermatologists used A (skin pigments mole image analysis software and Photoshop software combination) and B method (use of skin pigmented nevus image analysis software separately) to the skin lesions of patients before and after treatment The tablet is extracted, the area quantitative and the color rate is evaluated, and the data of spssl3.0 statistics are used to compare the repeatability effect and efficiency of the two methods in the image analysis.
2, the quality of life (DLQI) was used to investigate the quality of life of patients with vitiligo vulgaris with 3 excimer laser treatment courses (30 times) before and after different courses of treatment. At the same time, the skin lesions before and after the treatment were collected, and the best method of image analysis was selected. Objective to evaluate the effect of 308nm excimer laser therapy on the quality of life of patients.
Research results
1, when the skin contour is extracted, the area is quantified and the rate of recolor is evaluated, the repeatability and efficiency of the A method are better than that of the B method, and the A method is established for the evaluation of the curative effect.
2, analysis of therapeutic effect and effect observation
1) the difference of color rate between different courses
After 1 courses, after 2 courses, the rate of color recovery after 3 courses were 35.85% + 1.43%, 51.59% + 1.96% and 61.99% + 2.15%. as a whole. There were significant differences between the 3 time points (P0.001). The difference was statistically significant (P0.001).
2) comparison of clinical effects in different courses of treatment
The average rank of color recovery after different course of treatment was 197.79152.34105.87, and there was significant difference between different treatments (H=65.683, P < 0.001). As the course of treatment increased, the proportion of improvement gradually decreased, and the proportion of effective and effective increased gradually.
3) the effect of sex, age, stage and duration on the rate of color rendering.
The stepwise regression analysis showed that the stage and course of the general data had a significant effect on the rate of color recovery (P 0.001). The rate of color recovery was higher than that in the stable stage patients with the same treatment times, and the rate of complex color was negatively correlated with the course of disease in the same treatment times and stages, and the higher the disease course was, the higher the color rate was.
3, the effect of treatment on the quality of life of the patients
1) the effect of DLQI on the total score of the patients
The total score of DLQI was gradually reduced as the course of treatment increased. After 1 courses of treatment, after 2 courses, the total score of DLQI after 3 courses was (10.19 + 2.82), (9.06 + 2.42), (6.79 + 2.03), (5.80 + 2.23). The difference between the 4 time levels of repeated factors was statistically significant (F=134.77, P0.001). 22 compared with DL before and after each course of DL. There was a significant difference in the total score of QI (P0.001).
2) the effect of different color grading levels on DLQI scores after third courses of treatment.
The difference of DLQI scores between different color levels after third courses of treatment was compared by covariance analysis. There was a significant difference in the DLQI score between the different color levels (P 0.05) after the impact of the balance covariate (age, course of disease, and pre therapy).
The conclusions are as follows:
1, the image analysis software can continuously record the area of the patient's skin and the improvement of the chromatic rate. The results of the objective evaluation of the treatment of vitiligo by the alignment molecular laser are objective and scientific than the traditional method.
The effect of 2308nm excimer laser on vitiligo is affected by the stage and duration of disease.
3308nm excimer laser can improve the quality of life in all aspects of daily life while improving skin lesions.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R758.41

【引证文献】