调Q激光与豚鼠皮肤色素沉着的量效关系研究

发布时间：2018-07-05 17:44

本文选题：激光 + 量效关系　；参考：《安徽医科大学》2011年硕士论文

【摘要】：背景较多损容性皮肤病与色素沉着密切相关,例如炎症后色素沉着(PIH)、雀斑和黄褐斑等,临床常见但治疗困难,且疗效不确定。传统治疗一直都是药物治疗为主,其主要目的是抑制黑素细胞活性及增生、抑制黑素颗粒形成及加速降解。外治药物主要包括化学剥脱剂、单用或联合皮肤脱色剂、类视黄醇类和皮质激素类、维生素C及其衍生物类和一些天然植物提取物等。这些药物疗法往往起效较慢,且疗效欠佳,不良反应较多,例如皮肤刺激、过敏等,甚至有引起新的色素沉着风险。因此,如何研究皮肤色素沉着的规律,如何有效又快速地治疗色素沉着,业已成为皮肤美容科医生的难点和兴趣点。现代激光技术是以“选择性光热作用理论”为前提。利用“选择性光热作用”的调Q激光技术降低了对正常皮肤的热损伤作用,提高了安全性,痛苦小且不留疤痕,国内外有成功治疗雀斑、黄褐斑、炎症后色素沉着的临床病例报道。但是,调Q激光技术也是一把“双刃剑”,一方面在可以治疗色素沉着性皮肤病的同时,另一方面,在亚洲人种最常见的FitzpatrickⅢ～IV型人群中,调Q激光在常规能量参数或较高能量参数下又非常容易引发新的色素沉着(俗称“激光的光斑反应”),因此,此类激光对色素沉着性皮肤病的治疗利弊争议一直不断。近年来,有部分国外学者试用低能量参数的调Q激光治疗色素沉着取得了一定的效果:但是对皮肤色素沉着的调Q激光治疗缺乏相关的动物实验支持和理论研究探讨,更缺乏量效关系的研究。因此,对这方面的研究意义重大。目的研究调Q激光对紫外线照射引起皮肤色素沉着的治疗改善作用,研究调Q激光不同波长不同能量梯度对皮肤黑素颗粒和黑素细胞的形态和功能影响的量效关系,为进一步开发新的低能量治疗模式提供实验依据和参考。研究对象与方法浙江中医药大学实验动物中心10只棕黄色豚鼠,①采用中波紫外线(UVB)照射豚鼠背部皮肤诱导色素沉着实验动物模型;②选择了调Q Nd:YAG激光(波长1064nm,以下简称Q-1064)和调Q红宝石激光(波长694 nm,以下简称Q-694) 2种激光各3个能量参数,观察其对实验动物皮肤色素沉着的不同治疗作用;③皮肤生理功能测试和共聚焦激光扫描显微镜(CLSM)全程活体的动态观察,实验前、中、后再取材组织病理观察黑素细胞(MC)和黑素颗粒的变化等,分析色素沉着的不同治疗反应与调Q激光能量能量的量效关系。④采用SPSS 13.0统计软件对实验结果行多个样本均数的方差分析和t检验,p0.05为有统计学意义。结果①两种激光治疗疗效相比:Q-694治疗后的黑素指数均数为63.82,Q-1064治疗后的黑素指数均数为125.20,两组比较,疗效差异显著,说明Q-694疗效优于Q-1064;②同一种激光不同能量组治疗疗效相比:两种激光的最佳效应组均为低能量组,肉眼观察治疗区色素沉着完全消退,且维持时间长于其他能量组;皮肤黑素指数(MCI)明显下降,与其它组比较,差异有统计学意义(P 0.05);硫酸亚铁染色和CLSM结果显示色素沉积量、黑素颗粒和MC的数目、密度明显减小。中高能量组皮肤色素沉着在治疗结束后4～8周均有不同程度复发。结论调Q激光治疗豚鼠皮肤色素沉着疗效确切,皮肤组织效应程度与能量、治疗频率之间存在一定的关系,小能量多次治疗疗效较好。Q-694和Q-1064相比,Q-694治疗表皮色素沉着疗效更好。应用CLSM可以直观的观察到调Q激光治疗后的黑素变化。
[Abstract]:Background more skin lesions are closely related to pigmentation, such as post inflammatory pigmentation (PIH), freckles and chloasma, which are common clinical but difficult to treat, and the curative effect is uncertain. Traditional treatment has been mainly drug treatment, its main purpose is to inhibit melanocyte activity and proliferation, inhibit melanin granules formation and accelerate degradation. Medications mainly include chemical exfoliation agents, single or combined skin decolorizing agents, retinoids and corticosteroids, vitamin C and its derivatives and some natural plant extracts, which tend to be slow, with poor efficacy, and more adverse reactions, such as skin irritation, allergies, and even new pigmentation. Therefore, how to study the regularity of skin pigmentation and how to effectively and quickly treat the pigmentation have become a difficult and interesting point for the skin cosmetology doctor.
Modern laser technology is based on the "selective photothermal theory". Using the "selective light and heat action" Q laser technique, it reduces the heat damage to normal skin, improves safety, has little pain and does not leave scars. There are clinical reports of successful treatment of freckles, chloasma, and post inflammatory pigmentation at home and abroad. Q laser technology is also a "double-edged sword". On the one hand, it can treat pigmented dermatosis. On the other hand, in the most common people of Fitzpatrick III to IV in Asian people, the modulation of Q laser can easily lead to new pigmentation under conventional energy parameters or high energy parameters (commonly known as "laser spot response". In recent years, some foreign scholars have tried to use the low energy parameter Q laser to treat the pigmentation. However, the Q laser treatment for skin pigmentation is short of related animal experimental support and theoretical research. There is a lack of research on dose effect relationship. Therefore, this research is of great significance.
Objective to study the effect of Q laser on the treatment of skin pigmentation caused by ultraviolet radiation, and to study the effect of different wavelength of Q laser on the morphologic and functional effects of different energy gradients on skin melanin particles and melanocytes, and to provide experimental basis and reference for the further development of a new type of low energy treatment model.
Research object and method 10 brown yellow guinea pigs of experimental animal center of Zhejiang Chinese Medicine University, (1) using UVB to irradiate the pigmentation animal model of the skin of the guinea pig's back, and select 2 kinds of laser, Q Nd:YAG laser (wavelength 1064nm, hereinafter referred to as Q-1064) and Q ruby laser (wavelength 694 nm, hereinafter referred to as Q-694) The different therapeutic effects of 3 energy parameters on the skin pigmentation of experimental animals were observed. (3) the dynamic observation of skin physiological function and confocal laser scanning microscope (CLSM). The changes of melanocytes (MC) and melanin granules were observed before, during and after the experiment, and the different treatments for pigmentation were analyzed. The relationship between the reaction and the energy and energy of the Q laser. (4) the SPSS 13 statistical software was used to analyze the variance and t test of the experimental results, and the P0.05 was statistically significant.
Results (1) compared the curative effect of two kinds of laser treatment: the average number of melanin index after Q-694 treatment was 63.82, the average of melanin index after Q-1064 treatment was 125.20, and the difference of the curative effect was significant in the two groups, indicating that the curative effect of Q-694 was better than that of Q-1064. The pigmentation in the observation area was completely subsided and the maintenance time was longer than the other energy groups; the skin melanin index (MCI) decreased obviously, and the difference was statistically significant (P 0.05) compared with the other groups. The ferrous sulfate staining and CLSM results showed the amount of pigment deposition, the number of melanin particles and MC and the density of the skin, and the skin pigmentation in the middle and high energy group. At the end of treatment, 4~8 Zhou Junyou recurred to varying degrees.
Conclusion Q laser therapy is effective in the treatment of pigmentation in guinea pig skin. There is a certain relationship between the degree of skin tissue effect and the frequency of energy, the frequency of treatment. Compared with.Q-694 and Q-1064, the curative effect of Q-694 is better than that of Q-1064. The application of CLSM can be used to observe the melanin changes after the Q laser treatment.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R758.4

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