共聚焦显微镜在鲜红斑痣激光治疗的疗效和预后的评价
发布时间：2018-08-27 12:23
【摘要】：第一部分595nm可调脉宽脉冲染料激光不同脉冲宽度治疗鲜红斑痣的临床疗效和安全性评估 目的：研究595nm脉冲染料激光不同脉冲宽度治疗中国鲜红斑痣(PWS)患者的临床疗效和安全性。方法：使用595nm脉冲染料激光,按不同脉冲宽度(1.5ms、3ms、6ms、10ms)分别进行治疗并随访。入组中国Ⅲ或Ⅳ型皮肤的PWS患者11例,男6例,女性5例,年龄15-50岁,平均24.82±9.82岁,系我院皮肤科门诊患者。每个患者每次分别用不同的脉冲宽度治疗皮损内选定的4个区域,治疗光斑直径选用7mm,能量密度9-12J/cm2。每2月一次治疗,共治疗3-5次。治疗前及最后一次治疗结束后2个月拍照,并由一名独立的皮肤科医生根据照片进行疗效评价和评分(1分,25%；2分,26%-50%；3分,51%-75%；4分,76%-100%),其中评分依据是治疗前后皮损消退、面积缩小、颜色淡化等情况的总体评价,并记录治疗过程中发生的不良反应,如色素改变和疤痕等。结果：所有的PWS患者接受了3-5次激光治疗,总计治疗了44处皮损区域(4个脉冲宽度组)。最后一次治疗后2个月随访时所有44处治疗区总有效率和显效率分别为47.73%和27.28%,只有7处(15.91%)治疗区域无效。1.5ms、3ms、6ms、10ms四个脉冲宽度组PWS患者的总有效率分别是63.64%、63.64%、36.37%、27.27%,而相应的治愈率为45.46%、27.27%、18.18%、18.18%。疗效平均分值中1.5ms脉冲宽度组为3.00,高于其它组(2.82、2.36、2.18),而且随着脉冲宽度增大分值下降,所有治疗区域的总的疗效分值是2.59。紫红色PWS皮损较粉红色、红色皮损效果差,在所有显效和有效脉冲宽度组的治疗区中,粉红色和红色皮损占了57.14%,高于紫红色皮损区。不良反应：紫癜见于所有患者,少量患者出现色素沉着(11.36-15.91%)和色素减退(2.27-6.82%),主要见于1.5ms和3ms脉冲宽度治疗组,为暂时性,都在三个月内消退。没有患者出现疤痕。结论：595nm脉冲染料激光可以有效地治疗中国PWS患者,安全性高,无疤痕等明显副作用。不同脉冲宽度的治疗效果是有差异的,以1.5ms脉冲宽度组效果最好。 第二部分鲜红斑痣的共聚焦激光扫描显微镜在体检测 目的：研究应用RCM对鲜红斑痣患者皮损血管情况(直径、密度等)进行初步描述和观察,并与正常人皮肤血管情况相比较。方法：招募20例(男8例,女性12例)Ⅲ或Ⅳ型皮肤志愿者,其中无PWS皮损正常人10例,面颈部PWS患者10例,年龄在13-36岁之间(平均18.30+5.66岁)。PWS患者皮损部位选择一处区域进行RCM检测,正常对照者选择同样区域做相应检测。结果：PWS患者皮损内的血管平均直径均值为71.70±27.11μm,正常对照者对应部位的血管平均直径均值19.00±9.74μ m,P0.01。PWS患者皮损内血管平均密度15.00±2.87个,正常对照者对应部位的血管平均密度8.50±3.21个,P0.01。皮损颜色紫红色的血管直径偏粗大,PWS患者面部的血管平均直径均值是80.43±25.47μ m,比颈部平均直径均值51.33±21.73μm更粗大。结论：RCM检测可以帮助描述PWS皮损内异常血管和正常人皮肤内血管情况特征,通过检测所得数据帮助初步判断正常和异常血管。在PWS的激光治疗中,RCM可作为客观判断治疗终止点和预后的工具。 第三部分共聚焦激光扫描显微镜在鲜红斑痣临床疗效评估和预后判断中的应用 目的：通过共聚焦激光扫描显微镜(RCM)检测鲜红斑痣患者皮损血管直径和密度,研究595nm脉冲染料激光不同脉冲宽度治疗中国PWS患者的临床疗效与脉冲宽度参数的相关性以及对预后判断的意义。方法：使用595nm PDL按4组不同脉冲宽度(1.5、3、6、lOms)治疗并随访44处治疗区,入组11例中国Ⅲ或Ⅳ型皮肤PWS患者,男6例,女性5例,每个患者每次治疗前及最后一次治疗结束后2个月都进行相应治疗区的RCM检测,包括血管直径范围、平均直径、密度等,并拍照记录,由一名独立的皮肤科医生根据治疗前后照片进行疗效评价和评分。同时记录治疗的不良反应,如色素改变和疤痕等。结果：1.RCM100μm和150μm扫描层面都显示同一脉冲宽度组治疗前后血管平均直径和密度有明显减小,P值均0.05。2.100μ m扫描层面不同脉冲宽度组治疗后的血管平均直径和密度变化无统计差异,而150μ m扫描层面1.5ms组和其它脉冲宽度组治疗后的血管平均直径有统计学差异(P值均0.05),但是治疗后血管密度变化各组脉冲宽度的差异不明显(P值均0.05)。3.紫红色PWS皮损治疗效果较粉红色、红色皮损效果差,RCM显示紫红色皮损处血管平均直径偏大,100μm和150μm扫描层面平均血管直径最大的5例患者都是紫红色皮损,占紫红色皮损5/7,150μm扫描层面比100μ m层面的血管更粗。4.脉冲染料激光治疗后出现紫癜的反应见于所有患者,1.5ms脉宽组紫癜颜色最明显,10ms组比较轻微,可出现延迟性紫癜。RCM150μm扫描层面的血管直径改变幅度的大小与紫癜反应明显程度有正相关性,1.5ms组治疗前后血管直径变化也最明显(P值均0.05)。5.四组不同脉宽组三次PDL治疗后,在RCM100μm和150μm扫描层面上1.5ms组血管平均直径减小幅度最大,分别是49.69%和66.06%；而两个扫描层面所有脉冲宽度组的血管密度减少幅度在50-69%之间,但是结果平均密度都是接近10个左右,与正常皮肤的平均血管密度(8.50±3.21个)接近。结论：RCM可无创、实时地检测PWS皮损治疗前后血管平均直径和密度等情况的具体变化情况，，RCM检测结果显示决定淡化效果的是血管平均直径的减小幅度。RCM检测数据表明,通过术前检测可以大概预测不同扫描层面血管平均直径、密度情况的治疗区的血管变化情况及相应疗效,深层血管的变化对疗效判断可能更有意义。因此,RCM检测有助于选择合适的PWS皮损和决定PDL治疗参数,有助于判断预后和治疗终止时间。
[Abstract]:Part 1 Clinical efficacy and safety of 595 nm pulsed dye laser with different pulse widths in the treatment of port wine stains
Objective: To study the clinical efficacy and safety of 595 nm pulsed dye laser (PDL) with different pulse widths in the treatment of Chinese patients with port wine stain (PWS). Each patient was treated with different pulse widths in 4 selected areas of the lesion. The diameter of the treatment spot was 7 mm and the energy density was 9-12J/cm2. The treatment was given every 2 months for 3-5 times. Photographs were taken before treatment and 2 months after the last treatment. Independent dermatologists evaluated and scored the effectiveness of the treatment according to the photos (1, 25%; 2, 26% - 50%; 3, 51% - 75%; 4, 76% - 100%). The scoring was based on the overall evaluation of skin lesions before and after treatment, area reduction, color dilution, and recorded adverse reactions such as pigmentation and scarring. All PWS patients received 3-5 laser treatments with 44 lesions (4 pulse width groups). The total effective rate and marked effective rate were 47.73% and 27.28% in all 44 treatment areas at 2 months follow-up after the last treatment. Only 7 (15.91%) treatment areas were ineffective. The effective rates were 63.64%, 63.64%, 36.37%, 27.27% respectively, and the corresponding cure rates were 45.46%, 27.27%, 18.18% and 18.18%. The average score of 1.5ms pulse width group was 3.00, higher than that of other groups (2.82, 2.36, 2.18), and the total effective score of all treatment areas was 2.59. Purple PWS skin lesions were pink. Adverse reactions: Purpura was seen in all patients, a small number of patients showed hyperpigmentation (11.36-15.91%) and hypopigmentation (2.27-6.82%), mainly in the 1.5ms and 3MS pulse width treatment group. Conclusion: 595 nm pulsed dye laser can effectively treat PWS patients in China with high safety, no scar and other obvious side effects. The therapeutic effects of different pulse widths are different, and the effect of 1.5ms pulse width group is the best.
The second part: confocal laser scanning microscopy in vivo for detection of port wine stains.
Objective: To study the vascular condition (diameter, density, etc.) of skin lesions in patients with port wine stain by RCM and compare it with that of normal people. Methods: Twenty skin volunteers (8 males, 12 females) of type III or type IV were recruited, including 10 normal persons without PWS lesions, 10 patients with PWS in the face and neck, aged 13-36 years. Results: The average diameter of blood vessels in the lesions of PWS patients was 71.70 6550 The average vessel density was 15.00 (+ 2.87), and the average vessel density was 8.50 (+ 3.21) in the corresponding parts of the normal control group, P 0.01. The average vessel diameter in the face of PWS patients was 80.43 (+ 25.47) um, which was larger than that in the neck of 51.33 (+ 21.73) um. The abnormal blood vessels in the lesion and the normal blood vessels in the skin can be identified by detecting the data. In the laser treatment of PWS, RCM can be used as an objective tool to judge the termination point and prognosis.
Part III Application of confocal laser scanning microscopy in clinical evaluation and prognosis of port wine stains
Objective: To investigate the correlation between the clinical efficacy of 595 nm pulsed dye laser (PDL) with different pulse widths and the parameters of pulse widths and the prognostic significance of different pulse widths (PWS) in Chinese patients with port wine stain (PRS). 1.5, 3, 6, lOms) were treated and followed up in 44 treatment areas. Eleven Chinese patients with type III or IV skin PWS, 6 males and 5 females, were enrolled in the study. RCM tests were performed in each treatment area before and 2 months after the end of the last treatment, including vessel diameter, mean diameter, density, etc., and photographic records were taken by an independent dermatologist. Results: 1. The mean diameter and density of blood vessel in the same pulse width group were significantly reduced at 100 and 150 micron scan levels, P values were 0.05.2.100 micron scan levels with different pulse widths. There was no significant difference in the mean diameter and density of blood vessels between the two groups after treatment, but there was significant difference in the mean diameter of blood vessels between the 1.5ms group and the other pulse width groups (P 0.05). However, there was no significant difference in the pulse width of each group after treatment (P 0.05). 3. Purple PWS was more effective in the treatment of skin lesions. RCM showed that the average diameter of blood vessels in purple skin lesions was larger than that in red skin lesions. All the 5 patients with the largest average diameter of blood vessels in 100 and 150 microns were purple skin lesions. All patients, 1.5ms pulse width group purpura color is the most obvious, 10ms group is slight, can appear delayed purpura. RCM 150 micron scan changes in the size of vascular diameter and purpura response significantly correlated, 1.5ms group before and after treatment vascular diameter changes were the most significant (P 0.05). 5. Four different pulse width groups after three PDL treatment. On RCM 100 and 150 microns, the average diameter of blood vessels decreased by 49.69% and 66.06% in 1.5 ms group, respectively, while the average density of blood vessels decreased by 50-69% in all pulse width groups on both scanning planes, but the average density was close to 10, which was close to that of normal skin (8.50 (+ 3.21). CONCLUSION: RCM is noninvasive and can be used to detect the changes of mean diameter and density of blood vessels before and after PWS treatment in real time. The results of RCM show that the decrease of mean diameter of blood vessels is the decisive factor for desalination effect. Therefore, RCM is helpful to select the appropriate PWS lesions and determine the PDL treatment parameters, and is helpful to judge the prognosis and treatment termination time.
【学位授予单位】：复旦大学
【学位级别】：博士
【学位授予年份】：2013
【分类号】：R758.51
本文编号：2207268
[Abstract]:Part 1 Clinical efficacy and safety of 595 nm pulsed dye laser with different pulse widths in the treatment of port wine stains
Objective: To study the clinical efficacy and safety of 595 nm pulsed dye laser (PDL) with different pulse widths in the treatment of Chinese patients with port wine stain (PWS). Each patient was treated with different pulse widths in 4 selected areas of the lesion. The diameter of the treatment spot was 7 mm and the energy density was 9-12J/cm2. The treatment was given every 2 months for 3-5 times. Photographs were taken before treatment and 2 months after the last treatment. Independent dermatologists evaluated and scored the effectiveness of the treatment according to the photos (1, 25%; 2, 26% - 50%; 3, 51% - 75%; 4, 76% - 100%). The scoring was based on the overall evaluation of skin lesions before and after treatment, area reduction, color dilution, and recorded adverse reactions such as pigmentation and scarring. All PWS patients received 3-5 laser treatments with 44 lesions (4 pulse width groups). The total effective rate and marked effective rate were 47.73% and 27.28% in all 44 treatment areas at 2 months follow-up after the last treatment. Only 7 (15.91%) treatment areas were ineffective. The effective rates were 63.64%, 63.64%, 36.37%, 27.27% respectively, and the corresponding cure rates were 45.46%, 27.27%, 18.18% and 18.18%. The average score of 1.5ms pulse width group was 3.00, higher than that of other groups (2.82, 2.36, 2.18), and the total effective score of all treatment areas was 2.59. Purple PWS skin lesions were pink. Adverse reactions: Purpura was seen in all patients, a small number of patients showed hyperpigmentation (11.36-15.91%) and hypopigmentation (2.27-6.82%), mainly in the 1.5ms and 3MS pulse width treatment group. Conclusion: 595 nm pulsed dye laser can effectively treat PWS patients in China with high safety, no scar and other obvious side effects. The therapeutic effects of different pulse widths are different, and the effect of 1.5ms pulse width group is the best.
The second part: confocal laser scanning microscopy in vivo for detection of port wine stains.
Objective: To study the vascular condition (diameter, density, etc.) of skin lesions in patients with port wine stain by RCM and compare it with that of normal people. Methods: Twenty skin volunteers (8 males, 12 females) of type III or type IV were recruited, including 10 normal persons without PWS lesions, 10 patients with PWS in the face and neck, aged 13-36 years. Results: The average diameter of blood vessels in the lesions of PWS patients was 71.70 6550 The average vessel density was 15.00 (+ 2.87), and the average vessel density was 8.50 (+ 3.21) in the corresponding parts of the normal control group, P 0.01. The average vessel diameter in the face of PWS patients was 80.43 (+ 25.47) um, which was larger than that in the neck of 51.33 (+ 21.73) um. The abnormal blood vessels in the lesion and the normal blood vessels in the skin can be identified by detecting the data. In the laser treatment of PWS, RCM can be used as an objective tool to judge the termination point and prognosis.
Part III Application of confocal laser scanning microscopy in clinical evaluation and prognosis of port wine stains
Objective: To investigate the correlation between the clinical efficacy of 595 nm pulsed dye laser (PDL) with different pulse widths and the parameters of pulse widths and the prognostic significance of different pulse widths (PWS) in Chinese patients with port wine stain (PRS). 1.5, 3, 6, lOms) were treated and followed up in 44 treatment areas. Eleven Chinese patients with type III or IV skin PWS, 6 males and 5 females, were enrolled in the study. RCM tests were performed in each treatment area before and 2 months after the end of the last treatment, including vessel diameter, mean diameter, density, etc., and photographic records were taken by an independent dermatologist. Results: 1. The mean diameter and density of blood vessel in the same pulse width group were significantly reduced at 100 and 150 micron scan levels, P values were 0.05.2.100 micron scan levels with different pulse widths. There was no significant difference in the mean diameter and density of blood vessels between the two groups after treatment, but there was significant difference in the mean diameter of blood vessels between the 1.5ms group and the other pulse width groups (P 0.05). However, there was no significant difference in the pulse width of each group after treatment (P 0.05). 3. Purple PWS was more effective in the treatment of skin lesions. RCM showed that the average diameter of blood vessels in purple skin lesions was larger than that in red skin lesions. All the 5 patients with the largest average diameter of blood vessels in 100 and 150 microns were purple skin lesions. All patients, 1.5ms pulse width group purpura color is the most obvious, 10ms group is slight, can appear delayed purpura. RCM 150 micron scan changes in the size of vascular diameter and purpura response significantly correlated, 1.5ms group before and after treatment vascular diameter changes were the most significant (P 0.05). 5. Four different pulse width groups after three PDL treatment. On RCM 100 and 150 microns, the average diameter of blood vessels decreased by 49.69% and 66.06% in 1.5 ms group, respectively, while the average density of blood vessels decreased by 50-69% in all pulse width groups on both scanning planes, but the average density was close to 10, which was close to that of normal skin (8.50 (+ 3.21). CONCLUSION: RCM is noninvasive and can be used to detect the changes of mean diameter and density of blood vessels before and after PWS treatment in real time. The results of RCM show that the decrease of mean diameter of blood vessels is the decisive factor for desalination effect. Therefore, RCM is helpful to select the appropriate PWS lesions and determine the PDL treatment parameters, and is helpful to judge the prognosis and treatment termination time.
【学位授予单位】：复旦大学
【学位级别】：博士
【学位授予年份】：2013
【分类号】：R758.51
【共引文献】
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