A型肉毒素联合疗法治疗瘢痕疙瘩临床疗效和不良反应评价

发布时间：2019-06-16 15:41

【摘要】：目的:比较A型肉毒素联合得宝松局部注射及透明质酸外用与单纯得宝松局部注射及透明质酸外用对瘢痕疙瘩的疗效及不良反应。方法:选取瘢痕疙瘩患者58例,分为A型肉毒素联合得宝松(复方倍他米松注射液)局部注射及透明质酸外用组(联合治疗组)28例和单纯得宝松局部注射及透明质酸外用组(对照组)30例。2组患者均局部注射得宝松,每4周1次,连续3次,每日外用透明质酸。联合治疗组患者在第1次得宝松注射后皮损周边注射1次A型肉毒素。收集入组病例每次治疗前后参数数据、不良反应观察指标和每次治疗前后临床照片,并进行对比分析。结果:与对照组比较,3次治疗后联合治疗组患者皮损外观改善更好。对照组患者在治疗1个月时痛痒感的视觉模拟评分(VAS)下降,但在2和3个月时又逐渐上升;联合治疗组患者在治疗3个月内VAS值逐渐下降,与对照组比较在2和3个月时VAS值差异有统计学意义(P0.05)。治疗3个月内,联合治疗组患者皮损厚度逐渐下降,而对照组降低幅度不明显;治疗3个月时,联合治疗组患者疗效明显优于对照组(P0.05)。对照组患者痛痒症状及皮损厚度在每次注射2周后出现反跳,而联合治疗组无反跳。对照组患者不良反应发生率为26.7%,联合治疗组患者不良反应发生率为25.0%,2组各项不良反应发生率比较差异无统计学意义(P0.05)。结论:A型肉毒素联合得宝松局部注射及透明质酸外用治疗瘢痕疙瘩与单纯得宝松局部注射及透明质酸外用相比疗效更好,不良反应发生率无明显差异,值得临床上推广应用。
[Abstract]:Objective: to compare the efficacy and side effects of botulinum toxin A combined with local injection of hyaluronic acid and hyaluronic acid in the treatment of keloid. Methods: 58 patients with keloid were divided into two groups: local injection of botulinum toxin type A (compound betamisone injection) and hyaluronic acid treatment group (combination treatment group, n = 28) and simple local injection and hyaluronic acid external use group (control group, n = 30). The patients in the two groups were locally injected with Baosong once every 4 weeks for 3 times, and the patients in the two groups were treated with hyaluronic acid every day. The patients in the combined treatment group were injected with botulinum toxin A around the skin lesions after the first injection. The data of parameters before and after each treatment, the observation indexes of adverse reactions and the clinical photos before and after each treatment were collected and compared and analyzed. Results: compared with the control group, the appearance of skin lesions in the combined treatment group was better than that in the control group. The visual analog score of pain in the control group decreased at 1 month after treatment, but increased gradually at 2 and 3 months, and the VAS value in the combined treatment group decreased gradually within 3 months of treatment, which was significantly different from that in the control group at 2 and 3 months (P 0.05). Within 3 months of treatment, the thickness of skin lesions in the combined treatment group decreased gradually, but the decrease in the control group was not obvious; at 3 months of treatment, the curative effect of the combined treatment group was significantly better than that of the control group (P 0.05). The symptoms of pain and itching and the thickness of skin lesions in the control group showed rebound 2 weeks after each injection, while there was no rebound in the combined treatment group. The incidence of adverse reactions was 26.7% in the control group and 25.0% in the combined treatment group. There was no significant difference in the incidence of adverse reactions between the two groups (P 0.05). Conclusion: local injection of botulinum toxin A combined with hyaluronic acid is more effective than local injection and hyaluronic acid alone in the treatment of keloid, and there is no significant difference in the incidence of adverse reactions. It is worth popularizing and applying in clinic.
【作者单位】：吉林大学中日联谊医院皮肤科;吉林大学中日联谊医院病理科;
【基金】：吉林省科技厅科研基金资助课题(20150101166JC,20140414032GH,20170414056GH)
【分类号】：R622

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