中华皮肤科杂志 ›› 2012, Vol. 45 ›› Issue (3): 165-168.

• 论著 • 上一篇    下一篇

微等离子体与超脉冲CO2点阵激光治疗痤疮凹陷性瘢痕的对比研究

陆雯丽,张振,费烨,陈向东   

  1. 上海交通大学医学院附属第九人民医院
  • 收稿日期:2011-04-11 修回日期:2011-10-27 出版日期:2012-03-15 发布日期:2012-02-29
  • 通讯作者: 陈向东 E-mail:xdchen@medmail.com.cn

Comparison of a fractional micro-plasma radio-frequency technology versus fractional ultrapulsed CO2 laser for the treatment of atrophic acne scars

  • Received:2011-04-11 Revised:2011-10-27 Online:2012-03-15 Published:2012-02-29

PDF

34

赞

摘要：

目的 比较微等离子体与超脉冲CO2点阵激光治疗痤疮凹陷性瘢痕的疗效及不良反应。 方法 对21例痤疮凹陷性瘢痕患者进行自身对照试验，一侧面部进行微等离子体治疗，另一侧进行CO2点阵激光治疗，1次治疗后随访6个月，观察两种治疗方法的疗效和不良反应。对各组治疗前后及组间痤疮瘢痕权重评分（ECCA）、患者自身评估（四分值法）微等离子体治疗1次后6个月的瘢痕改善值及治疗后疼痛评分、水肿评分、结痂时间和炎症性红斑持续时间进行非参数秩和检验，比较治疗前后及不同方法间的临床疗效及不良反应。选用1只新西兰大耳兔，在双侧兔耳分别造瘢痕模型，分别用微等离子体和CO2点阵激光在两侧兔耳瘢痕模型上扫描1遍，即刻取下组织，观察组织学改变。结果 痤疮凹陷性瘢痕治疗1次后，微等离子体组ECCA从50.71降至34.76，评分下降率为31.5%，21例中有19例治疗后ECCA评分下降，有效率为90.5%；超脉冲CO2点阵激光组评分从53.57降至38.10，评分下降率为29.9%，其中18例治疗后ECCA评分下降，有效率为86.7%，两组间有效率差异无统计学意义（P > 0.05）。治疗后微等离子组水肿较轻，红斑持续时间为13.95 d，结痂持续时间为6.95 d，而超脉冲CO2点阵激光组分别为45.81 d和10.10 d。微等离子体侧无1例发生色素沉着，而CO2点阵激光治疗侧色素沉着发生率达19%。兔耳瘢痕组织HE染色显示，微等离子体的微剥脱区宽而浅，CO2点阵激光的微剥脱区窄而深。结论 微等离子体和超脉冲CO2点阵激光对痤疮凹陷性瘢痕均有较好疗效，但微等离子体相对不良反应较小，色素沉着发生率低。

关键词: 凹陷性瘢痕

Abstract:

Objective To compare the efficacy of and adverse reactions to a fractional micro-plasma radio-frequency technology versus fractional ultrapulsed CO2 laser in the treatment of atrophic acne scars. Methods Twenty-one patients with atrophic acne scars were enrolled in this study. Half of each subject′s face was treated with micro-plasma, and the other half with fractional ultrapulsed CO2 laser, for one session. Treatments were randomly administered in a split-face manner. The efficacy and adverse effects were evaluated 6 months after the treatment by using the following outcome parameters: ECCA grading scale （échelle d′évaluation clinique des cicatrices d′acné）, degrees of post-treatment pain and edema, time taken for crusting and durations of inflammatory erythema, patients′ subjective rating of improvement in scar by using a quartile grading scale. A non-parametric rank test was conducted to compare the efficacy and adverse effects between the two treatments. A scar model was established on both ears of a New Zealand big ear rabbit, and treated with the CO2 laser and micro-plasma respectively, immediately followed by the resection of scar tissue for the observation of histological changes. Results A decrease of ECCA score was observed in 90.5% （19/21） of the patients after micro-plasma treatment, and in 86.7% （18/21） after CO2 laser treatment; no significant difference was observed in the response rate （P > 0.05）. In detail, ECCA score decreased by 31.5% （from 50.71 to 34.76 ） after micro-plasma treatment, compared to 29.9% （from 53.57 to 38.10） after CO2 laser treatmet. Mild edema was observed after micro-plasma treatment, with the duration of erythema and crusting being 13.95 days and 6.95 days, respectively, compared to 45.81 days and 10.10 days respectively, after CO2 laser treatment. Pigmentation occurred in none of the patients after micro-plasma treatment, but in 19% after CO2 laser treatment. Animal experiment showed that microscopic ablation zones were broad and shallow after micro-plasma treatment, but narrow and deep after CO2 laser treatment. Conclusions Fractional micro-plasma and CO2 laser are both effective for the treatment of atrophic acne scars, but the former seems to have less side effects with a lower incidence of pigmentation.

Key words: atrophic acne scars

中图分类号: 

  • R75