中华皮肤科杂志 ›› 2013, Vol. 46 ›› Issue (2): 105-108.

• 论著 • 上一篇    下一篇

长脉宽Nd:YAG激光治疗甲真菌病疗效观察

陆晟1,张振2,费烨2,陈向东2   

  1. 1. 上海长海医院皮肤科
    2. 上海交通大学医学院附属第九人民医院
  • 收稿日期:2012-02-28 修回日期:2012-10-09 出版日期:2013-02-15 发布日期:2013-02-01
  • 通讯作者: 陈向东 E-mail:xdchen@medmail.com.cn

An evaluation of the efficacy of long pulsed Nd:YAG laser in the treatment of onychomycosis

  • Received:2012-02-28 Revised:2012-10-09 Online:2013-02-15 Published:2013-02-01

摘要: 目的 探讨长脉宽Nd:YAG激光治疗甲真菌病的疗效及安全性。 方法 对35例甲真菌病患者使用长脉宽Nd:YAG激光进行治疗,治疗参数:波长1064 nm,能量30 ~ 40 J/cm2,脉宽35 ms,光斑4 mm。观察疗效及不良反应,并根据不同感染菌种、临床类型、病甲位置对病例进行分组,采用SPSS17.0统计软件进行卡方检验比较不同分组间疗效、复发情况的差异。结果 共治疗79甲,随访至初次治疗后9个月,临床有效率为67.1%,真菌学有效率为73.4%,复发或再感染率为19.0%。红色毛癣菌组的临床疗效(χ2 = 10.913,P < 0.05)及真菌学疗效(χ2 = 13.532,P < 0.05)均优于其他真菌组,复发或再感染率低于其他真菌组(χ2 = 10.980,P < 0.05),但与白念珠菌组比较这三方面的差异均无统计学意义。白色浅表甲真菌病(WSO)组的临床疗效优于远侧甲下真菌病(DLSO)组(χ2 = 11.935,P < 0.05),而DLSO组的临床疗效又优于近端甲下真菌病(PSO)及全甲营养不良甲真菌病(TDO)组(χ2 = 17.515,P < 0.05)。根据病甲位置不同分类,第2 ~ 5指甲组的临床疗效优于拇指甲/第2 ~ 5趾甲组(χ2 = 13.437,P < 0.05)及拇趾甲组(χ2 = 10.595,P < 0.05),而拇指甲/第2 ~ 5趾甲组与拇趾甲组相比临床疗效差异无统计学意义(χ2 = 3.030,P > 0.05),它们的真菌学疗效及治疗后的复发或再感染率差异无统计学意义。治疗过程中除疼痛外未发生其他不良反应。结论 长脉宽Nd:YAG激光是治疗甲真菌病的一种安全有效的方法,其疗效受到感染菌种、临床类型、病甲位置的影响。

关键词: 甲真菌病, 光疗法, 治疗结果

Abstract: LU Sheng, ZHANG Zhen, FEI Ye, CHEN Xiang-dong. Department of Dermatology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China Corresponding author: CHEN Xiang-dong, Email: xdchen@medmail.com.cn 【Abstract】 Objective To evaluate the efficacy and safety of long pulsed Nd:YAG laser in the treatment of onychomycosis. Methods Thirty-five patients with onychomycosis were treated by long pulsed Nd:YAG laser with a wavelength of 1064 nm, power of 30-40 J/cm2, pulse width of 35 milliseconds, diameter of light spot of 4 mm. One treatment session included 4 times of irradiation at an interval of 2 minutes. Patients were treated once a week for 4 weeks followed by once a month for 6 months. Clinical and mycological efficacy was evaluated 9 months after the beginning of treatment. Side effects were recorded and analyzed. Nails were divided into various groups according to causative fungal species, clinical phenotypes, and distribution of affected nails. Data were processed by using SPSS 17.0 software. Chi-square test was performed to compare the response and recurrence rate between these groups. Results A total of 79 nails were treated by long pulsed Nd:YAG laser in this study. At 9 months after the first treatment, clinical response was observed in 67.1% of these nails, mycological response in 73.4%, and recurrence in 19.0%. The Trichophyton rubrum group showed a better clinical (χ2 = 10.913, P < 0.05) and mycological response (χ2 = 13.532, P < 0.05), but a lower recurrence/reinfection rate (χ2 = 10.980,P < 0.05) compared with the other-species group. No significant difference was observed between the Trichophyton rubrum group and Candida albicans group in the clinical and mycological response rate or recurrence/reinfection rate. The clinical response in the distal lateral subungual onychomycosis (DLSO) group was significantly poorer than that in the white superficial onychomycosis (WSO) group(χ2 = 11.935, P < 0.05), but better than that in the proximal subungual onychomycosis (PSO)/total dystrophic onychomycosis (TDO) group(χ2 = 17.515, P < 0.05). Increased clinical response rate was observed in the second-fifth finger nail group compared with the thumb nail/second-fifth toe nail group(χ2 = 13.437, P < 0.05)and hallux nail group (χ2 = 10.595, P < 0.05), while no statistical difference was observed in clinical response rate between the hallux nail group and thumb nail/second-fifth toe nail group (χ2 = 3.030, P > 0.05), or in mycological response rate or recurrence/reinfection rate among the second-fifth finger nail group, thumb nail/second-fifth toe nail group and hallux nail group. There was no obvious adverse reaction but pain during the treatment. Conclusions Long pulsed Nd:YAG laser appears to be an effective and safe approach to the treatment of onychomycosis, and the treatment outcome is affected by clinical types, location, and causative fungal species of onychomycosis. 【Key words】 Phototherapy; Onychomycosis; Treatment outcomes

Key words: Onychomycosis