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A型肉毒毒素与曲安奈德治疗瘢痕疙瘩的疗效和安全性比较

2020-06-01羊乃康孙琦

中国美容医学 2020年5期
关键词:曲安奈德疼痛

羊乃康 孙琦

[摘要]目的:探究A型肉毒毒素与曲安奈德治疗瘢痕疙瘩的疗效和安全性。方法:收集笔者医院2017年1月-2019年6月收治的80例瘢痕疙瘩患者的临床资料,依据治疗方法分为观察组(40例)和对照组(40例)。观察组采用A型肉毒毒素局部注射治疗,对照组采用曲安奈德局部注射治疗。比较两组总有效率、疼痛视觉模拟评分(Visual analogue scale,VAS)、皮损厚度及不良反应情况。结果:观察组有效率为95.00%显著高于对照组的72.50%,差异有统计学意义(P<0.05)。治疗后1个月、2个月和4个月观察组相同时间点的VAS评分、皮损厚度均显著低于对照组,差异均有统计学意义(P<0.05)。观察组不良反应发生率为10.00%,对照组为27.50%,组间比较差异无统计学意义(P>0.05);治疗4个月后,观察组无复发,对照组复发6例,复发率为15.00%,组间比较差异有统计学意义(P=0.010)。结论:A型肉毒毒素治疗瘢痕疙瘩的疗效比曲安奈德更好,能有效降低瘢痕厚度、减轻患者疼痛,复发率低,且不良反应轻微,值得推广。

[关键词]A型肉毒毒素;曲安奈德;瘢痕疙瘩;局部注射治疗;疼痛

[中图分类号]R619+.6    [文献标志码]A    [文章编号]1008-6455(2020)05-0066-04

Abstract: Objective  To explore the efficacy and safety of botulinum toxin type A and triamcinolone acetonide in the treatment of keloid. Methods  The clinical data of 80 patients with keloids admitted to our hospital from January 2017 to June 2019 were collected and divided into the observation group (40 cases) and the control group (40 cases) according to the treatment. The observation group was treated by local injection of botulinum toxin type A, while the control group was treated by local injection of triamcinolone acetonide.The total effective rate, pain visual analogue scale (VAS), skin lesion thickness and adverse reactions were compared between the two groups. Results  The effective rate of the observation group was 95.00%, significantly higher than that of the control group (72.50%), the difference was statistically significant (P<0.05). The VAS score and the thickness of skin lesions in the observation group were significantly lower than those in the control group at 1, 2 and 4 months after treatment (P<0.05). The incidence of adverse reactions was 10.00% in the observation group and 27.50% in the control group, there was no significant difference between groups (P>0.05). After 4 months of treatment, there was no recurrence in the observation group and 6 cases(15.00%) in the control group, and the recurrence rate of the observation group was significantly lower than that in the control group (P=0.010). Conclusion  Botulinum toxin type A is better than triamcinolone acetonide in the treatment of keloid. It can effectively reduce the thickness of keloid and relieve the pain of patients with low recurrence rate and mild adverse reactions, which is worthy of promotion.

Key words: botulinum toxin type A; triamcinolone acetonide; keloid; local injection; pain

瘢痕疙瘩的发生是由于组织修复机制失调导致皮肤损伤后胶原过度沉积最后超出损伤边缘,并且呈浸润性生长的真皮纤维化疾病,其特点是具有强大的增生能力,大多会伴随患者一生,不但影响外观,還伴随瘙痒和疼痛[1]。曲安奈德是目前临床上治疗瘢痕疙瘩常用且最为有效的皮质类固醇类药物之一,但应用后复发几率较大,临床效果不一[2]。A型肉毒毒素是在美容外科广泛应用的一种高度神经毒性药物[3]。最近研究发现,A型肉毒毒素可以促进伤口修复,具有萎缩、软化瘢痕,抑制瘢痕疙瘩成纤维细胞增殖的作用[4]。但目前关于A型肉毒毒素治疗瘢痕疙瘩的相关研究文献和报道较少,因此本研究对二者进行对比研究探讨在瘢痕治疗中的作用。

治疗后1、2、4个月观察组相同时间点的皮损厚度均显著低于对照组,瘢痕厚度和瘢痕面积也均显著低于对照组。考虑原因是A型肉毒毒素抑制乙酰胆碱释放,起到麻痹瘢痕皮肤局部横纹肌的作用,有利于皮肤稳定性,从而进一步减少瘢痕处表皮牵拉张力,对瘢痕周围炎症有效抑制[17]。A型肉毒毒素治疗瘢痕疙瘩的机制主要包括诱导成纤维细胞和内皮细胞凋亡、抑制细胞增殖、抗血管新生,从而抑制瘢痕增生,降低瘢痕厚度和瘢痕面积;此外,A型肉毒毒素可以明显提高瘢痕疙瘩成纤维细胞的敏感性,增加其凋亡率[18]。本研究结果还发现观察组不良反应发生率为10.00%,对照组不良反应发生率为27.50%,观察组具有更高的安全性。于水等[19]在A型肉毒毒素在皮肤科的应用现状研究中指出,其可以作为有效且安全的瘢痕疙瘩防治方法。既往研究[20]中应用肉毒毒素治疗瘢痕疙瘩安全性都较好。本研究治疗4个月后,观察组无一例复发,对照组复发6例,对照组复发率为15.00%。表示A型肉毒毒素治疗瘢痕疙瘩具有显著优越性。但考虑到样本量和随访时间,其实际疗效和不良反应还有待进一步明确。

综上所述,A型肉毒毒素治疗瘢痕疙瘩的疗效明显优于曲安奈德,能有效降低瘢痕厚度、对减轻痛痒症状效果尤为明显,复发率低,且安全性较好,但其机制还需要进一步研究。

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[收稿日期]2019-10-09

本文引用格式:羊乃康,孙琦.A型肉毒毒素与曲安奈德治疗瘢痕疙瘩的疗效和安全性比较[J].中国美容医学,2020,29(5):66-69.

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