本文選題：甲真菌病 + Nd:YAG1064-nm激光儀器�。� 參考：《首都醫(yī)科大學(xué)》2013年碩士論文

【摘要】：背景：甲真菌病是真菌感染甲板及甲下組織所致的病變，如今常用的治療方法有局部外用抗真菌藥膏、口服抗真菌藥物，但上述方法在一定程度上都存在療程長、依從性差、療效差、治療痛苦等不足。近年來，醫(yī)學(xué)激光技術(shù)發(fā)展迅猛，現(xiàn)已有經(jīng)美國食品與藥品管理局(foodanddrugadministration,FDA)批準(zhǔn)的專業(yè)激光設(shè)備投入市場用于甲真菌病的治療，效果肯定而且安全性好。激光治療甲真菌病規(guī)范化療程的建立尚不明確。回顧藥物治療甲真菌病，治療足部甲真菌病口服用藥的療程較治療手部甲真菌病相比更長，激光治療甲真菌病的療程中并無明確將治療手、足病甲的療程區(qū)分開。 目的：為完善激光治療甲真菌病療程的建立，我們將針對激光治療手、足甲真菌病的療效進(jìn)行比較，觀察激光治療甲真菌病是否有效，治療手、足病甲的療效是否存在差異。 方法：分別收集手足病甲，每組病甲根據(jù)SCIO評分系統(tǒng)各分為不同嚴(yán)重程度的臨床亞組，使用歐洲之星TM靚甲TM長脈寬Nd:YAG-1064nm激光治療儀，波長為1064nm激光，能量密度為50~60J/cm2，光斑大小為2mm，脈寬35ms,頻率1.5Hz，治療病甲共兩個療程（8次）。根據(jù)第8周、16周、24周真菌學(xué)檢查結(jié)果來評價有效率，對比手足甲激光治療有效率的整體差異，并且對不同嚴(yán)重程度手足病甲之間的療效進(jìn)行比較。采用SPSS17.0統(tǒng)計軟件對數(shù)據(jù)進(jìn)行統(tǒng)計學(xué)分析，應(yīng)用χ2檢驗、t檢驗，P值小于0.05認(rèn)為有顯著差異。 結(jié)果：試驗收集112枚病甲，指甲50枚，趾甲62枚。治療24周時，真菌學(xué)治愈率指甲為74.0%，趾甲為83.9%。激光治療第24周時，，手、足病甲治療臨床有效率有明顯差異，趾甲激光治療后臨床有效率為71.0%，指甲為52.0%。相同嚴(yán)重程度，即III度病甲中，激光治療趾甲療效優(yōu)于治療指甲，趾甲激光治療有效率為84.8%，指甲為52.0%。紅色毛癬菌感染者對激光治療的敏感度更高，紅色毛癬菌組治療有效率為68.7%，白色念珠菌組為58.8%。 結(jié)論：1、激光治療甲真菌病總體有效；2、治療趾甲療效優(yōu)于治療指甲；3、最終臨床療效除與感染部位（手/足）有關(guān)，還與感染菌種有關(guān)，紅色毛癬菌感染者對激光治療的敏感度更高；4、相同感染菌種，激光治療手、足甲真菌病無明顯差異。
[Abstract]:Background: onychomycosis is a disease caused by fungal infection deck and subnail tissue. Nowadays, the commonly used treatment methods include topical antifungal ointment and oral antifungal drugs. However, to some extent, these methods have long course of treatment and poor compliance. The curative effect is poor, the treatment pain and so on insufficient. In recent years, the medical laser technology has developed rapidly. Now, the specialized laser equipment approved by the Food and Drug Administration (FDA) has been put into the market for the treatment of onychomycosis. The establishment of a standardized course of laser treatment for onychomycosis is still unclear. The treatment course of oral treatment of foot onychomycosis was longer than that of hand onychomycosis. The course of laser treatment of onychomycosis did not distinguish the course of treatment of hand and foot nail. Objective: in order to improve the course of laser treatment for onychomycosis, we will compare the efficacy of laser in treating hand and foot onychomycosis, and observe whether the laser is effective in treating onychomycosis, whether there are differences in curative effect between hands and foot onychomycosis. Methods: hand and foot disease A were collected, and each group was divided into clinical subgroups with different severity according to the SCIO scoring system. The European star TM was treated with ND: YAG-1064nm laser, wavelength was 1064nm laser. The energy density was 50 ~ 60 J / cm ~ 2, the spot size was 2 mm, the pulse width was 35 Ms, the frequency was 1.5 Hz. According to the results of mycological examination at week 8, week 16 and week 24, the effective rate was evaluated, and the overall difference of the effective rate of laser treatment of hand and foot nail was compared, and the curative effect of different severity of hand and foot disease was compared. SPSS 17.0 statistical software was used for statistical analysis of the data. It was considered that there was significant difference by 蠂 2 test and t test (P < 0.05). Results: 112 diseased nails, 50 fingernails and 62 toenails were collected. After 24 weeks of treatment, the cure rate of mycology and toenail were 74.0 and 83.9 respectively. At the 24th week of laser treatment, there was significant difference in the clinical effective rate of hand and foot nail treatment. The clinical effective rate was 71.0 after laser treatment of toenail and 52.0 percent of nail. In the same degree of severity, the laser treatment of toenail is better than that of nail. The effective rate of laser treatment of toenail is 84.8%, and that of nail is 52.0%. The sensitivity to laser therapy was higher in infected patients with Trichophyton rubrum. The effective rate was 68.7 in the Trichophyton rubrum group and 58.8 in the Candida albicans group. ConclusionThe overall efficacy of laser treatment of onychomycosis is 2%, and the curative effect of treating toenail is better than that of nail trochanter. The final clinical efficacy is related not only to the infected site (hand / foot), but also to the species of infected bacteria. The sensitivity of Tinea rubrum infection to laser treatment was higher than that of other infected individuals. There was no significant difference between the same infection species and the treatment of hand and foot onychomycosis.
【學(xué)位授予單位】：首都醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R756

【參考文獻(xiàn)】

相關(guān)期刊論文 前8條

1 任曉楠;魏守水;楊憲章;高迪;;光能量在生物組織中傳輸?shù)拿商乜_研究[J];生物醫(yī)學(xué)工程學(xué)雜志;2010年03期

2 何艷嫦;凌步致;姚鎮(zhèn)華;;佛山地區(qū)甲真菌病感染情況的調(diào)查研究[J];實用醫(yī)技雜志;2012年01期

3 陳麗娜,溫海,廖萬清,徐紅,陳江漢;臨床疑診甲真菌病1036例真菌學(xué)分析[J];中國皮膚性病學(xué)雜志;2004年04期

4 占志萍;聶振華;;甲真菌病719例臨床及致病真菌分析[J];中國皮膚性病學(xué)雜志;2010年04期

5 程會;顧瑛;黃乃艷;曾晶;;激光與生物組織的光熱作用研究概況[J];中國激光醫(yī)學(xué)雜志;2010年04期

6 楊少華,程培華,唐春蘭,黃熙;氦氖激光照射對幾種常見皮膚癬菌生長抑制效應(yīng)觀察[J];中華理療雜志;1999年05期

7 侯幼紅;呂江陵;黃瑛;伍藝儀;;真菌色素與真菌感染[J];中國真菌學(xué)雜志;2008年06期

8 王睿,梁蓓蓓;抗真菌藥的不良反應(yīng)[J];中國新藥雜志;2004年02期

本文編號：2110919