本文選題：紫外線　切入點：豚鼠　出處：《河北醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：點陣模式的Q開關(guān)紅寶石激光（QSwitchRubyStarLaser，QSRL）已成功應(yīng)用于治療色素沉著性疾病，氨甲環(huán)酸治療色素性疾病也得到了廣泛應(yīng)用，但二者聯(lián)合應(yīng)用在治療色素性疾病鮮有報道，本研究采用Q開關(guān)紅寶石激光的點陣模式聯(lián)合外用氨甲環(huán)酸注射液對窄波紫外線誘導(dǎo)豚鼠皮膚色素沉著的影響，通過大體評估色素沉著變化、黑色素細(xì)胞數(shù)量、黑素顆粒表達(dá)，求證此法治療色素沉著性疾病的有效性。 方法：健康花色豚鼠10只（清潔級），雌性，年齡1月-2月,豚鼠棕黃色皮膚脫毛，接受窄波紫外線（narrowbandultravioletB,NB-UVB)照射，照射前調(diào)整焦距，使兩個紅色指示燈重合，照射劑量根據(jù)預(yù)實驗結(jié)果最小紅斑量(minimalerythemadose,MED)及定為2MED,即900mJ／cm2，每周照射1次，共3次，總劑量2700mJ／cm2.造模成功區(qū)域，平均分為4組： A組：無治療處理。 B組：氨甲環(huán)酸外用治療：將氨甲環(huán)酸注射液稀釋后（5ml/50ml），與激光治療同步濕敷于相應(yīng)組別，連續(xù)濕敷3天。 C組：點陣QSRL照射聯(lián)合氨甲環(huán)酸治療：光斑直徑7mm、能量密度2.5J/cm2，掃描一遍，激光治療后立即將氨甲環(huán)酸注射液稀釋后（5ml/50ml），連續(xù)濕敷3天，1周治療1次，共2次。 D組：點陣QSRL治療：光斑直徑7mm、能量密度2.5J/cm2，掃描一遍。 分別采用拍照大體評估色素沉著，各組同時取材，，分別進(jìn)行黑素細(xì)胞染色(Imokawa法)以及黑素顆粒染色(Masson-Fontana法)，觀察表皮色沉、黑色素細(xì)胞數(shù)量及黑素顆粒的改變，以明確其治療效果及可能的機(jī)理。 結(jié)果： 1色素沉著變化 NB-UVB照射完成后，照射區(qū)域色素沉著均勻，穩(wěn)定。 A組：未治療組：色素沉著較模型有所減少，但較正常皮膚組織，仍可見較多色素沉著。 B組：氨甲環(huán)酸外用治療：色素沉著較模型有所減少，但較正常皮膚組織，仍可見較多色素沉著。 C組：點陣QSRL照射聯(lián)合氨甲環(huán)酸治療：色素沉著較模型明顯減少，與正常皮膚組織相似。 D組：點陣QSRL治療：色素沉著較模型明顯減少，與正常皮膚相比較未見明顯差異。 2黑色素細(xì)胞變化 2.1形態(tài)改變 正常皮膚黑色素細(xì)胞呈兩極狀，少數(shù)呈多極樹枝狀突起，胞體狹長，經(jīng)紫外線照射后，黑色素細(xì)胞胞體增大變圓，樹枝狀樹突增多，點陣QSRL治療后，胞體有所減小，樹枝狀樹突減少，未治療組及氨甲環(huán)酸治療組黑色素細(xì)胞形態(tài)無明顯變化 2.2數(shù)目改變 NB-UVB照射完成后，照射區(qū)域黑色素細(xì)胞數(shù)目較正常皮膚明顯增多。 A組：未治療組：黑色素細(xì)胞數(shù)目較模型有有所減少，但較正常皮膚組織，數(shù)目仍為增加。 B組：氨甲環(huán)酸外用治療：黑色素細(xì)胞數(shù)目較模型有所減少，但較正常皮膚組織，數(shù)目仍增加。 C組：點陣QSRL照射聯(lián)合氨甲環(huán)酸治療：黑色素細(xì)胞數(shù)目較模型明顯減少，較正常皮膚組織數(shù)目偏多。 D組：點陣QSRL治療：黑色素細(xì)胞數(shù)目較模型明顯減少，較正常皮膚組織數(shù)目偏多。2.3黑色素顆粒變化 正常皮膚為表皮基底細(xì)胞和棘層偶見黑素顆粒，NB-UVB照射完成后，模型區(qū)域黑素顆粒顯著增多，表皮全層密布黑素顆粒，并見較多黑素帽。 A組：未治療組：黑色素顆粒較模型部分有所減少，基底細(xì)胞和棘層可見大量連續(xù)呈帶狀分布的黑素顆粒，部分仍為表皮全層密布黑素顆粒。 B組：氨甲環(huán)酸外用治療：黑色素顆粒較模型部分有所減少，基底細(xì)胞和棘層可見大量連續(xù)呈帶狀分布的黑素顆粒，部分仍為表皮全層密布黑素顆粒。 C組：點陣QSRL照射聯(lián)合氨甲環(huán)酸治療：治療2周后，黑色素顆粒較模型明顯減少，較正常皮膚有所減少，但4周后，逐漸恢復(fù)，與正常皮膚接近。 D組：點陣QSRL治療：治療2周后，黑色素顆粒較模型明顯減少，較正常皮膚有所減少，4周后，逐漸恢復(fù)，與正常皮膚接近。 通過各組色素沉著評分、黑色素細(xì)胞數(shù)量、黑色素顆粒面積占表皮面積百分比統(tǒng)計分析，低能量密度點陣QSRL可減少黑色素細(xì)胞數(shù)量、黑色素顆粒，有效治療色素沉著（P0.05）,氨甲環(huán)酸注射液外敷對減退色素沉著無顯著作用（P0.05），兩者聯(lián)合治療與單獨點陣激光治療差異無統(tǒng)計學(xué)意義（P0.05）。 結(jié)論： （1）低能量密度點陣QSRL治療NB-UVB誘導(dǎo)豚鼠色素沉著安全有效，其原理與減少部分黑色素細(xì)胞，靶向破壞部分黑色素小體有關(guān)，觀察一個月，未見明顯復(fù)發(fā)。 （2）氨甲環(huán)酸注射液單獨外敷治療色素沉著無效，對改變黑色素細(xì)胞，黑色素小體無明顯作用 （3）兩者聯(lián)合作用有待進(jìn)一步研究探索。
[Abstract]:Objective : The Q - switched ruby laser ( QSR ) in dot matrix mode has been successfully applied in the treatment of pigmentation diseases , and the treatment of pigmentary diseases has been widely used in the treatment of pigmentary diseases .

Methods : 10 healthy guinea pigs ( clean grade ) , female , age 1 month - February , guinea pig buffy skin were treated with ultraviolet ( NB - UVB ) irradiation , the focal length was adjusted before irradiation , and the two red indicators were coincident . The irradiation dose was 2 MED , i.e . 900 mJ / cm2 , once a week . The total dose was 2700 mJ / cm2 . The successful area of the mold was divided into 4 groups :

Group A : No treatment .

Group B : Treatment of external use of tranexamic acid : After diluted with ammonia A - ring acid injection ( 5 ml / 50 ml ) , it was applied to the corresponding group synchronously with laser treatment , and was continuously wet - applied for 3 days .

Group C : The laser irradiation combined with tranexamic acid treatment : The spot diameter was 7 mm , the energy density was 2.5 J / cm2 , the scanning was repeated , and immediately after the laser treatment , the ammonia A - ring acid injection was diluted ( 5 ml / 50 ml ) , followed by continuous wet application for 3 days and 1 week for 1 week .

Group D : The laser spot diameter was 7 mm , the energy density was 2.5 J / cm2 , and the scanning was repeated .

In order to clarify the therapeutic effect and possible mechanism , the pigmentation , the number of melanin cells and the changes of melanin particles were observed by the method of Imokawa staining ( Imokawa method ) and melanin particle staining respectively .

Results :

1 pigmentation change

After the irradiation of NB - UVB , the pigment of the irradiated region was more uniform and stable .

Group A : Untreated group : pigmentation was reduced compared with the model , but more pigmentation was still visible in the normal skin tissue .

Group B : The external use of tranexamic acid : The pigmentation of pigmentation was reduced , but more pigmentation was seen in the more normal skin tissue .

Group C : The combination of dot - dot - dot - dot irradiation combined with tranexamic acid treatment : pigmentation of pigmentation was significantly reduced compared with normal skin tissue .

Group D : The treatment of dot - dot matrix : The pigmentation was significantly reduced compared with the normal skin , and no significant difference was found in the comparison with the normal skin .

2 . Melanin cell change

2.1 Morphological changes

The normal skin melanin cells were in the form of bipolar , with a small number of dendritic protrusions . After irradiation with ultraviolet rays , the cells of the melanin cells increased , the dendritic dendritic cells increased , and the lattice of the cells decreased , the dendritic dendritic cells decreased , and the morphology of the melanin cells in the untreated group and the aminomethyl cyclic acid treatment group was not significantly changed .

2.2 Number of changes

After the NB - UVB irradiation , the number of melanin cells in the irradiated area was significantly increased than that of the normal skin .

Group A : There was a decrease in the number of melanin cells in the untreated group , but the number of normal skin tissues was still increased .

Group B : Topical treatment of tranexamic acid : The number of melanin cells decreased , but the number of normal skin tissues was still increased .

Group C : The number of melanin cells was significantly decreased and the number of normal skin tissues was more than that of normal skin tissue .

Group D : The number of melanin cells was significantly decreased and the number of normal skin tissues was more than that of normal skin tissue .

In normal skin , melanin granules were observed in epidermal basal cell and ratchet layer , and after NB - UVB irradiation , the melanin granules in the model area increased significantly , the whole layer of epidermis was densely covered with melanin granules , and more melanin hats were found .

Group A : There was a decrease in the number of melanin granules in the untreated group . The basal cells and the spinous layer showed a large number of melanin particles which were continuously in band - like distribution , and the part of the melanin granules was still the whole layer of the epidermis .

Group B : The external use of tranexamic acid : The smaller part of melanin granule , the basal cell and the ratchet layer can see a large number of melanin particles which are continuously in band - like distribution , and the part of the skin is still the whole layer of the epidermis .

Group C : The combination of dot - dot - dot - dot - dot - dot - dot irradiation combined with tranexamic acid treatment : After 2 weeks of treatment , the model of melanin granule decreased obviously , and the normal skin decreased , but after 4 weeks , it gradually recovered to close to the normal skin .

Group D : The treatment of dot - dot - dot - dot matrix : After 2 weeks of treatment , the model of melanin granule decreased obviously , the normal skin was decreased , and after 4 weeks , it gradually recovered and approached the normal skin .

The number of melanin cells and the area of melanin particles accounted for the percentage of epidermal area . The low - energy density dot - dot - dot matrix could reduce the number of melanin cells , melanin granules and treat pigmentation ( P0.05 ) . There was no significant difference in the external application of tranexamic acid injection ( P0.05 ) . There was no significant difference between the two treatments ( P0.05 ) .

Conclusion :

( 1 ) Treatment of NB - UVB induced pigmentation of guinea pig by low - energy density dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - dot - matrix Q@@

( 2 ) There was no obvious effect on the change of melanin cells and melanin in the treatment of pigmentation .

( 3 ) The joint action of both should be further explored .

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R758.54

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