發(fā)布時(shí)間：2018-06-16 11:32

  本文選題：308nm準(zhǔn)分子激光 + 白癜風(fēng)　； 參考：《南方醫(yī)科大學(xué)》2010年碩士論文

【摘要】： 背景： 雖然308nm準(zhǔn)分子激光在臨床上一經(jīng)用于白癜風(fēng)的治療,就顯示出其療效好,見(jiàn)效快的優(yōu)點(diǎn),但是臨床上對(duì)于其療效的評(píng)估采取的仍然是傳統(tǒng)的肉眼粗略估算評(píng)價(jià)方法,這種方法所得結(jié)果不僅難以令患者信服,而且也影響到學(xué)術(shù)交流,同時(shí)還不能充分反映治療方法對(duì)患者精神心理的影響。因此,傳統(tǒng)評(píng)價(jià)方法已不能滿足現(xiàn)代生物—心理—社會(huì)醫(yī)學(xué)模式的需求。 對(duì)白癜風(fēng)療效進(jìn)行客觀評(píng)價(jià)的關(guān)鍵環(huán)節(jié)是實(shí)現(xiàn)對(duì)治療前后皮損面積的定量。傳統(tǒng)評(píng)價(jià)方法主要是依賴于醫(yī)生按照自己的經(jīng)驗(yàn)手工對(duì)皮損的外觀進(jìn)行測(cè)量和面積估算。該法僅適用于規(guī)則形狀皮損的面積定量,而絕大多數(shù)白癜風(fēng)皮損其不僅形狀不規(guī)則,而且皮損中間還存有形狀各異的色素小島,對(duì)于這類外觀的皮損,這種評(píng)價(jià)方法測(cè)量效率低、誤差大,易受評(píng)估者主觀因素的影響,存在肉眼粗略估計(jì)和個(gè)體評(píng)判誤差的缺陷。在療效判斷上無(wú)法客觀的進(jìn)行分析對(duì)比。再則,目前流行的準(zhǔn)分子激光治療費(fèi)用也常與白斑的面積有關(guān),并且在治療上要求分多次照射,相應(yīng)的療效評(píng)估也要分多次進(jìn)行。所以,急需一種快速、客觀、重復(fù)性好的評(píng)價(jià)方法來(lái)代替肉眼估算。 隨著計(jì)算機(jī)圖像分析技術(shù)的發(fā)展,計(jì)算機(jī)圖像分析軟件已能實(shí)現(xiàn)對(duì)目標(biāo)圖像與背景圖像的分割,并能根據(jù)需要給出目標(biāo)圖像特征參數(shù)。因此,我們可以利用圖像處理軟件提取接受準(zhǔn)分子激光治療的白癜風(fēng)療前療后的皮損輪廓,計(jì)算白斑面積和復(fù)色率,進(jìn)而實(shí)現(xiàn)對(duì)308nm準(zhǔn)分子激光治療白癜風(fēng)進(jìn)行客觀的療效評(píng)價(jià)。 由于白癜風(fēng)是一種身心疾病,其對(duì)患者精神心理的影響已遠(yuǎn)遠(yuǎn)超出皮損本身對(duì)患者軀體健康的影響,尤其是面頸部的白癜風(fēng),嚴(yán)重干擾患者精神心理和日常生活。所以在對(duì)308nm準(zhǔn)分子激光治療白癜風(fēng)進(jìn)行客觀療效評(píng)價(jià)的同時(shí),為了滿足現(xiàn)代醫(yī)學(xué)模式的要求,體現(xiàn)“以人為本”的思想,我們?cè)噺幕颊叩慕嵌仍u(píng)價(jià)治療方法的有效性或不足。為此,我們將借助對(duì)患者生活質(zhì)量的測(cè)評(píng)來(lái)完善準(zhǔn)分子激光治療白癜風(fēng)的療效評(píng)價(jià)體系。 研究目的： 1、利用圖像分析軟件對(duì)接受308nm準(zhǔn)分子激光治療的白癜風(fēng)皮損進(jìn)行輪廓提取、面積定量和復(fù)色率評(píng)定,分析所選圖像分析軟件進(jìn)行圖像處理和分析的效果,篩選最佳的圖像分析方法。 2、采用最佳的圖像分析方法對(duì)308nm準(zhǔn)分子激光治療白癜風(fēng)進(jìn)行客觀的療效評(píng)價(jià),分析影響療效的因素；同時(shí)對(duì)患者進(jìn)行生活質(zhì)量調(diào)查,探討準(zhǔn)分子激光治療對(duì)患者生活質(zhì)量的影響。 研究方法： 1、以308nm準(zhǔn)分子激光作為治療手段,收集白癜風(fēng)患者治療前和治療10次后的皮損圖片,由3名皮膚科醫(yī)師分別應(yīng)用A法(皮膚色素斑痣圖像分析軟件及photoshop軟件聯(lián)合)和B法(單獨(dú)使用皮膚色素斑痣圖像分析軟件)對(duì)治療前后患者的皮損圖片進(jìn)行輪廓提取、面積定量及復(fù)色率評(píng)定,運(yùn)用spssl3.0統(tǒng)計(jì)軟件分析資料,比較兩種方法在進(jìn)行圖像分析時(shí)的可重復(fù)性效果和效率。 2、采用皮膚病生活質(zhì)量指數(shù)量表(DLQI),于治療前及不同療程后對(duì)接受滿3個(gè)準(zhǔn)分子激光治療療程(30次)皮損局限于面頸部尋常型白癜風(fēng)患者進(jìn)行生活質(zhì)量調(diào)查,同時(shí)收集患者治療前及不同療程后的皮損圖片,選用最佳的圖像分析方法對(duì)療效進(jìn)行客觀評(píng)價(jià),探討308nm準(zhǔn)分子激光治療對(duì)患者生活質(zhì)量的影響。 研究結(jié)果 1、在進(jìn)行皮損輪廓提取、面積定量及復(fù)色率評(píng)定時(shí)A法的可重復(fù)性及效率優(yōu)于B法,確立A法為療效評(píng)價(jià)的方法。 2、療效觀察及影響療效的因素分析 1)不同療程間復(fù)色率的差異 1個(gè)療程后、2個(gè)療程后、3個(gè)療程后復(fù)色率分別為：35.85%±1.43%、51.59%±1.96%、61.99%±2.15%。整體比較重復(fù)因素3個(gè)時(shí)間點(diǎn)間差異有統(tǒng)計(jì)學(xué)意義(P0.001)。兩兩比較前后差異有統(tǒng)計(jì)學(xué)意義(P0.001)。 2)不同療程臨床效果的比較 不同療程后復(fù)色效果的平均秩次分別197.79、152.34、105.87,不同療程間復(fù)色效果也存在顯著性差異(H=65.683,P＜0.001)。隨著療程增加,好轉(zhuǎn)的比例在逐漸減少,顯效及有效的比例在逐步增加。 3)性別、年齡、分期及病程對(duì)復(fù)色率的影響 經(jīng)逐步回歸分析示,一般資料中分期及病程對(duì)復(fù)色率有顯著性影響(P均0.001),相同治療次數(shù)下處于進(jìn)展期的患者其復(fù)色率高于穩(wěn)定期患者；相同治療次數(shù)及分期情況下復(fù)色率與病程呈負(fù)相關(guān),病程越短者復(fù)色率越高。 3、治療對(duì)患者生活質(zhì)量的影響 1)對(duì)患者DLQI總評(píng)分的影響 DLQI總評(píng)分隨療程增加而逐步降低,治療前、1個(gè)療程后、2個(gè)療程后、3個(gè)療程后的DLQI總評(píng)分分別為(10.19±2.82)分、(9.06±2.42)分、(6.79±2.03)分、(5.80±2.23)分。重復(fù)因素4個(gè)時(shí)間水平間差異有統(tǒng)計(jì)學(xué)意義(F=134.77,P0.001)。兩兩比較示療前及各療程后的DLQI總分值均存在顯著性差異(P0.001)。 2)第3個(gè)療程后不同復(fù)色級(jí)別對(duì)DLQI分的影響 比較第3個(gè)療程后不同復(fù)色級(jí)別間DLQI評(píng)分的差異采用協(xié)方差分析,在平衡協(xié)變量(年齡、病程、療前DLQI評(píng)分)影響后,不同復(fù)色級(jí)別間的DLQI評(píng)分存在顯著性差異(P均0.05)。 研究結(jié)論： 1、圖像分析軟件可以連續(xù)記錄患者皮損面積、復(fù)色率的改善情況,在對(duì)準(zhǔn)分子激光治療白癜風(fēng)進(jìn)行客觀評(píng)價(jià)時(shí),所得結(jié)果比傳統(tǒng)方法客觀、科學(xué)。 2、308nm準(zhǔn)分子激光治療白癜風(fēng)的效果受疾病分期和病程的影響。 3、308nm準(zhǔn)分子激光治療在改善皮損的同時(shí)能從日常生活的各方面提高患者的生活質(zhì)量。
[Abstract]:Background:
Although the 308nm excimer laser is used in the treatment of vitiligo in clinical, it shows the advantages of good effect and quick effect, but the clinical evaluation of its curative effect is still the traditional method of estimating the crude eye rough estimate. The results of this method are not only difficult to convince the patient, but also affect the academic exchange. However, the traditional evaluation method can not meet the needs of modern biological psycho social medical model.
The key to the objective evaluation of the curative effect of vitiligo is to realize the quantification of skin lesions before and after treatment. The traditional evaluation method mainly depends on the doctors' manual measurement and area estimation of skin lesions according to their own experience. This method is only suitable for the quantitative surface product of regular shape lesions, but most of vitiligo skin lesions are damaged. It is not only irregular in shape, but also in the middle of the skin. For skin lesions of this kind of appearance, this evaluation method has low efficiency, large error, easy to be influenced by the subjective factors of the evaluator, and there is a defect of rough estimation of the naked eye and the error of individual judgment. At present, the popular excimer laser treatment costs are often related to the area of leukoplakia, and the treatment requires multiple exposure, and the corresponding evaluation of the curative effect should be carried out several times. Therefore, a rapid, objective and repeatable evaluation method is urgently needed to replace the naked eye estimation.
With the development of computer image analysis technology, the computer image analysis software has realized the segmentation of the target image and the background image, and can give the target image characteristic parameters according to the needs. Therefore, we can use the image processing software to extract the skin lesions of the vitiligo after the treatment of the excimer laser treatment, and calculate the white spot. Area and rate of color rendering, and then achieve an objective evaluation of 308nm excimer laser in the treatment of vitiligo.
As vitiligo is a physical and mental illness, its influence on the psycho psycho of the patient is far beyond the effect of the skin lesion itself on the physical health of the patient, especially the vitiligo in the face and neck, which seriously interferes with the mental and daily life of the patients. Therefore, the objective effect of the 308nm excimer laser treatment for the treatment of the white purpura wind is evaluated to satisfy the objective. The requirement of modern medical model embodies the idea of "people-oriented". We try to evaluate the effectiveness or deficiency of the treatment method from the point of view of the patient. To this end, we will use the assessment of the quality of life of the patients to improve the evaluation system of the therapeutic effect of excimer laser in the treatment of vitiligo.
The purpose of the study is:
1, using the image analysis software to extract the skin lesions of vitiligo treated by 308nm excimer laser, evaluate the area and color rate, analyze the effect of image processing and analysis by the selected image analysis software, and screen the best method of image analysis.
2, the best image analysis method was used to evaluate the effect of 308nm excimer laser in the treatment of vitiligo, and to analyze the factors that affect the curative effect. At the same time, the quality of life of the patients was investigated and the effect of excimer laser therapy on the quality of life of the patients was discussed.
Research methods:
1, using 308nm excimer laser as the treatment method, the skin lesions of patients with vitiligo before and after 10 times of treatment were collected, and 3 dermatologists used A (skin pigments mole image analysis software and Photoshop software combination) and B method (use of skin pigmented nevus image analysis software separately) to the skin lesions of patients before and after treatment The tablet is extracted, the area quantitative and the color rate is evaluated, and the data of spssl3.0 statistics are used to compare the repeatability effect and efficiency of the two methods in the image analysis.
2, the quality of life (DLQI) was used to investigate the quality of life of patients with vitiligo vulgaris with 3 excimer laser treatment courses (30 times) before and after different courses of treatment. At the same time, the skin lesions before and after the treatment were collected, and the best method of image analysis was selected. Objective to evaluate the effect of 308nm excimer laser therapy on the quality of life of patients.
Research results
1, when the skin contour is extracted, the area is quantified and the rate of recolor is evaluated, the repeatability and efficiency of the A method are better than that of the B method, and the A method is established for the evaluation of the curative effect.
2, analysis of therapeutic effect and effect observation
1) the difference of color rate between different courses
After 1 courses, after 2 courses, the rate of color recovery after 3 courses were 35.85% + 1.43%, 51.59% + 1.96% and 61.99% + 2.15%. as a whole. There were significant differences between the 3 time points (P0.001). The difference was statistically significant (P0.001).
2) comparison of clinical effects in different courses of treatment
The average rank of color recovery after different course of treatment was 197.79152.34105.87, and there was significant difference between different treatments (H=65.683, P < 0.001). As the course of treatment increased, the proportion of improvement gradually decreased, and the proportion of effective and effective increased gradually.
3) the effect of sex, age, stage and duration on the rate of color rendering.
The stepwise regression analysis showed that the stage and course of the general data had a significant effect on the rate of color recovery (P 0.001). The rate of color recovery was higher than that in the stable stage patients with the same treatment times, and the rate of complex color was negatively correlated with the course of disease in the same treatment times and stages, and the higher the disease course was, the higher the color rate was.
3, the effect of treatment on the quality of life of the patients
1) the effect of DLQI on the total score of the patients
The total score of DLQI was gradually reduced as the course of treatment increased. After 1 courses of treatment, after 2 courses, the total score of DLQI after 3 courses was (10.19 + 2.82), (9.06 + 2.42), (6.79 + 2.03), (5.80 + 2.23). The difference between the 4 time levels of repeated factors was statistically significant (F=134.77, P0.001). 22 compared with DL before and after each course of DL. There was a significant difference in the total score of QI (P0.001).
2) the effect of different color grading levels on DLQI scores after third courses of treatment.
The difference of DLQI scores between different color levels after third courses of treatment was compared by covariance analysis. There was a significant difference in the DLQI score between the different color levels (P 0.05) after the impact of the balance covariate (age, course of disease, and pre therapy).
The conclusions are as follows:
1, the image analysis software can continuously record the area of the patient's skin and the improvement of the chromatic rate. The results of the objective evaluation of the treatment of vitiligo by the alignment molecular laser are objective and scientific than the traditional method.
The effect of 2308nm excimer laser on vitiligo is affected by the stage and duration of disease.
3308nm excimer laser can improve the quality of life in all aspects of daily life while improving skin lesions.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2010
【分類號(hào)】：R758.41

【引證文獻(xiàn)】

相關(guān)碩士學(xué)位論文 前1條

1 何小慧;白癜風(fēng)的治療進(jìn)展及導(dǎo)師經(jīng)驗(yàn)[D];北京中醫(yī)藥大學(xué);2011年

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本文編號(hào)：2026507