本文選題：激光 + 量效關(guān)系��； 參考：《安徽醫(yī)科大學(xué)》2011年碩士論文

【摘要】：背景較多損容性皮膚病與色素沉著密切相關(guān),例如炎癥后色素沉著(PIH)、雀斑和黃褐斑等,臨床常見(jiàn)但治療困難,且療效不確定。傳統(tǒng)治療一直都是藥物治療為主,其主要目的是抑制黑素細(xì)胞活性及增生、抑制黑素顆粒形成及加速降解。外治藥物主要包括化學(xué)剝脫劑、單用或聯(lián)合皮膚脫色劑、類(lèi)視黃醇類(lèi)和皮質(zhì)激素類(lèi)、維生素C及其衍生物類(lèi)和一些天然植物提取物等。這些藥物療法往往起效較慢,且療效欠佳,不良反應(yīng)較多,例如皮膚刺激、過(guò)敏等,甚至有引起新的色素沉著風(fēng)險(xiǎn)。因此,如何研究皮膚色素沉著的規(guī)律,如何有效又快速地治療色素沉著,業(yè)已成為皮膚美容科醫(yī)生的難點(diǎn)和興趣點(diǎn)。 現(xiàn)代激光技術(shù)是以“選擇性光熱作用理論”為前提。利用“選擇性光熱作用”的調(diào)Q激光技術(shù)降低了對(duì)正常皮膚的熱損傷作用,提高了安全性,痛苦小且不留疤痕,國(guó)內(nèi)外有成功治療雀斑、黃褐斑、炎癥后色素沉著的臨床病例報(bào)道。但是,調(diào)Q激光技術(shù)也是一把“雙刃劍”,一方面在可以治療色素沉著性皮膚病的同時(shí),另一方面,在亞洲人種最常見(jiàn)的FitzpatrickⅢ～I(xiàn)V型人群中,調(diào)Q激光在常規(guī)能量參數(shù)或較高能量參數(shù)下又非常容易引發(fā)新的色素沉著(俗稱(chēng)“激光的光斑反應(yīng)”),因此,此類(lèi)激光對(duì)色素沉著性皮膚病的治療利弊爭(zhēng)議一直不斷。近年來(lái),有部分國(guó)外學(xué)者試用低能量參數(shù)的調(diào)Q激光治療色素沉著取得了一定的效果:但是對(duì)皮膚色素沉著的調(diào)Q激光治療缺乏相關(guān)的動(dòng)物實(shí)驗(yàn)支持和理論研究探討,更缺乏量效關(guān)系的研究。因此,對(duì)這方面的研究意義重大。 目的研究調(diào)Q激光對(duì)紫外線照射引起皮膚色素沉著的治療改善作用,研究調(diào)Q激光不同波長(zhǎng)不同能量梯度對(duì)皮膚黑素顆粒和黑素細(xì)胞的形態(tài)和功能影響的量效關(guān)系,為進(jìn)一步開(kāi)發(fā)新的低能量治療模式提供實(shí)驗(yàn)依據(jù)和參考。 研究對(duì)象與方法浙江中醫(yī)藥大學(xué)實(shí)驗(yàn)動(dòng)物中心10只棕黃色豚鼠,①采用中波紫外線(UVB)照射豚鼠背部皮膚誘導(dǎo)色素沉著實(shí)驗(yàn)動(dòng)物模型;②選擇了調(diào)Q Nd:YAG激光(波長(zhǎng)1064nm,以下簡(jiǎn)稱(chēng)Q-1064)和調(diào)Q紅寶石激光(波長(zhǎng)694 nm,以下簡(jiǎn)稱(chēng)Q-694) 2種激光各3個(gè)能量參數(shù),觀察其對(duì)實(shí)驗(yàn)動(dòng)物皮膚色素沉著的不同治療作用;③皮膚生理功能測(cè)試和共聚焦激光掃描顯微鏡(CLSM)全程活體的動(dòng)態(tài)觀察,實(shí)驗(yàn)前、中、后再取材組織病理觀察黑素細(xì)胞(MC)和黑素顆粒的變化等,分析色素沉著的不同治療反應(yīng)與調(diào)Q激光能量能量的量效關(guān)系。④采用SPSS 13.0統(tǒng)計(jì)軟件對(duì)實(shí)驗(yàn)結(jié)果行多個(gè)樣本均數(shù)的方差分析和t檢驗(yàn),p0.05為有統(tǒng)計(jì)學(xué)意義。 結(jié)果①兩種激光治療療效相比:Q-694治療后的黑素指數(shù)均數(shù)為63.82,Q-1064治療后的黑素指數(shù)均數(shù)為125.20,兩組比較,療效差異顯著,說(shuō)明Q-694療效優(yōu)于Q-1064;②同一種激光不同能量組治療療效相比:兩種激光的最佳效應(yīng)組均為低能量組,肉眼觀察治療區(qū)色素沉著完全消退,且維持時(shí)間長(zhǎng)于其他能量組;皮膚黑素指數(shù)(MCI)明顯下降,與其它組比較,差異有統(tǒng)計(jì)學(xué)意義(P 0.05);硫酸亞鐵染色和CLSM結(jié)果顯示色素沉積量、黑素顆粒和MC的數(shù)目、密度明顯減小。中高能量組皮膚色素沉著在治療結(jié)束后4～8周均有不同程度復(fù)發(fā)。 結(jié)論調(diào)Q激光治療豚鼠皮膚色素沉著療效確切,皮膚組織效應(yīng)程度與能量、治療頻率之間存在一定的關(guān)系,小能量多次治療療效較好。Q-694和Q-1064相比,Q-694治療表皮色素沉著療效更好。應(yīng)用CLSM可以直觀的觀察到調(diào)Q激光治療后的黑素變化。
[Abstract]:Background more skin lesions are closely related to pigmentation, such as post inflammatory pigmentation (PIH), freckles and chloasma, which are common clinical but difficult to treat, and the curative effect is uncertain. Traditional treatment has been mainly drug treatment, its main purpose is to inhibit melanocyte activity and proliferation, inhibit melanin granules formation and accelerate degradation. Medications mainly include chemical exfoliation agents, single or combined skin decolorizing agents, retinoids and corticosteroids, vitamin C and its derivatives and some natural plant extracts, which tend to be slow, with poor efficacy, and more adverse reactions, such as skin irritation, allergies, and even new pigmentation. Therefore, how to study the regularity of skin pigmentation and how to effectively and quickly treat the pigmentation have become a difficult and interesting point for the skin cosmetology doctor.
Modern laser technology is based on the "selective photothermal theory". Using the "selective light and heat action" Q laser technique, it reduces the heat damage to normal skin, improves safety, has little pain and does not leave scars. There are clinical reports of successful treatment of freckles, chloasma, and post inflammatory pigmentation at home and abroad. Q laser technology is also a "double-edged sword". On the one hand, it can treat pigmented dermatosis. On the other hand, in the most common people of Fitzpatrick III to IV in Asian people, the modulation of Q laser can easily lead to new pigmentation under conventional energy parameters or high energy parameters (commonly known as "laser spot response". In recent years, some foreign scholars have tried to use the low energy parameter Q laser to treat the pigmentation. However, the Q laser treatment for skin pigmentation is short of related animal experimental support and theoretical research. There is a lack of research on dose effect relationship. Therefore, this research is of great significance.
Objective to study the effect of Q laser on the treatment of skin pigmentation caused by ultraviolet radiation, and to study the effect of different wavelength of Q laser on the morphologic and functional effects of different energy gradients on skin melanin particles and melanocytes, and to provide experimental basis and reference for the further development of a new type of low energy treatment model.
Research object and method 10 brown yellow guinea pigs of experimental animal center of Zhejiang Chinese Medicine University, (1) using UVB to irradiate the pigmentation animal model of the skin of the guinea pig's back, and select 2 kinds of laser, Q Nd:YAG laser (wavelength 1064nm, hereinafter referred to as Q-1064) and Q ruby laser (wavelength 694 nm, hereinafter referred to as Q-694) The different therapeutic effects of 3 energy parameters on the skin pigmentation of experimental animals were observed. (3) the dynamic observation of skin physiological function and confocal laser scanning microscope (CLSM). The changes of melanocytes (MC) and melanin granules were observed before, during and after the experiment, and the different treatments for pigmentation were analyzed. The relationship between the reaction and the energy and energy of the Q laser. (4) the SPSS 13 statistical software was used to analyze the variance and t test of the experimental results, and the P0.05 was statistically significant.
Results (1) compared the curative effect of two kinds of laser treatment: the average number of melanin index after Q-694 treatment was 63.82, the average of melanin index after Q-1064 treatment was 125.20, and the difference of the curative effect was significant in the two groups, indicating that the curative effect of Q-694 was better than that of Q-1064. The pigmentation in the observation area was completely subsided and the maintenance time was longer than the other energy groups; the skin melanin index (MCI) decreased obviously, and the difference was statistically significant (P 0.05) compared with the other groups. The ferrous sulfate staining and CLSM results showed the amount of pigment deposition, the number of melanin particles and MC and the density of the skin, and the skin pigmentation in the middle and high energy group. At the end of treatment, 4~8 Zhou Junyou recurred to varying degrees.
Conclusion Q laser therapy is effective in the treatment of pigmentation in guinea pig skin. There is a certain relationship between the degree of skin tissue effect and the frequency of energy, the frequency of treatment. Compared with.Q-694 and Q-1064, the curative effect of Q-694 is better than that of Q-1064. The application of CLSM can be used to observe the melanin changes after the Q laser treatment.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2011
【分類(lèi)號(hào)】：R758.4

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本文編號(hào)：2101132