强脉冲光嫩肤疗效评价及病理变化的研究

目的比较强脉冲光嫩肤治疗前后照片、组织学检查及皮肤纹理数字化图像分析等变化，为研究强脉冲光改善皮肤纹理质地的机制和建立临床疗效评价方法提供可参考依据。方法对58例强脉冲光嫩肤患者治疗前后照片行主观评价；4例行病理检查及胶原纤维免疫组化检查，并对弹力、胶原纤维特殊染色病理片行图像定量分析；2例行透射电镜研究；34例行皮肤纹理数字化图像分析。结果皮肤纹理质地改善有效率62．1％，色素性病变改善有效率84．60％，血管性病变改善有效率81．25％。组织学示真皮Ⅰ、Ⅲ型胶原纤维增多，弹力纤维总量减少，排列均较前整齐；电镜示幼稚成纤维细胞数量增加，成纤维细胞分泌活性增强，胶原纤维排列整齐致密编织成网状。皮肤纹理的数字化图像分析示治疗前后皮肤纹理深度及宽度改善，皮肤平均粗糙度、皮肤算术平均粗糙度及皮肤平均光滑度差异均有统计学意义（均P〈0．01）。结论强脉冲光嫩肤技术对改善皮肤纹理质地的疗效肯定；其机制可能与成纤维细胞活性增强，胶原纤维和弹力纤维的增生与重排有关。

Effects of rejuvenation by intense pulsed light and basic mechanism thereof

OBJECTIVE: To evaluate the effects of rejuvenation by intense pulsed light (IPL) and the mechanism thereof. METHODS: Fifty-eight patients with photo aging were treated with IPL of single, double, or triple pulse pattern for 3 - 5 times with the intervals of 3 - 4 weeks. Three weeks after the last treatment, photography was conducted and the pictures underwent grading by the physicians and patients according to blind method. Skin specimens of the posteroinferior ear lobe or the nape were obtained from 4 patients to undergo HE staining, Uana orcein staining of elastin, immunohistochemical staining for collagenous fibers of types I and III, and transmission electron microscopy was conducted in 2 of the 4 patients. Skin digitalized image analysis was conducted on 34 female patients to measure and analyze the depth and width of dermatographs, roughness of skin. RESULTS: After the third treatment, the wrinkles and skin texture of 62.1% of the patients showed improvement, and 84.60% of the pigmented lesions and 81.25% of the vascular lesions showed improvement. Pathology showed that type I and type III collagen increased while elastin decreased, and the fibers were orderly re-arranged. Transmission electron microscopy showed that after treatment the fibroblasts increased in number and became more active in secretion and there were more collagen fibers orderly re-arranged in the stroma. Digitalized image analysis showed significant improvement in skin smoothness, depth, arithmetic average roughness and average roughness of skin texture (all P < 0.01). CONCLUSION: IPL is effective to improve the skin texture. The mechanism may be the increasing of the activity of the fibroblasts, and hyperplasia and re-arrangement of collagen and elastin.