0.9 ms 1064 nm Nd：YAG激光联合伊曲康唑治疗趾甲真菌病

目的探究0.9 ms 1064 nm Nd：YAG激光联合伊曲康唑治疗趾甲真菌病的临床疗效及安全性。方法对37例（178个甲）趾甲真菌病患者随机分为甲乙两组，再按甲真菌病临床评分指数（SCIO）和甲真菌病严重度指数（OSI）分值高低各分为不同亚组。所有患者均使用激光治疗（1次/周，共8次）。乙组第1周口服伊曲康唑0.2 g，2/日。比较治疗前后的疗效、临床评分、外观变化以及不良反应，并进行患者满意度调查。结果随访12个月，临床有效率甲组31.33%、乙组35.79%；真菌清除率甲组30.00%、乙组41.18%；两组临床有效率、真菌清除率差异均无统计学意义（P>0.05）。SCIO/OSI变化，甲组均无统计学意义（P>0.05）、乙组均有统计学意义（P<0.05）；SCIO<12、OSI<16时，不同亚组之间临床有效率无明显差异（P>0.05）；SCIO≥12、OSI≥16时，不同亚组之间临床有效率有差异性（P<0.05）。分别有33.71%、74.72%、70.79%的病甲在面积、形状、颜色方面得到改善。62.16%患者对治疗效果满意。所有患者无明显不良反应。结论0.9 ms 1064 nm Nd：YAG激光1年内有效改善甲真菌病病甲的外观，对于较为严重的甲真菌病，联合伊曲康唑治疗是个更好的选择。

Effect of 0.9-ms 1064-nm Nd:YAG laser combined with itraconazole for treatment oftoenail onychomycosis

Objective To evaluate the efficacy and safety of 0.9-ms 1064-nm Nd:YAG laser alone or combined with itraconazolefor treatment of toenail onychomycosis. Methods A total of 37 patients with onychomycosis (178 toenails) were randomlyassigned to groups A and B, and each group was further divided into different subgroups according to the Scoring ClinicalIndex of Onychomycosis (SCIO) and Onychomycosis Severity Index (OSI) scoring. All the patients were treated with 0.9-msNd:YAG laser once a week for 8 times. The patients in group A were treated with laser alone, and those in group B weretreated with laser combined with itraconazole. The clinical effect, clinical scores, appearance of the toenails and adversereactions in the two groups were analyzed, and the patients’satisfaction rate was also investigated. Results At the 12thmonths of follow-up, the clinical response rate and mycological cure rate in group A were 31.33% and 30.00%, respectively,similar to the rates in group B (35.79% and 41.18%, respectively) (P>0.05). After the treatments, the SCIO and OSI scoresshowed no significant changes in group A (P>0.05) but both increased significantly in group B (P<0.05). The response rates didnot differ significantly among the subgroups with SCIO<12 or with OSI<16 (P>0.05), but showed significant differences amongthe subgroups with SCIO≥12 or with OSI≥16 (P<0.05). Of the total of 178 toenails, 33.71%, 74.72% and 70.79% toenails showedimprovements in terms of clear nail growth, shape and color, respectively. The overall patients’satisfaction rate was 62.16%,and no adverse reactions related with the therapy were recorded in these patients. Conclusion For treatment of toenailonychomycosis, 0.9-ms 1064-nm Nd:YAG laser can effectively improve the aesthetic appearance of the toenails, and acombined treatment with Nd:YAG laser and itraconazole can be better option in severe cases of onychomycosis.