Q开关红宝石激光联合氨甲环酸治疗黄褐斑的疗效评价及对黑素代谢的作用

 目的 观察Q开关红宝石激光联合氨甲环酸治疗黄褐斑的疗效及对黑素代谢的作用。方法将60例黄褐斑患者随机分为3组：药物组（口服氨甲环酸500 mg/d，疗程6个月）、激光组（Q开关红宝石激光，每2周1次，疗程2个月）、联合组（激光联合氨甲环酸，方法及疗程同其他两组）,比较治疗后三组黄褐斑面积及严重程度评分（MASI）、疗效、患者满意度以及血清酪氨酸酶（Tyr）、黑色素细胞刺激素(MSH)、褪黑素(MT)水平。结果治疗后，联合组MASI下降百分比［（67.02±18.58）%］高于激光组［（53.13±20.66）%］和药物组［（53.97±18.48）%］,联合组有效率(90.00%)显著高于激光组（60.00%）和药物组（55.00%）,联合组患者满意度（90.00%）显著高于激光组（60.00%）和药物组（60.00%），差异均有统计学意义（均P<0.05）。治疗前联合组与激光组、药物组血清中Tyr、MSH和MT比较，差异均无统计学意义（均P>0.05），治疗后联合组Tyr、MSH均低于激光组和药物组，MT高于激光组和药物组，差异均有统计学意义（均P<0.05）。 结论Q开关红宝石激光联合氨甲环酸治疗黄褐斑疗效显著，可降低血清Tyr、MSH水平，升高MT水平。

Evaluation of the efficacy of Q-switched ruby laser combined with tranexamic acid for melasma and its effects on melanin metabolism

ObjectiveTo observe the efficacy of Q switch ruby laser combined with tranexamic acid for melasma and its effects on melanin metabolism. MethodsA total of 60 patients with melasma were divided into three groups: Drug group (oral tranexamic acid 500 mg/day for six months), the laser group (Q switched ruby laser, once every 2 weeks for 2 months), combination therapy (laser plus tranexamic acid, same method and course of treatment as in single modality). ResultsCombination therapy significantly lowered Melasma Area and Severity Index compared to single treatment modality ［(67.02±18.58)% vs. (53.13±20.66)% in laser and (53.97±18.48)% in drug group), both P<0.05］. The effective rate in the groups of combination therapy, laser and drug treatments were 90.00%, 60.00% and 55.00%, respectively. Patients satisfaction rate was higher in the combination group than in either laser or drug treatment alone (90.00% in combination therapy vs. 60.00% in both laser and drug groups, both P<0.05). Before the treatment, serum levels of tyrosinase (Tyr), melanocyte stimulating hormone (MSH) and melatonin (MT) were comparable among all three groups (all P>0.05). After the treatment, levels of Tyr and MSH in the combination therapy were lower than that in the laser and drug groups, while MT levels was higher in the combination therapy than in the laser and drug groups (all P<0.05). ConclusionQ switch ruby laser combined with tranexamic acid is effective for melasma and can reduce the serum levels of Tyr and MSH, while increasing MT levels.