可变脉宽 Nd:YAG激光与强脉冲光治疗鲜红斑痣动物模型的研究

目的 通过动物模型研究可调脉宽Nd:YAG激光与强脉冲光对鲜红斑痣的治疗作用。方法 以38只莱亨鸡作为鲜红斑痣动物模型,随机分为4组,其中1组（2只）作为空白对照组不给予激光照射,其余3组（每组12只）分别给予可变脉宽Nd:YAG激光照射2次、强脉冲光照射2次、Nd:YAG激光和强脉冲光照射各1次,分别观察鸡冠形态学、组织学变化,对照射前后每高倍镜下血管数的变化进行统计学分析。结果 2次照射后,各组鸡冠被照射区颜色变淡,光镜下可见真皮血管层变薄,血管闭锁,血管数目减少。每高倍镜（ × 400）下血管数Nd：YAG照射组为（17.92 ± 3.63）个,强脉冲光照射组为（8.08 ± 1.56）个,联合照射组为（7.08 ± 1.31）个,与未照射的对照组（37.08 ± 3.97）个相比,各组血管数均减少,差异均有统计学意义（P < 0.01）。联合照射组与强脉冲光照射组比较,差异无统计学意义（P > 0.01）,但低于Nd:YAG组（P < 0.01）。结论 可变脉宽Nd:YAG激光照射、强脉冲光照射、两者联合照射均可用于鲜红斑痣的治疗。强脉冲光照射、二者联合照射治疗鲜红斑痣效果可能优于单独可变脉宽Nd:YAG激光照射。     

可变脉宽1064nm Nd:YAG激光联合强脉冲光治疗鲜红斑痣疗效评价

目的:评价可变脉宽1064 nm Nd:YAG激光联合强脉冲光(IPL)治疗鲜红斑痣的疗效。方法:将329例鲜红斑痣患者随机分为2组,分别给予可变脉宽Nd:YAG 1064 nm激光单独照射(165例)以及可变脉宽Nd:YAG 1064 nm激光与强脉冲光联合照射(164例)。结果:联合治疗组总有效率(91.46%)优于单独照射组(79.96%),P0.01。结论:可变脉宽1064 nm Nd:YAG激光联合IPL较单独可变脉宽Nd:YAG 1064 nm激光治疗鲜红斑痣有效。     

长脉宽与Q开关1064 nm Nd:YAG激光对皮肤作用的比较

目的:比较长脉宽1064 nm Nd:YAG激光和Q开关1064 nm Nd:YAG激光照射对小鼠皮肤的影响.方法:分别使用长脉宽1064 nm Nd:YAG激光(脉宽为3 ms、50 ms)和Q开关1064 nm Nd:YAG激光(脉宽5 ns)对小鼠背部脱毛后的皮肤进行照射,共照射4次,每次间隔1周.检测照射后不同时间点的皮肤弹性、皮肤羟脯氨酸含量,真皮内胶原增生情况以及红斑指数和经表皮失水量的变化情况.结果:从首次照射后第3或4周至第7周,各实验组的皮肤弹性都明显好于对照组;首次照射7周后各组实验侧的皮肤羟脯氨酸含量和真皮内胶原厚度都较对照组显著增大(P＜0.01),但各实验组之间无显著差异;苦味酸一天狼猩红染色-偏振光法检查显示各组增生的胶原主要为I型胶原.首次激光照射后即刻,各实验组的经表皮失水量及Q开关1064 nm Nd:YAG激光实验组的红斑指数都较其对照组显著增高(P＜0.01),并于1周内恢复.结论:长脉宽1064 nm Nd:YAG激光可以取得与Q开关1064 nm Nd:YAG激光对皮肤相似的效果,且不良反应较轻.     

585 nm Q开关脉冲激光、强脉冲光及长脉宽Nd:YAG激光治疗皮肤血管性疾病临床疗效比较

目的:观察比较585nmQ开关脉冲激光、强脉冲光及长脉宽1064nm Nd:YAG激光治疗皮肤血管性疾病的临床疗效和不良反应.方法:分别应用585nm Q开关脉冲激光(能量密度3.0～6.0 J/cm2,脉宽10ns)、590～1200 nm强脉冲光(能量密度30～60 J/cm2,脉宽3.0～5.5 ms)以及长脉宽1064nm Nd:YAG激光(能量密度120-145J/cm2,脉宽20～50ms)共治疗1415例毛细血管扩张、977例蜘蛛痣、742例血管瘤及442例鲜红斑痣患者.结果:585 nm Q开关脉冲激光、强脉冲光及长脉宽Nd:YAG激光治疗毛细血管扩张的有效率分别为86.3%、89.7%及88.6%;治疗蜘蛛痣的有效率分别为97.2%、96.5%及98.8%;治疗血管瘤的有效率分别为51.2%、59.6%及74.2%;治疗鲜红斑痣的有效率分别为28.4%、33.1%及40.3%.长脉宽Nd:YAG激光治疗血管瘤及鲜红斑痣的瘢痕发生率分别为8.5%和10.7%.结论:3种治疗方法对毛细血管扩张、蜘蛛痣及鲜红斑痣疗效无明显差异;长脉宽1064nm Nd:YAG激光治疗血管瘤的有效率明显优于585nm Q开关脉冲激光及强脉冲光,但瘢痕发生率也较高.     

595 nm PDL与1064 nm Nd: YAG激光联合治疗婴儿尿布区溃疡性血管瘤疗效分析

目的:评价595 nm PDL与1064 nm Nd:YAG激光联合治疗婴儿尿布区溃疡性血管瘤的疗效及安全性。方法:针对尿布区域溃疡性血管瘤患者,溃疡创面采用PDL治疗,光斑直径7 mm,脉宽1.5 ms,能量密度7～9 J/cm²,每周重复治疗1次。非溃疡部分采用PDL和1064 nm Nd:YAG激光模式联合治疗。激光参数如下,PDL采用7 mm光斑,脉宽6 ms,能量密度12 J/cm²,Nd:YAG脉宽45 ms,能量密度30～40 J/cm²,每两周进行1次。结果:共治疗32例患者,溃疡面治疗1周后,有9例患者开始愈合,治疗2周后进行随访,有28例患者溃疡面逐渐愈合。非溃疡处皮损经2～6次治疗后,29例患者皮疹消退60%以上。3例溃疡面较大者出现明显瘢痕。结论:595 nm PDL与1064 nm Nd:YAG激光联合治疗婴儿尿布区溃疡性血管瘤安全有效。     

长脉冲可调脉宽1064nmNd：YAG激光治疗小儿皮肤血管瘤196例疗效分析

随着激光技术的发展,激光在血管瘤治疗方面的应用越来越多.过去我们常采用连续Nd:YAG(1064 nm)激光治疗,该激光作用深、疗效快,但极易遗留明显瘢痕.2007年4-10月,我科采用长脉冲可调脉宽1064 nm Nd:YAG激光治疗196例小儿血管瘤,取得了满意的疗效.     

非磨削型嫩肤激光对小鼠皮肤失水的影响

目的 研究非磨削型激光嫩肤对皮肤屏障功能的影响.方法 用CooltouchⅡ 1320nm激光、Gentlelase755nm激光、Vbeam595nm激光、GentleYAG1064nm激光照射小鼠皮肤.并用1%透明质酸钠涂抹于GentleYAG 1064nm激光照射后的皮肤,观察1周内皮肤经表皮失水、含水量的变化.结果 激光照射小鼠皮肤1h时就出现了经表皮失水较正常对照组显著性增高(P<0.05),595nm激光照射引起的皮肤经表皮失水值增高在激光照射后的第7天恢复正常(P>0.05).1320nm激光在第2天时恢复正常(P>0.05),1064nm激光在第4天恢复正常(P>0.05),755nm激光在第4天恢复正常(P>0.05).GentleYAG1064nm激光照射部位的皮肤每天用1%透明质酸钠涂抹1次后,经表皮失水值在第4天恢复正常(P>0.05).结论 各种非磨削型嫩肤激光照射小鼠背部皮肤后均引起局部皮肤经表皮失水增加,24h内均未能恢复正常,但是在1周时均可基本恢复正常.波长较短的595nm激光引起的经表皮失水恢复较慢,而波长较长的1320nm激光引起的经表皮失水恢复较快.激光照射后外用1%透明质酸钠无助于皮肤经表皮失水的恢复.     

Q开关1064nm Nd:YAG激光照射对大鼠皮肤中羟脯氨酸含量、皮肤厚度和FGF-1表达的影响

目的:确定Q开关1064 nm Nd:YAG激光非磨削性嫩肤对大鼠真皮胶原增生和成纤维细胞生长因子-1(FGF-1)表达的影响.方法:用Q开关1064 nm Nd:YAG激光照射大鼠脱毛的背部皮肤,每3天1次,连续4次.照射后第14天和30天分别取大鼠皮肤测量真皮厚度并检测羟脯氨酸含量,免疫组化法检测FGF-1的表达.结果:激光照射后第14天大鼠皮肤真皮厚度明显增加,胶原纤维束粗大、密集,皮肤中羟脯氨酸含量增加,与对照组相比有显著性差异(P<0.05).免疫组化显示FCF-1在激光照射后第14天表达明显上调.照射第30天时,真皮厚度和羟脯氨酸含量下降,:FGF-1表达下调.结论:FGF-1在激光非磨削性嫩肤治疗大鼠皮肤中表达上调,可能导致真皮内胶原增生密切相关.     

Q开关1064 nm Nd：YAG激光照射对大鼠皮肤中羟脯氨酸含量、皮肤厚度和FGF-1表达的影响

目的：确定Q开关1064 nm Nd：YAG激光非磨削性嫩肤对大鼠真皮胶原增生和成纤维细胞生长因子-1（FGF-1）表达的影响。方法：用Q开关1064 nm Nd：YAG激光照射大鼠脱毛的背部皮肤,每3天1次,连续4次。照射后第14天和30天分别取大鼠皮肤测量真皮厚度并检测羟脯氨酸含量,免疫组化法检测FGF-1的表达。结果：激光照射后第14天大鼠皮肤真皮厚度明显增加,胶原纤维束粗大、密集,皮肤中羟脯氨酸含量增加,与对照组相比有显著性差异（P〈0．05）。免疫组化显示FGF-1在激光照射后第14天表达明显上调。照射第30天时,真皮厚度和羟脯氨酸含量下降,FGF-1表达下调。结论：FGF-1在激光非磨削性嫩肤治疗大鼠皮肤中表达上调,可能导致真皮内胶原增生密切相关。     

Q开关Nd:YAG激光非损伤嫩肤的小鼠动物实验研究

目的:评估Q开关Nd:YAG激光非损伤嫩肤后小鼠真皮胶原蛋白含量的变化,为临床治疗提供理论依据。方法:采用532nm,1064nm的Q开关Nd:YAG激光;对32只小鼠随机分为4组,1组对照组,3组实验组。分别用532nm、1064nm以及这两种波长激光联合各照射5次,间隔7天。免疫组化技术检测32只小鼠真皮中Ⅰ和Ⅲ型胶原蛋白含量,HE染色测定真皮胶原纤维的厚度。结果:(1)胶原纤维的厚度及Ⅰ和Ⅲ型胶原蛋白的含量均比对照组高(P<0.01);(2)532nm组的胶原纤维的厚度及Ⅰ和Ⅲ型胶原蛋白的含量均比1064nm组高(P<0.01);两种波长联合的胶原纤维的厚度及Ⅰ和Ⅲ型胶原蛋白的含量均比532nm组和1064nm组高(P<0.01)。结论:532nm、1064nm以及这两种波长的激光联合照射是有效的嫩肤方法,532nm优于1064nm,两种波长联合优于单用一种波长。     

长脉冲Nd:YAG 1064nm激光对红色毛癣菌生长及超微结构的影响

目的:确定长脉冲Nd:YAG 1064 nm激光对临床分离红色毛癣菌Y生长及超微结构的影响。方法:长脉冲Nd:YAG 1064 nm激光以200 J/cm~2、400 J/cm~2、600 J/cm~2能量体外照射含有等菌量的红色毛癣菌Y菌落,观察照射后菌落生长的变化,同时将激光照射前后的菌落制备成标本,分别用扫描电镜及透射电镜观察其超微结构变化。结果:长脉冲Nd:YAG 1064 nm激光能量为400 J/cm~2时,可抑制红色毛癣菌Y菌落的生长,600 J/cm~2时,红色毛癣菌Y菌落停止生长。激光照射后的红色毛癣菌Y菌落,在扫描电镜下菌丝结构由光滑变为粗糙,延长变为皱缩、截短,膨大;透射电镜下菌体细胞壁及细胞器结构破坏。可见髓样小体及蛋白凝固体。600 J/cm~2处理组:菌体崩解、坏死。结论:长脉冲Nd:YAG 1064 nm激光可抑制或终止红色毛癣菌菌落的生长,改变菌体的超微结构。     

New approaches to the laser treatment of vascular lesions

The pulsed dye laser (PDL) was developed based on the concept of selective photothermolysis. Using a wavelength of light well absorbed by the target and a pulse duration short enough to spatially confine thermal injury, specific vascular injury could be produced. While the PDL revolutionized the treatment of port wine stains (PWS) and a variety of other vascular lesions, the mathematical model predicted that the ideal thermal relaxation time for the vessels in PWS is actually 1-10 msec, not 450 microseconds. These original theoretical calculations have been proved correct recently in a study using both an animal vessel model and in human PWS. Longer wavelengths of light within the visible spectrum penetrate deeper into the skin and are more suitable for deeper vessels; while longer pulse duration is required for larger calibre vessels. A variety of lasers have been developed recently for the treatment of vascular lesions that incorporate these concepts into their design, including PDL at 1.5 msec, a filtered flash-lamp pulsed light source with pulse durations of 1-20 msec, several 532 nm pulsed lasers with pulse durations of 1 to as high as 100 msec, long pulsed alexandrite lasers at 755 nm with pulse durations up to 20 msec, pulsed diode lasers in the 800-900 nm range, and long pulsed 1064 Nd:YAG sources. Preliminary results are encouraging.     

Q开关Nd:YAG 1 064 nm激光对表皮葡萄球菌活性及结构的影响

 目的:探讨不同能量密度的Q开关Nd:YAG 1 064 nm激光对表皮葡萄球菌的菌体活性及结构的影响。方法: 临床获取毛囊炎标本，用胰蛋白胨大豆肉汤琼脂平板（TSA）培养获取菌落，基因测序进行鉴定，确定表皮葡萄球菌后进行培养，使用Q开关Nd:YAG 1 064 nm激光对菌体进行照射。实验组：激光光斑直径2 mm，脉宽≤8 ns，根据不同能量密度159、191、222、254、287 J/cm2分设5组；对照组不予激光照射。以菌落计数法评估菌体活性，并利用透射电镜观察菌体结构的改变。激光能量与菌落数的相关性采用Pearson相关分析。结果:实验组菌落计数分别为（234 500±12 554）、（89 200±10 485）、（52 200±6 214）、（26 200±4 157）、（8 300±2 213） CFU/mL，对照组菌落数为（276 400±13 150) CFU/mL，各组间差异有统计学意义（F=1 536.97， P<0.05）。激光能量与菌落数呈负相关（r=-0.90，P<0.05）。能量密度在191 J/cm2以上时，对菌体结构有破坏作用，能量越大，破坏程度越大。结论: Q开关Nd:YAG 1 064 nm激光对表皮葡萄球菌有抑菌和结构破坏作用。     

Long‐pulsed 1064 nm Nd:YAG laser improves hypertrophic port‐wine stains

Background Hypertrophic port‐wine stains (PWS) usually respond poorly to pulsed dye laser treatment. The long‐pulsed 1064 nm Nd:YAG laser can target deeper situated vessels and may therefore be more effective. Objective To evaluate the efficacy and safety of the Nd:YAG laser for the treatment of hypertrophic PWS. Methods In a retrospective cohort study, all hypertrophic PWS patients treated with the Nd:YAG laser between 2005 and 2011 were invited for follow‐up. Clinical improvement was assessed using Physician Global Assessment (PhGA) and Patient Global Assessment (PGA). Results Assessment was obtained in 32 of 44 eligible patients (mean age 51.4 years), after a mean of 2.8 (SD ± 2.1) Nd:YAG laser treatments. Good or excellent improvement of hypertrophy was found in a majority of patients, both by PhGA (91%) and PGA (93%). Good or excellent improvement of colour was found in 63% of patients by PhGA, and in 87% by PGA. Recurrence of hypertrophy was seen in three patients. All but two patients would recommend Nd:YAG treatment to other patients. Mild to moderate scars were seen in seven patients, hypopigmentation in 14 patients. Conclusion The 1064 nm Nd:YAG laser is highly effective in the treatment of hypertrophic PWS with only a few treatments needed. Mostly mild side effects were seen in half of all patients. Hypertrophy seems to respond better than colour. To further improve colour, a combination with pulsed dye laser treatment is advisory. Observation of immediate clinical endpoints is important when using the Nd:YAG laser, to optimize outcomes and reduce side effects.     

Q开关Nd:YAG激光与强脉冲光对鼠皮肤热休克蛋白70表达的影响

目的:确定Q开关1064 nm Nd:YAG激光与强脉冲光(IPL)对Wistar大鼠皮肤热休克蛋白70(HSP70)表达的影响.方法:Wistar大鼠20只,背部皮肤脱毛,平均分成3部分:近头侧区为正常对照组,中间区为IPL组,近尾侧区为YAG组.于照射后1天、1周、4周取大鼠皮肤标本,免疫组化技术检测HSP70的表达.结果:免疫组化显示:Q开关1064 nm Nd:YAG激光和IPL照射后1周,HSP70表达最为显著;照射后4周,HSP70表达下调,IPL组表达与正常对照组无差别,YAG组仍较正常对照组表达增强(P＜0.05);两光照组间于照射后1天、1周和4周HSP70表达差别有统计学意义(P＜0.05).结论:HSP70的表达强度与光照后组织热损伤的程度和深度有关,Q开关1064 nm Nd:YAG激光对大鼠皮肤的非剥脱性嫩肤作用较IPL强且持久.     

Q开关1064nm和532nm Nd:YAG激光对大鼠皮肤非剥脱性嫩肤作用的比较

目的:比较Q开关1064 nm和Q开关532 nm Nd:YAG激光照射对大鼠皮肤的非剥脱性嫩肤作用.方法:分别使用上述两种激光的三种不同能量密度对大鼠背部皮肤进行照射,动态观测皮肤弹性和皮肤含水量变化,光镜下观察大鼠背部皮肤真皮层厚度的变化,测定局部皮肤羟脯氨酸含量.结果:末次照射后第4周,大鼠试验侧的皮肤弹性和含水量都明显好于对照侧;试验侧皮肤羟脯氨酸含量和真皮层厚度都较对照侧显著提高(P<0.05).结论:Q开关1064 nm Nd:YAG激光较532 nm Nd:YAG激光具有更为明显非剥脱性嫩肤效果.     

Investigation of irradiation by different nonablative lasers on primary cultured skin fibroblasts

Background. A variety of lasers with different wavelengths and biological effects are widely used for nonablative skin rejuvenation, but the underlying mechanisms have not been fully investigated. Aim. To investigate the effects of irradiation by different nonablative lasers on collagen synthesis and the antioxidant status of cultured fibroblasts to identify a possible mechanism for laser photorejuvenation. Methods. Cultured skin fibroblasts were irradiated with three different lasers: 532 nm potassium–titanyl phosphate (KTP), 1064 nm Q‐switched neodymium:yttrium–aluminium–garnet (Nd:Yag) and 1064 nm long‐pulse Nd:YAG, and production of collagen and changes in lactate dehydrogenase (LDH), malondialdehyde (MDA), superoxide dismutase (SOD) and glutathione peroxidase (GSH‐Px) were assayed. Results. Irradiation by all three lasers led to a marked increase in collagen production. Two major antioxidant enzymes, SOD and GSH, were significantly increased, whereas MDA was markedly reduced after laser irradiation. No change in LDH activity was found between nonirradiated and irradiated fibroblasts. Conclusion. This study indicates that the increased collagen synthesis by fibroblasts after laser treatment may be partly due to improved antioxidant capacity, which reduces oxidative stress and thus stimulates new collagen production.