氨甲环酸联合谷胱甘肽治疗黄褐斑的临床观察

目的探讨氨甲环酸联合谷胱甘肽治疗黄褐斑的临床疗效。方法选择2016年1月~2017年4月期间本院收治的86例黄褐斑患者,根据治疗方式分为谷胱甘肽和联合组,各43例。对照组采用谷胱甘肽+维生素C注射液治疗,联合组在对照组基础上增加氨甲环酸治疗,对比两组治疗后黄褐斑面积及颜色改善情况,并采用共聚焦激光扫描显微镜检查观察患者黄褐斑改善情况,同时追踪随访两年,对比两组长期疗效。结果联合组黄褐斑(93.35%)治疗总有效率显著高于对照组(76.74%),差异具有统计学意义(P<0.05)。但联合组治疗后皮损面积(1.12±0.23)cm^2和皮损颜色评分(0.79±0.6)5分均显著低于对照组(2.38±0.75)cm^2、(1.54±0.38)分,差异具有统计学意义(P<0.05)。联合组治疗后共聚焦激光扫描显微镜检查显示:41例患者棘细胞层黑色素颗粒的亮度和密度较治疗前显著降低,1例偏真皮混合型和1例表皮型患者改善不显著;对照组治疗后共聚焦激光扫描显微镜检查显示:30例患者治疗后皮损区域皮肤色素显著降低,与正常皮肤区域相似,棘细胞层黑色素颗粒的亮度和密度显著降低,3例表皮型患者棘细胞层黑色素颗粒减少不显著,3例偏表皮混合型基底层黑色素细胞仍呈增生活跃状态,散在黑色素颗粒未减少;4例偏真皮混合型患者真皮浅层噬黑色素细胞及黑色素颗粒无改善。随访2年显示,观察组复发4例,对照组复发10例,观察组复发率(9.30%)显著低于对照组(23.30%),差异具有统计学意义(P<0.05)。结论谷胱甘肽治疗黄褐斑基础上联用氨甲环酸,可进一步提升祛斑效果,促进黄褐斑消退、淡化,治疗效果较为理想。

Clinical observation of tranexamic acid combined with glutathione in the treatment of melasma

Objective To investigate the clinical efficacy of tranexamic acid combined with glutathione in the treatment of melasma.Methods A total of 86 melasma patients admitted to our hospital from January 2016 to April 2017 were selected and divided into glutathione and combined groups according to the treatment method,43 cases each.The control group was treated with glutathione + vitamin C injection,and the combined group was treated with tranexamic acid on the basis of the control group.The melasma area and color improvement after the two groups were compared,and the confocal laser scanning microscope was used to check The patients’ melasma improvement was observed,and the follow-up was followed for two years.The long-term effects of the two groups were compared.Results The total effective rate of melasma (93.35%) in the combination group was significantly higher than that in the control group (76.74%),and the difference was statistically significant (P<0.05).However,the skin area (1.12±0.23)cm^2 and skin color score (0.79±0.65) points in the combined group were significantly lower than those in the control group (2.38±0.75)cm^2,(1.54±0.38)points,and the differences were statistically significant (P<0.05).Confocal laser scanning microscopy examination of the combined group showed that the brightness and density of the melanin particles in the spinal cell layer of the 41 patients were significantly lower than before the treatment,and 1 patient with a mixed dermis type and 1 with an epidermal type showed no significant improvement.Confocal laser scanning microscopy examination showed that the skin pigmentation of the skin lesion area was significantly reduced in 30 patients after treatment,similar to the normal skin area,the brightness and density of melanin particles in the spinal cell layer were significantly reduced,and the melanin particles in the spinal cell layer of 3 epidermal patients were reduced.Not significant,3 cases of partial epidermal mixed basal layer melanocytes were still proliferative and active,and scattered melanin particles were not reduced;4 cases of partial dermal mixed type patients had no improvement in superficial dermal melanocytes and melanin particles.Follow-up for 2 years showed that there were 4 cases of recurrence in the observation group and 10 cases in the control group.The recurrence rate in the observation group (9.30%) was significantly lower than that in the control group (23.30%),and the difference was statistically significant (P<0.05).Conclusion The combined use of glutathione and tranexamic acid in the treatment of melasma can further improve the effect of freckle removal,promote the elimination and desalination of melasma,and the treatment effect is ideal.