王怀湘　李建明

[摘要] 目的 評价微波凝固辅助强脉冲光（IPL）治疗玫瑰痤疮的效果及安全性。 方法 选取2014年2月～2017年1月在火箭军总医院礼士路门诊部皮肤科就诊的64例玫瑰痤疮患者，按随机数字表法将其分为观察组和对照组，每组32例。观察组先给予IPL治疗，再用微波凝固扩张的毛细血管，对照组仅给予IPL治疗。观察并比较两组患者临床效果、副作用及治疗前后症状积分、皮肤病的生活质量指数量表（DLQI）评分。 结果 观察组在治疗后3、6、9周总有效率均明显高于同期对照组（P < 0.05），治疗后12周，两组总有效率比较差异无统计学意义（P > 0.05）。两组皮损总评分和DLQI评分的组间效应、时间效应及交互作用整体差异均有统计学意义（P < 0.05）。进一步两两比较，治疗后各时间点皮损总评分以及DLQI评分均比同组治疗前明显下降（P < 0.05）；观察组治疗后3、6、9、12周皮损总评分和治疗后3、6、9周DLQI评分均较对照组下降更明显（P < 0.05），但两组治疗后12周DLQI评分差异无统计学意义（P > 0.05）。 结论 微波凝固技术辅助IPL治疗鼻部及鼻周以毛细血管扩张为主的玫瑰痤疮效果确切，安全可靠，患者恢复时间短，生活质量得到明显改善，值得临床推广使用。

[关键词] 强脉冲光；微波；玫瑰痤疮；临床疗效

[中图分类号] R758.64 [文献标识码] A [文章编号] 1673-7210（2018）09（b）-0113-04

[Abstract] Objective To evaluate the efficacy and safety of microwave coagulation assisted intense pulse light （IPL） in the treatment of rosacea. Methods From February 2014 to January 2017， 64 patients with rosacea in the Department of Dermatology in Lishilu Outpatient， General Hospital of the PLA Rocket Force were divided into observation group and control group according to random number table method， with 32 cases in each group. The observation group was treated with IPL and microwave to coagulate the dilated capillaries， while the control group was treated with IPL only. The clinical effects， side effects， symptom scores and dermatology life quality index （DLQI） scores before and after treatment in the two groups were observed and compared. Results The total effective rate of the observation group was significantly higher than that of the control group at 3， 6， 9 weeks after treatment （P < 0.05）， but there was no significant difference between the two groups at 12 weeks after treatment （P > 0.05）. The overall difference of effects between groups， time effects and interaction effects of total score of skin lesions and DLQI score was statistically significant in the two groups （P < 0.05）. Further comparison showed that the total score of skin lesions and DLQI score at each time point after treatment were significantly lower than those in the same group before treatment （P < 0.05）. The total score of skin lesions at 3， 6， 9， 12 weeks after treatment， and DLQI score at 3， 6， 9 weeks after treatment in the observation group were decreased more significantly than those of control group （P < 0.05）， however， there was no significant difference at 12 weeks after treatment in DLQI score between the two groups （P > 0.05）. Conclusion Microwave coagulation assisted IPL in the treatment of rosacea patients with telangiectasia on the nasal and surrounding is effective， safe and reliable， the recovery time of the patients is short， the quality of life is obviously improved， which is worth popularizing in clinic.

[Key words] Intense pulsed light； Microwave； Rosacea； Clinical effect

玫瑰痤疮又名酒渣鼻，是一种多发于面中部，累及毛囊皮脂腺单位及血管的慢性炎症性皮肤病，表现为颜面中部皮肤阵发性潮红、持续性红斑、毛细血管扩张和丘疹、脓疱等皮损，少数患者后期会出现增生性鼻赘，严重影响患者容貌、心理和生活质量[1]。临床上分红斑血管扩张型、丘疹脓疱型、肥大型、眼型四个亚型，各型别之间有重叠，毛细血管扩张可出现在各型期[2]。传统治疗方法多采用口服抗生素、外用药物等，对炎性丘疹有效，但对红斑、毛细血管扩张无效[3]。本研究对鼻部及其周围以红斑、毛细血管扩张为主要表现的玫瑰痤疮患者应用微波凝固技术联合强脉冲光（intense pulsed light，IPL）進行序贯式治疗，获得满意的临床效果。……