符林瑜　吴伟伟　徐博譞　林景

[摘要]目的：探究氨甲環酸结合Q开关激光治疗女性黄褐斑的疗效及对血清雌二醇水平的影响。方法：选择88例符合条件的女性黄褐斑患者，并随机分为激光治疗组和氨甲环酸联合Q开关激光组（联合治疗组）。所有患者均接受2次低能量Q开关激光治疗，联合治疗组患者在激光治疗同时接受8周口服氨甲环酸治疗。使用改良的黄褐斑面积和严重程度评分（mMASI评分）和临床改善量表评估患者治疗前后病情，使用放免法检测患者治疗前后外周血中血清雌二醇和性激素结合蛋白的浓度。结果：在第2次Q开关激光治疗后4周，两组患者的平均mMASI均较基线水平显著下降，并且联合治疗组mMASI评分降低百分比显著低于激光治疗组。基于整体临床改善的评估中，联合治疗组中评分为3级及更高的患者高于激光治疗组，而激光治疗组中没有1例达到4级。激光治疗组治疗前后血清雌二醇水平没有明显降低，而联合治疗组患者的血清雌二醇水平治疗后显著降低，性激素结合蛋白则显著升高。结论：口服氨甲环酸结合Q开关激光治疗黄褐斑的疗效优于单独激光治疗，同时还能降低患者的血清雌二醇水平。

[关键词]氨甲环酸;Q开关激光;黄褐斑;雌二醇;性激素结合蛋白;改良的MASI评分

[中图分类号]R758.4+2    [文献标志码]A    [文章编号]1008-6455（2020）08-0065-04

Tranexamic Acid Combined with Q-switched Laser Improves Chloasma and Serum Estradiol

FU Lin-yu，WU Wei-wei，XU Bo-xuan，LIN Jing

（Department of Pharmacy， the Fifth People's Hospital of Hainan Province，  Haikou 570206，Hainan，China）

Abstract： Objective To investigate the effect of oral tranexamic acid combined with Q-switched laser on chloasma and serum estradiol. Methods  This study was a randomized， clinically controlled trial in which 88 eligible chloasma women were selected according to inclusion and exclusion criteria and were randomized into two groups： the laser treatment group and the oral tranexamic acid combined with the Q-switched laser group （Combination treatment group）. All patients received two low-energy Q-switched laser treatments， and patients in the combination treatment group received 8-week oral tranexamic acid treatment and laser treatment. Patients with pre- and post-treatment conditions were assessed using a modified melasma area and severity index （mMASI score） and a clinical improvement scale. Serum estradiol and sex hormone binding globin concentrations in peripheral blood before and after treatment were measured by radioimmunoassay. Results  At 4 weeks after the second Q-switched laser treatment，the mean mMASI of both groups was significantly lower than baseline， and the reduction percentage of mMASI score in the combination treatment group was significantly lower than that in the laser treatment group. Based on the overall clinical improvement assessment， the number of patients with grade 3 and higher in the combination treatment group was higher than that in the laser treatment group， while none of the laser treatment groups reached grade 4. Serum estradiol levels were not significantly reduced in the laser-treated group after treatment，where was serum estradiol levels in the combination-treated group were significantly decreased after treatment， but sex hormone binding globin in the combination-treated group were significantly increased after treatment. Conclusion  Women with chloasma got better results from treatment of oral tranexamic acid combined with Q-switched laser than treatment of laser alone.

Key words： tranexamic acid;Q-switched laser;chloasma; estradiol;sex hormone binding globin; mMASI score

黄褐斑是亚洲人群中一种常见的色素增加性疾病，主要出现在易被阳光照射的区域，包括面部、脸颊、前额、上唇、鼻子和下巴，呈现对称的色素沉着斑[1]。……