徐晓静 朱元杰

[摘要]目的：探討不同剂量异维A酸联合脉冲染料激光治疗酒渣鼻的疗效及安全性。方法：纳入2016年10月-2019年1月海军军医大学附属长征医院皮肤科收治的Ⅱ、Ⅲ期酒渣鼻患者150例，按照随机数字表法分为观察组、对照组和激光组，每组50例。三组患者均给予脉冲染料激光照射治疗，观察组：给予起始剂量20mg/d的异维A酸治疗，每周按每天5mg进行减量，3周后减至5mg/d口服，维持;对照组：给予15mg/d异维A酸治疗，维持;激光组：单纯给予脉冲染料激光治疗。三组患者均连续治疗8周，观察三组的临床疗效、治疗前后皮损评分及不良反应发生情况。结果：观察组临床总有效率为90.00%，对照组总有效率为92.00%，两组比较差异无统计学意义（Z=0.122，P=0.727）;但观察组、对照组总有效率均高于激光组（Z=4.336，5.741，P<0.05）;三组患者治疗后丘疹/脓疱、毛细血管扩张及鼻赘评分均低于治疗前（P<0.05）;治疗后，观察组和对照组比较差异无统计学意义（P>0.05）;治疗后，观察组和对照组丘疹/脓疱、毛细血管扩张及鼻赘评分均低于激光组，差异具有统计学意义（P<0.05）;治疗期间，观察组不良反应发生率低于对照组和激光组，差异具有统计学意义（χ2=5.655，P=0.019）。结论：与常规剂量相比，极低剂量的异维A酸联合脉冲染料激光治疗中重度酒渣鼻也能获得较好的疗效，能够明显改善面部皮损评分，且安全性高，值得临床医生借鉴应用。

[关键词]异维A酸;脉冲染料激光;酒渣鼻;临床疗效

[中图分类号]R758.73+4    [文献标志码]A    [文章编号]1008-6455（2021）01-0073-04

Efficacy and Safety of Different Doses of Isotretinoin Combined with Pulsed Dye Laser in the Treatment of Rosacea

XU Xiao-jing，ZHU Yuan-jie

（Department of Dermatology，Changzheng Hospital，Naval Medical University，Shanghai 200003，China）

Abstract： Objective  To explore the efficacy and safety of different doses of isotretinoin combined with pulsed dye laser in the treatment of rosacea. Methods 150 patients with stage II and III rosacea admitted to the Department of Dermatology， Changzheng Hospital， Naval Medical University from October 2016 to January 2019 were included. They were divided into observation group， control group and laser group according to random number table method. 50 cases each group， The patients in all three groups were given pulsed dye laser irradiation treatment， the observation group was given isotretinoin at a starting dose of 20 mg / day， and the weekly dose was reduced by 5 mg per day. After 3 weeks， it was reduced to 5 mg / day orally and maintained; the control group 15mg / d isotretinoin treatment was given and maintained， the laser group was given pulse dye laser treatment only，all three patients were treated continuously for 8 weeks.Observe the clinical efficacy， skin lesion scores and adverse reactions of the three groups before and after treatment. Results  The total clinical effective rate of the observation group was 90.00%， and the total effective rate of the control group was 92.00%， the difference was not statistically significant （Z=0.122， P=0.727）， but the total effective rate of the observation group and the control group was higher than that of the laser group （Z=4.336， 5.741， P<0.05）.After treatment， the scores of papules / pustules， telangiectasia and nasal folds were lower than those before treatment （P<0.05）， there was no statistically significant difference between the observation group and the control group after treatment （P>0.05）， observation after treatment The scores of papules / pustules， telangiectasia and nasal tagging in the group and the control group were lower than those in the laser group， the difference was statistically significant （P<0.05）.During treatment， the incidence of adverse reactions in the observation group was lower than that in the control group and the laser group， and the difference was statistically significant （χ2=5.655， P=0.019）. Conclusion  Compared with conventional doses， very low doses of isotretinoin combined with pulsed dye laser treatment can also achieve better curative effects and high safety， which is worthy of reference by clinicians.

Key words： isotretinoin; pulsed dye laser; rosacea; clinical efficacy

酒渣鼻又称“玫瑰痤疮”，是一种好发于颜面部的慢性炎症性疾病，主要累及颜面部的毛细血管和毛囊皮脂腺，临床表现为皮肤弥漫性红斑、丘疹脓疱、毛细血管扩张等。流行病学调查显示[1]，全世界酒渣鼻发病率5.0%～12.3%，西方国家发病率稍高。由于酒渣鼻严重影响患者面部美观度，给患者的生活及心理带来了极大困扰，严重者可导致抑郁、焦虑的发生[2]。目前，关于酒渣鼻的发病机制研究尚不明确，现有研究表明[3]，该病可能具有一定遗传倾向，且是由多种因素诱导的以免疫功能异常和血管舒缩功能障碍为主导的慢性炎症性疾病。……