熊友华 邓映 杨洪秋 杜宇

[摘要]目的：探究Q开关1 064nm Nd：YAG激光联合纳晶微针治疗黄褐斑的疗效及安全性。方法：选取2017年9月-2019年9月于笔者科室就诊的86例黄褐斑患者，随机分为治疗组（n=43）和对照组（n=43）。治疗组：采用Q开关1 064nm Nd：YAG激光联合纳晶微针导入氨甲环酸注射液治疗;对照组：采用Q开关1 064nm Nd：YAG激光治疗，每次治疗间隔2周，4次为1个疗程，两组均治疗2个疗程。治疗结束后比较两组MASI评分、临床疗效、满意度及不良反应发生率，随访12周观察复发率。结果：治疗组MASI评分降低、有效率以及满意度均高于对照组，治疗组不良反应发生率、复发率均低于对照组，差异具有统计学意义（P<0.05）。结论：Q开关1 064nm Nd：YAG激光联合纳晶微针导入氨甲环酸治疗黄褐斑较单独使用激光治疗效果好，不良反应发生率低，患者满意度高，值得临床推广应用。

[关键词]黄褐斑;Q开关1 064nm Nd：YAG激光;纳晶针;氨甲环酸;联合治疗

[中图分类号]R758.4    [文献标志码]A    [文章编号]1008-6455（2021）04-0022-04

Clinical Observation on the Treatment of Melasma with Q-switch 1 064nm Nd：YAG Laser and Nanocrystal Microneedle

XIONG You-hua，DENG Ying，YANG Hong-qiu，DU Yu

（Medical Cosmetology Center，Affiliated Hospital of Traditional Chinese Medicine，Southwest Medical University，Luzhou 646000，Sichuan，China）

Abstract：Objective To investigate the effects and safety of Q-switch 1 064nm Nd：YAG laser combined with nanocrystal microneedle in treatment with melasma. Methods 86 patients with melasma in our hospital from September 2017 to September 2019 were selected and randomly divided into treatment group （n=43） and control group （n=43）. The control group were applied Q-switch 1 064nm Nd：YAG laser， and the treatment group were applied Q-switch 1 064nm Nd：YAG laser combined with nanocrystal microneedle. nanocrystals were used to assist transdermal administration of tranexamic acid injection. Each treatment interval was 2 weeks， 4 times as a course of treatment， and the two groups were applied for 2 courses. The MASI scores， clinical efficacy， patient satisfaction and the incidence of adverse reactions were compared between the two groups， and follow up for 12 weeks to observed the recurrence rate after treatment. Results The decrease of MASI scores， effective rate and satisfaction in the treatment group were all higher than those in the control group， while the incidence and recurrence rates of the adverse reactions were lower than the control group. The difference was statistically significant （P<0.05）. Conclusion Q-switched 1 064nm Nd：YAG laser combined with nanocrystal microneedle infusion of tranexamic acid in the treatment of melasma was more effective than laser treatment only，with less adverse reactions， and the patients satisfaction was higher，and was worthy of clinical promotion and application.

Key words：melasma;Q-switch 1064nm Nd：YAG  laser;nanoneedle; tranexamic acid; combined therapy

黃褐斑是一种获得性、慢性损容性皮肤疾病，具有难根治、易复发的特点，常见于育龄期女性，表现为边界清楚、面积大小不一的淡褐色至深褐色斑片，一般对称性分布于前额、面颊、鼻梁及口周等部位，无自觉症状，俗称为“蝴蝶斑”[1]。其常见诱因包括妊娠、口服避孕药、日光照射、某些药物的光毒性、内分泌失调及心理压力等，目前常用的临床治疗手段包括系统口服药物、局部外用药物、光电治疗、化学换肤及中医中药等[2]。大量临床实验证实，Q开关1 064nm激光及氨甲环酸治疗黄褐斑有效[3-6]。为探寻一种更有效、安全的治疗方案，本研究运用Q开关1 064nm Nd：YAG激光联合纳晶微针导入氨甲环酸治疗黄褐斑，并评估其疗效、患者满意度、不良反应及疾病复发率，现将结果报道如下。……