陈辛亮 李文志 董永

[摘要]目的：探討铒激光与E光联合重组人源Ⅲ型胶原蛋白治疗面部痤疮凹陷性瘢痕的疗效及对痤疮瘢痕权重评分（Echelle d'Evaluation Clinique des Cicatrices d'acne，ECCA）、p38丝裂原活化蛋白激酶（P38 mitogen activated protein kinase，p38MAPK）通路蛋白的影响。方法：选取笔者医院2018年1月-2019年12月面部痤疮凹陷性瘢痕患者195例，按照随机数字法分为3组，各65例。对照1组给予E光联合重组人源Ⅲ型胶原蛋白，对照2组给予铒激光联合重组人源Ⅲ型胶原蛋白，研究组给予铒激光与E光联合重组人源Ⅲ型胶原蛋白。比较三组治疗效果、治疗前后温哥华瘢痕量表（Vancouver scar scale，VSS）变化情况、ECCA评分、视觉模拟评分（Visual analogue scale，VAS）、血清p38MAPK通路蛋白（ERK1、ERK2、MEK1、MEK2）、炎性因子[肿瘤坏死因子-α（Tumor necrosis factor-α，TNF-α）、白细胞介素-6（Interleukin-6，IL-6）、C反应蛋白（C-reactive protein，CRP）]及患者满意度。结果：研究组总有效率（95.38%）高于对照1组（81.54%）、对照2组（84.62%），差异有统计学意义（P<0.05）。治疗结束后三组瘢痕厚度、血管分布、色泽、柔软度评分、ECCA、VAS评分低于治疗前，研究组低于对照1组、对照2组，差异有统计学意义（P<0.05）。治疗结束后三组血清MEK1、MEK2、ERK1、ERK2、TNF-α、IL-6、CRP低于治疗前，研究组低于对照1组、对照2组，差异有统计学意义（P<0.05）。研究组患者满意度（93.85%）高于对照1组（80.00%）、对照2组（80.00%），差异有统计学意义（P<0.05）。结论：联合采取铒激光、E光、重组人源Ⅲ型胶原蛋白治疗面部痤疮凹陷性瘢痕效果显著，且患者满意度较高。

[关键词]铒激光;E光;重组人源Ⅲ型胶原蛋白;痤疮;凹陷性瘢痕;面部;ECCA评分;p38MAPK通路蛋白

[中图分类号]R758.73+3    [文献标志码]A    [文章编号]1008-6455（2021）06-0030-06

Efficacy of Erbium Laser and E-light Combined with Recombinant Human Collagen Type Ⅲ in the Treatment of Depressed Facial Acne Scars

and p38MAPK Pathway Protein

CHEN Xin-liang，LI Wen-zhi，DONG Yong

（Department of Plastic Surgery，Anzhen Hospital，Capital Medical University，Beijing 100029，China）

Abstract： Objective  To investigate the effect of erbium laser and E-light combined with recombinant human collagen type Ⅲ in the treatment of depressed facial acne scars and the effect on Echelle d'Evaluation Clinique des Cicatrices d'acne （ECCA） and P38 mitogen activated protein kinase （p38MAPK） pathway protein. Methods  From January 2018 to December 2019， 195 patients with depressed facial acne scars in our hospital were selected and divided into 3 groups according to the random number method， with 65 cases in each group. The control group 1 was given E-light combined with recombinant human collagen type Ⅲ， the control group 2 was given erbium laser combined with recombinant human collagen type Ⅲ， and the study group was given erbium laser and E light combined with recombinant human collagen type Ⅲ. The treatment effects， changes of Vancouver scar scale （VSS）， ECCA score， Visual analogue scale （VAS） score， and serum p38MAPK pathway proteins （ERK1， ERK2， MEK1， MEK2）， inflammatory factors [tumor necrosis factor-α （TNF-α）， interleukin-6 （IL-6）， C-reactive protein （CRP）] before and after treatment and the degree of patient satisfaction were compared among the three groups. Results  The total effective rate （95.38%） of the study group was higher than that of the control group 1 （81.54%） and the control group 2 （84.62%）， the differences were statistically significant （P<0.05）. After the treatment， the thickness， blood vessel distribution， color， softness score， ECCA， and VAS scores of the scars in the three groups were lower than before the treatment， and the study group were lower than the control group 1 and the control group 2 （P<0.05）. After treatment， serum MEK1， MEK2， ERK1， ERK2， TNF-α， IL-6， CRP in the three groups were lower than before treatment， and the study group were lower than the control group 1 and thecontrol group 2 （P<0.05）. The satisfaction degree of patients in the study group （93.85%） was higher than that of the control group 1 （80.00%） and the control group 2 （80.00%）， the differences were statistically significant（P<0.05）. Conclusion  The combined use of erbium laser， E-light， and recombinant human collagen type Ⅲ is effective in treating depressed facial acne scars， and the patients are satisfied with it.

Key words： erbium laser; E-light; recombinant human collagen type Ⅲ; acne; depressed scar; facial; ECCA score; p38MAPK pathway protein

痤疮为毛囊皮脂腺慢性炎症性病症，其在青春期后一般可痊愈或减轻，但若痤疮较严重或治疗不及时，则会遗留凹陷性瘢痕，对患者造成了极大困扰[1-3]。同時，当前临床治疗面部痤疮凹陷性瘢痕的措施较多，但不良反应严重及恢复时间较长，极易增大患者心理压力，因此如何对其进行安全有效治疗成为研究热点[4-6]。重组人源Ⅲ型胶原蛋白及激光治疗在面部痤疮凹陷性瘢痕中具有重要作用，前者可促使创面自身水溶性清创，减少积液，吸收渗出物，促进创面愈合。激光治疗包括铒激光、E光等，其作用于皮肤组织可刺激胶原蛋白增生，促进肌肤伤口迅速愈合，在疾病治疗中发挥了重要作用[7-9]。……