周玲 杨云 吴雨 雷淑英 陈昌望

[摘要]目的：探討点阵CO2激光联合积雪苷霜软膏对瘢痕疙瘩改善程度、胶原纤维及热休克蛋白47的影响。方法：选取2017年1月-2019年1月笔者医院收治的60例瘢痕疙瘩患者，采用随机数字表法分为实验组（n=31）和对照组（n=29）。对照组采用点阵CO2激光治疗，实验组在对照组的基础上给予积雪苷霜软膏治疗。对比两组患者在治疗前和治疗第1个、第2个疗程时瘢痕疙瘩改善程度、胶原纤维及热休克蛋白47的水平。对比两组患者治疗后临床疗效和不良反应。结果：治疗后，实验组在第1个疗程和第2个疗程VSS评分显著低于对照组（P<0.05）;实验组在第1个疗程和第2个疗程总胶原像素面积差显著低于对照组（P<0.05）;实验组在第1个疗程和第2个疗程热休克蛋白47显著低于对照组，差异具有统计学意义（P<0.05）;治疗后，实验组总有效率74.19%，显著高于对照组的48.27%（P<0.05）;实验组不良反应发生率35.48%，显著低于对照组的65.51%，差异具有统计学意义（P>0.05）。结论：点阵CO2激光联合积雪苷霜软膏可有效改善患者的瘢痕、胶原纤维和热休克蛋白47，疗效较好，能降低不良反应发生率。

[关键词]点阵CO2激光;积雪草;瘢痕疙瘩;疗效;胶原纤维

[中图分类号]R619+.6    [文献标志码]A    [文章编号]1008-6455（2021）06-0090-04

Clinical Observation of CO2 Dot Array Laser Combined with Centella Triterpenes Cream in Treating Keloid

ZHOU Ling1，YANG Yun1， WU Yu1，LEI Shu-ying1，CHEN Chang-wang2

（1.Department of Dermatology;2.Department of Gastrointestinal Surgery，Enshi Central Hospital， Enshi 445000，Hubei，China）

Abstract： Objective  To study the effects of fractional CO2 laser combined with Centella asiatica on keloids improvement， collagen fibers and heat shock protein 47. Methods Sixty patients with keloid admitted to our hospital from January 2017 to January 2019 were randomly divided into experimental group （n=31） and control group （n=29）. The experimental group was treated with Centella Triterpenes Cream on the basis of the control group， and the control group with fractional CO2 laser. The keloid improvement， collagen fibers， and heat shock protein 47 before treatment and during the first and second courses of treatment， the clinical efficacy and adverse reactions after treatment were compared. Results After treatment， the VSS scores of the experimental group in the first and second courses were significantly lower than those in the control group （P<0.05）.The difference between the total collagen pixel area of the experimental group in the first and second courses was significantly lower than that in the control group （P<0.05）. The difference in shock protein 47 between the first course and the second course of the experimental group was significantly lower than that of the control group， and the difference was statistically significant （P<0.05）. After treatment， the total effective rate of the experimental group was significantly higher than that of the control group （74.19%  vs. 48.27% ， P<0.05）. The adverse reaction rate of the experimental group was significantly lower than that of the control group （35.48% vs. 65.51%， P>0.05）. Conclusion  Fractional CO2 laser combined with Centellaasiatica can effectively improve keloid， collagen fibers and heat shock protein 47with good efficacy， which can reduce adverse reactions.

Key words： fractional CO2  laser;centellaasiatica; keloids; efficacy; collagen fiber

瘢痕疙瘩是因为皮肤伤口的愈合或者某些未知因素造成皮肤受损恢复后产生的生长异常的瘢痕组织[1]。点阵CO2激光是治疗瘢痕疙瘩的一种手段，可以改善患者的瘢痕状态，但会产生明显疼痛感、灼烧感和水疱等[2]。积雪苷霜软膏是一种从积雪草提炼而成的药物，可以起到消肿解毒、预防色素沉着，抑制纤维细胞增生的功效[3-4]。本研究选取笔者医院近年来收治的60例瘢痕疙瘩患者临床资料进行分析，探讨点阵CO2激光联合积雪苷霜软膏治疗瘢痕疙瘩的临床疗效，现将结果报道如下。

1  资料和方法

1.1 一般资料：选取2017年1月-2019年1月笔者医院收治的60例瘢痕疙瘩患者为研究对象，随机分为实验组和对照组，每组31例。……