毛囊单位提取移植术联合重组牛碱性成纤维细胞生长因子以及米诺地尔治疗继发性瘢痕秃发的临床效果

杨青; 薛萍; 窦文婕; 樊星; 宋保强

doi:10.3760/cma.j.cn501120-20210416-00132

毛囊单位提取移植术联合重组牛碱性成纤维细胞生长因子以及米诺地尔治疗继发性瘢痕秃发的临床效果

doi: 10.3760/cma.j.cn501120-20210416-00132

空军军医大学第一附属医院整形外科，西安　　710032

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薛萍，Email：psdtwen@163.com

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出版历程
- 收稿日期: 2021-04-16

Clinical effects of follicle unit extraction transplantation combined with recombinant bovine basic fibroblast growth factor and minoxidil in the treatment of secondary cicatricial alopecia

Department of Plastic and Reconstructive Surgery, the First Affiliated Hospital of Air Force Medical University, Xi′an 710032, China

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Corresponding author: Xue Ping, Email: psdtwen@163.com

摘要

摘要: 目的探讨毛囊单位提取（FUE）移植术联合重组牛碱性成纤维细胞生长因子（rb-bFGF）凝胶和米诺地尔酊剂治疗继发性瘢痕秃发（下称瘢痕秃发）的临床效果。方法采用回顾性观察性研究方法。根据不同治疗方法，将空军军医大学第一附属医院2013年3月—2017年4月接诊的符合人选标准的仅行FUE移植术的瘢痕秃发患者50例［男26例、女24例，年龄（28±13）岁］纳入单纯FUE组，将该单位2017年5月—2020年4月接诊的符合人选标准的行FUE移植术后1~14 d使用rb-bFGF凝胶+术后15~180 d使用米诺地尔酊剂的瘢痕秃发患者50例［男32例、女18例，年龄（27±9）岁］纳入FUE+rb-bFGF+米诺地尔组。观察并计算2组患者术后3、6个月的脱发率，术后12个月的毛发成活率和患者满意率，术后12个月内的不良反应发生率。对数据行χ²检验、Fisher确切概率法检验、独立样本t检验。结果术后3、6个月，单纯FUE组患者脱发率均明显高于FUE+rb-bFGF+米诺地尔组（t=70.850、42.610，P<0.01）。术后12个月，FUE+rb-bFGF+米诺地尔组患者毛发成活率为（91.0±2.8）%，明显高于单纯FUE组的（80.9±6.9）%（t=9.665，P<0.01）。术后12个月，单纯FUE组患者中非常满意者25例、相当满意者12例、稍微满意者10例、不满意者2例、非常不满意者1例，FUE+rb-bFGF+米诺地尔组患者中非常满意者42例、相当满意者5例、稍微满意者3例；单纯FUE组患者满意率为74%（37/50），明显低于FUE+rb-bFGF+米诺地尔组的94%（47/50），P<0.01。术后12个月内，与FUE+rb-bFGF+米诺地尔组比较，单纯FUE组患者移植区毛囊炎、毛发方向异常、皮肤坏死发生率无明显变化（P>0.05），供区瘢痕发生率明显升高（P<0.05）。结论与单独行FUE移植术相比，FUE移植术联合rb-bFGF及米诺地尔外用能降低瘢痕秃发患者FUE移植术后脱发率，提高术后毛发成活率及患者满意率，且不良反应少，利于瘢痕秃发的治疗。
- 瘢痕 /
- 秃发 /
- 米诺地尔 /
- 毛囊单位提取 /
- 牛碱性成纤维细胞生长因子
Abstract: Objective To explore the clinical effects of follicle unit extraction (FUE) transplantation combined with recombinant bovine basic fibroblast growth factor (rb-bFGF) gel and minoxidil tincture in treating secondary cicatricial alopecia (hereinafter referred to as cicatricial alopecia). Methods A retrospective observational study was conducted. According to the different treatment methods, 50 cicatricial alopecia patients who met the inclusion criteria and only underwent FUE transplantation in the First Affiliated Hospital of Air Force Medical University from March 2013 to April 2017 were recruited into FUE alone group (26 males and 24 females, aged (28±13) years), and 50 cicatricial alopecia patients who met the inclusion criteria and underwent FUE transplantation+rb-bFGF gel during 1 to 14 days after surgery+minoxidil tincture during 15 to 180 days after surgery in this hospital from May 2017 to April 2020 were recruited into FUE+rb-bFGF+minoxidil group (32 males and 18 females, aged (27±9) years). Hair loss rates in post surgery month (PSM) 3 and 6, hair survival rates and satisfaction rates of patients in PSM 12, and the adverse effect rates of patients in the 2 groups within PSM 12 were observed and calculated. Data were statistically analyzed with chi-square test, Fisher's exact probability test, and independent sample t test. Results In PSM 3 and 6, the hair loss rates of patients in FUE alone group were significantly higher than those in FUE+rb-bFGF+minoxidil group, respectively (t=70.850, 42.610, P<0.01). In PSM 12, the hair survival rate of patients in FUE+rb-bFGF+minoxidil group was (91.0±2.8)%, which was significantly higher than (80.9±6.9)% in FUE alone group (t=9.665, P<0.01). In PSM 12, 25 patients were very satisfied, 12 patients were fairly satisfied, 10 patients were slightly satisfied, 2 patients were not satisfied, and 1 patient was very unsatisfied in FUE alone group; 42 patients were very satisfied, 5 patients were fairly satisfied, and 3 patients were slightly satisfied in FUE+rb-bFGF+minoxidil group. The satisfaction rate of patients in FUE alone group was 74% (37/50), which was significantly lower than 94% (47/50) in FUE+rb-bFGF+minoxidil group (P<0.01). Within PSM 12, compared with those in FUE+rb-bFGF+minoxidil group, the incidence rates of folliculitis, abnormal growth direction, and skin necrosis in transplant site were not obviously changed in FUE alone group (P>0.05), while the incidence of scar in donor site was significantly higher (P<0.05). Conclusions Compared with FUE transplantation alone, FUE transplantation combined with rb-bFGF and minoxidil can reduce the hair loss rate, improve the hair survival rate and the satisfaction rate of patients with cicatricial alopecia after FUE transplantation, with less adverse effects, thus are good for cicatricial alopecia treatment.
- Cicatrix /
- Alopecia /
- Minoxidil /
- Follicle unit extraction /
- Recombinant bovine basic fibroblast growth factor
所有作者均声明不存在利益冲突

据报道，烧伤后出现增生性瘢痕的概率高达70%，这些瘢痕在外观上是不美观的，并伴有瘙痒、疼痛和活动受限等症状，影响患者生活质量。这种瘢痕被认为是由创伤后正常伤口愈合失调引起的，手术切除和挛缩释放仍然是重要的矫正疗法，然而，复发风险很高；非手术干预经常在手术干预之前进行，以抑制或减缓瘢痕的发展；非手术干预措施包括穿戴压力衣、应用硅凝胶片、瘢痕内注射、冷冻治疗、放射治疗、激光和光疗法等，其中激光和光疗法是一种微创的、低风险的疗法，术后恢复期短。

激光治疗增生性瘢痕的选择性光热解原理如下：（1）适当的波长、照射时间和能量集中在靶组织上使组织吸收激光能量，从而产生光化学反应或加热。（2）在不同的温度范围内，组织内发生不同的生理变化，60~70 ℃时，胶原蛋白和其他结构性蛋白变性；70~80 ℃时，细胞膜渗透压增加，核酸变性；70~100 ℃时，通过关闭血管和使血浆蛋白变性而导致凝固性坏死；超过100 ℃，组织水汽化，导致物理分离或消融。选择性的性质依赖于以下原则：与周围组织相比，瘢痕组织在某一特定波长时光吸收能力更强。激光的范围包括从可见光光谱上波长较短的磷酸钛钾到红外光光谱上波长较长的二氧化碳。根据不同的波长，激光能量被皮肤中的血红蛋白、氧血红蛋白、黑色素、水或胶原蛋白吸收，产生热量，选择性地作用于毛细血管、色素沉着和瘢痕组织。

约翰-霍普金斯大学医学院整形与重建外科系Kevin M. Klifto教授团队在《Burns & Trauma》发文《Laser management of hypertrophic burn scars: a comprehensive review》，该研究介绍增生性瘢痕往往是在烧伤有关的伤害后形成的。这些瘢痕在外观上可能影响美观，而相关的瘙痒、疼痛和运动范围受限等症状会影响患者的生活质量。随着激光技术的发展和应用，研究表明激光治疗可以降低瘢痕厚度，减轻神经性疼痛，减少手术切除的需要，改善瘢痕的色素沉着、红斑、柔韧度、质地、厚度和瘙痒感。这篇综述着重介绍了激光治疗烧伤后增生性瘢痕的演变，不同类型的激光如何发挥作用、适应证、围手术期的应用和实践应用的指南。

樊拂晓，编译自《Burns Trauma》，2020,8:tkz002；徐庆连，审校

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1 单纯毛囊单位提取移植术治疗例1患者额、顶、左颞部热液烫伤后继发性瘢痕秃发的效果。1A.术前，萎缩性瘢痕伴秃发；1B.术后1 d，局部血痂明显；1C.术后6个月，秃发较前明显改善，未见任何不良反应

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2 毛囊单位提取移植+重组牛碱性成纤维细胞生长因子+米诺地尔联合治疗例2患者额、顶部热液烫伤后继发性瘢痕秃发的效果。2A.术前，萎缩性瘢痕伴秃发；2B.术后7 d，局部痂皮基本脱落；2C.术后6个月，移植区新生毛发遮盖头皮、瘢痕区域头皮色泽正常，未见任何不良反应

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3 单纯毛囊单位提取移植术治疗例3患者额部烫伤后继发性瘢痕秃发的供区不良反应情况。3A.术后3个月正后位，可见枕部供区密集点状低色素瘢痕；3B.术后6个月正后位，可见枕部供区新生毛发密度均匀，未见明显瘢痕；3C.术后6个月低头位，可见点状低色素瘢痕变模糊

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表1 2组继发性瘢痕秃发患者的临床资料比较

组别	例数	性别（例）		年龄（岁，x¯±s）	受伤原因（例）		秃发面积（cm²，x¯±s）	秃发时间（年，x¯±s）
组别	例数	男	女	年龄（岁，x¯±s）	热液烫伤	其他	秃发面积（cm²，x¯±s）	秃发时间（年，x¯±s）
单纯FUE组	50	26	24	28±13	34	16	15±11	14±11
FUE+rb-bFGF+米诺地尔组	50	32	18	27±9	35	15	11±11	16±11
统计量值		χ²=1.478		t=0.422	χ²=0.047		t=1.882	t=1.072
P值		0.224		0.674	0.829		0.063	0.286
注：FUE为毛囊单位提取，rb-bFGF为重组牛碱性成纤维细胞生长因子；其他为化学烧伤、手术

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表2 2组继发性瘢痕秃发患者FUE移植术后各时间点脱发率比较（%，x¯±s）

组别	例数	3个月	6个月
单纯FUE组	50	67.5±2.8	34.1±2.4
FUE+rb-bFGF+米诺地尔组	50	33.9±1.8	14.6±2.2
t值		70.850	42.610
P值		<0.001	<0.001
注：FUE为毛囊单位提取，rb-bFGF为重组牛碱性成纤维细胞生长因子

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表3 2组继发性瘢痕秃发患者FUE移植术后12个月内的不良反应发生情况比较［例（%）］

组别	例数	移植区			供区
组别	例数	毛囊炎	毛发方向异常	皮肤坏死	点状低色素瘢痕
单纯FUE组	50	2（4）	4（8）	1（2）	8（16）
FUE+rb-bFGF+ 米诺地尔组	50	0	2（4）	0	1（2）
P值		0.495	0.678	>0.999	0.031
注：FUE为毛囊单位提取，rb-bFGF为重组牛碱性成纤维细胞生长因子

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