Prospective randomized controlled trial on 2 940 nm fractional erbium laser combined with fractional micro-plasma radiofrequency in the treatment of facial atrophic acne scars
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摘要:
目的 比较2 940 nm点阵铒激光联合点阵微等离子体射频（FMR）疗法与2 940 nm点阵铒激光治疗萎缩性痤疮瘢痕的疗效及安全性。 方法 采用前瞻性随机对照研究方法。招募2018年3月—2021年3月就诊于上海交通大学医学院附属第九人民医院整复外科瘢痕激光门诊的符合入选标准的萎缩性痤疮瘢痕患者100例（男38例、女62例，年龄18~37岁），随机分为铒激光+FMR组及单纯铒激光组，每组50例。单纯铒激光组患者面部痤疮瘢痕采用2 940 nm点阵铒激光进行治疗，铒激光+FMR组患者面部痤疮瘢痕除同前采用铒激光治疗外，还对U、M型瘢痕予FMR治疗，每3个月治疗1次，共治疗3次。首次治疗前及每次治疗后3个月，采用痤疮瘢痕临床评分量表（ECCA）进行瘢痕评分；观察并记录治疗过程中不良反应发生情况并计算发生率。末次治疗后3个月，采用5级分类法评价患者对治疗效果的满意情况并计算满意率。对数据行独立样本 t检验、 χ 2检验。 结果 最终89例患者完成试验，其中铒激光+FMR组46例［男19例、女27例，年龄（26±5）岁］、单纯铒激光组43例［男15例、女28例，年龄（27±6）岁］。2组患者首次治疗前及第1次治疗后3个月ECCA评分均相近（ P>0.05）。铒激光+FMR组患者第2、3次治疗后3个月ECCA评分分别为（72±23）、（61±18）分，均明显低于单纯铒激光组的（85±26）、（76±25）分， t值分别为-2.45、-3.26， P<0.05。铒激光+FMR组和单纯铒激光组患者治疗过程中不良反应发生率分别为23.91%（11/46）、16.28%（7/43），组间比较差异无统计学意义（ P>0.05）。末次治疗后3个月，铒激光+FMR组患者对治疗效果的满意率为78.26%（36/46），明显高于单纯铒激光组的53.49%（23/43）， χ 2=6.10 ，P<0.05。 结论 2 940 nm点阵铒激光联合FMR治疗面部萎缩性痤疮瘢痕的疗效显著优于单纯2 940 nm点阵铒激光，且不会显著增加不良反应的发生率，患者对治疗效果的满意度更高，可作为推荐疗法应用于临床。 Abstract:Objective To compare the efficacy and safety of 2 940 nm fractional erbium laser combined with fractional micro-plasma radiofrequency (FMR) therapy and 2 940 nm fractional erbium laser in the treatment of atrophic acne scars. Methods A prospective randomized controlled research was conducted. A total of 100 atrophic acne scar patients (38 males and 62 females, aged 18-37 years) who were treated in the Scar Laser Clinic of the Department of Plastic and Reconstructive Surgery of Shanghai Ninth People's Hospital of Shanghai Jiao Tong University School of Medicine from March 2018 to March 2021 and conformed to the inclusion criteria were recruited. The patients were randomly divided into erbium laser+FMR group and erbium laser alone group, with 50 cases in each group. The facial acne scars of patients in erbium laser alone group were treated with 2 940 nm fractional erbium laser, while the facial acne scars of patients in erbium laser+FMR group were treated with erbium laser as above, besides, the scars of U and M types were treated with FMR, once every 3 months for a total of 3 times. Before the first treatment and 3 months after each treatment, the Echelle D'Assessment Clinique des Cicatrices D'Acne (ECCA) was used to score the scar. The occurrence of adverse reaction during the treatment process was observed and recorded, and the incidence was calculated. Three months after the last treatment, the 5-level classification method was used to evaluate the satisfaction of patients with the treatment effect, and the satisfaction rate was calculated. Data were statistically analyzed with independent sample t test and chi-square test. Results A total of 89 patients completed the study, including 46 patients in erbium laser+FMR group (19 males and 27 females, aged (26±5) years) and 43 patients in erbium laser alone group (15 males and 28 females, aged (27±6) years). The ECCA scores before the first treatment and 3 months after the first treatment of patients were similar between the two groups ( P>0.05). The ECCA scores of patients in erbium laser+FMR group at 3 months after the second and third treatment were 72±23 and 61±18, respectively, which were significantly lower than 85±26 and 76±25 in erbium laser alone group (with t values of -2.45 and -3.26, respectively, P<0.05). During the treatment process, the incidence of adverse reaction of patients in erbium laser+FMR group and erbium laser alone group were 23.91% (11/46) and 16.28% (7/43), respectively, and there was no statistically significant difference between the two groups ( P>0.05). The satisfaction rate of patients in erbium laser+FMR group was 78.26% (36/46) at 3 months after the last treatment, which was significantly higher than 53.49% (23/43) in erbium laser alone group ( χ 2=6.10, P<0.05). Conclusions The 2 940 nm fractional erbium laser combined with FMR is superior to 2 940 nm fractional erbium laser alone in the treatment of facial atrophic acne scars, achieving significantly higher efficacy without significantly increasing the incidence of adverse reaction, and patients are more satisfied with the efficacy. It can be used as a recommended therapy in clinical practice. -
Key words:
- Cicatrix /
- Laser therapy /
- Acne vulgaris /
- Erbium laser /
- Micro-plasma radiofrequency
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参考文献
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1 2 940 nm点阵铒激光+点阵微等离子体射频（FMR）治疗面部萎缩性痤疮瘢痕的效果。1A.治疗前右侧面部存在大量萎缩性痤疮瘢痕（V、U、M型均存在），边缘锐利、深度深；1B.第1次治疗后3个月，右侧颞部、颧部瘢痕U、M型瘢痕深度变浅、边缘已模糊不清，颊部、鼻翼及上唇处V型瘢痕深度变浅；1C.第2次治疗后3个月，各区域瘢痕的深度及边缘锐利程度较图1B进一步改善；1D.第3次治疗后3个月，右侧面部大多数区域的萎缩性痤疮瘢痕的深度和边缘锐利程度已得到改善，仅鼻翼及上唇处散在个别明显的V型瘢痕
表1 萎缩性痤疮瘢痕ECCA权重评分标准（分）
瘢痕类型 权重分值（a值） 半定量分值（b值） 总分值（a值×b值） V型瘢痕 15 0~3 0~45 U型瘢痕 20 0~3 0~60 M型瘢痕 25 0~3 0~75 表浅萎缩性瘢痕（弹性纤维崩解） 30 0~3 0~90 总分 — — 0~270 注：该表引自文献[ 7]；ECCA为痤疮瘢痕临床评分量表；b值中无瘢痕为0分，少量瘢痕（瘢痕数≤5个）为1分，有限数量瘢痕（5个<瘢痕数≤20个）为2分，大量瘢痕（瘢痕数>20个）为3分；“—”表示无此项 
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表2 2组面部萎缩性痤疮瘢痕患者一般资料比较
组别 例数 性别（例） 年龄（岁， 病程（年， 男 女 铒激光+FMR组 46 19 27 26±5 9±5 单纯铒激光组 43 15 28 27±6 11±4 t值 — 0.79 0.58 χ 2值 0.39 — — P值 0.533 0.430 0.150 注：2组患者均在瘢痕区域全范围行2 940 nm点阵铒激光，铒激光+点阵微等离子体射频（FMR）组患者另于U、M型瘢痕处予FMR治疗；“—”表示无此统计量值
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表3 2组面部萎缩性痤疮瘢痕患者首次治疗前及每次治疗后3个月ECCA评分比较（分，
组别 例数 首次治疗前 第1次治疗后 第2次治疗后 第3次治疗后 铒激光+FMR组 46 130±36 94±25 72±23 61±18 单纯铒激光组 43 115±35 98±30 85±26 76±25 t值 1.96 -0.68 -2.45 -3.26 P值 0.053 0.500 0.032 0.001 注：ECCA为痤疮瘢痕临床评分量表；2组患者均在瘢痕区域全范围行点阵2 940 nm铒激光，铒激光+点阵微等离子体射频（FMR）组患者另于U、M型瘢痕处予FMR治疗
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