低能量Q开关Nd:YAG激光对黄褐斑体表温度与黑素指数的影响(1)
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[摘要]目的：观察Q开关Nd:YAG激光治疗黄褐斑时皮肤体表的温度变化，探讨体表温度的改变与黑素指数的关系。方法：对22例黄褐斑患者使用Q开关Nd:YAG1064nm激光治疗，光斑直径6mm或8mm，能量密度2.0～3.3J/cm2，每周1次，12次为1个疗程。单次激光治疗前、治疗中、治疗后即刻用红外测温仪测量黄褐斑部位皮肤体表温度，并在治疗前、治疗6次、12次后使用皮肤多功能测试仪检测相应固定部位黑素指数。结果：黄褐斑皮损区单次治疗后双面颊体表温度高于治疗前，但与正常皮肤相比无差异；激光治疗6次、12次后黑素指数均显著性减少。结论：低能量Q开关Nd:YAG激光治疗黄褐斑后皮肤温度有一定程度升高，但并不引起明显光斑反应，治疗后黑素指数降低，表明温度并非导致激光光斑反应的唯一及主要因素，可能与Q开关激光激活黑素细胞内部的反应原件相关。
[关键词]黄褐斑；Q开关Nd:YAG激光；黑素指数；温度
[中图分类号]R758.4+2 [文献标识码]A [文章编号]1008-6455(2012)05-0793-03
Effect of melasma's temperature and melanin index treated by Q-switched laser
CAI Hong1, SONG Wei-min2, WANG Yi-xia1, JIN Xian-qiang2, SHEN Jing1, ZHENG Han2, ZHAO Guang1
(1.Department of Dermatology,The General Hospital of Air Force,Beijing 100141,China;2.Department of Dermatology,The Third People's Hospital of Hangzhou)
Abstract: Objective To investigate the effectiveness and temperature influences of 1064nm Q-switched neodymium-doped yttrium aluminum garnet (QS-Nd:YAG) laser treatment of melasma . Methods Twenty-two patients were treated with 1,064-nm QS-Nd:YAG laser, 6 or 8-mm spot size, 2.0- to 3.3-J/cm2 fluence for 12 sessions at 1-week intervals. The skin temperature and melanin index were evaluated by infrared thermometer and the skin multifunction ester at different time point,respectively. Results After 12 laser treatments, statistically significant improvement of melasma from baseline was observed.However,there was no significant difference in temperature between after treatment area and control area. Conclusion Nd:YAG laser treatment for melasma produced improvement and had temperature effects. But temperature was not the only reason for hypopigmentation and rebound hyperpigmentation.
Key words:Melasma;QS Nd:YAG laser;Melanin content index;temperature
激光对组织的影响包括光热作用、光机械效应、光化学效应和光生物学效应。目前，对Q开关Nd:YAG激光治疗色素增加性皮肤病机理的认识主要还是选择性光热作用理论的光致爆破效应[1]，而对Q开关Nd:YAG 激光照射可能存在的对人表皮黑素细胞生物学的影响却并不清楚。临床上用Nd:YAG 激光治疗黄褐斑时,有的患者出现色素加重及炎症后色素沉着(post inflammatory pigmentation，PIH)等副作用。因此，有学者提出激光治疗黄褐斑后产生的光热作用，可能会激活黑素细胞(melanocytes，MC)，产生“激光光斑反应”[2]。本文采用红外测温仪和皮肤多功能测试仪，初步观察Q开关Nd:YAG激光治疗黄褐斑的热效应，并分析体表温度的改变与黑素指数的关系。
1 临床资料
1.1 研究对象：选择黄褐斑患者22例，均为女性。年龄28～48岁，平均(38.45±5.16)岁。病程6月～14年，平均(6.13±4.35)年。
1.2 纳入和排除标准：纳入标准：①符合中国中西医结合学会皮肤性病专业委员会色素病学组2001年拟定的《黄褐斑的诊断和疗效标准》[3]；②治疗前3个月未接受过其他治疗 ......
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