A型肉毒素联合疗法治疗瘢痕疙瘩临床疗效和不良反应评价

doi:10.13481/j.1671-587x.20170234

吉林大学学报(医学版) ›› 2017, Vol. 43 ›› Issue (02): 386-390.doi: 10.13481/j.1671-587x.20170234

A型肉毒素联合疗法治疗瘢痕疙瘩临床疗效和不良反应评价

周明伟¹, 王连有², 姜日花¹, 朱明姬¹, 陈凤¹

1. 吉林大学中日联谊医院皮肤科, 吉林长春 130033;
2. 吉林大学中日联谊医院病理科, 吉林长春 130033

收稿日期:2016-12-23 出版日期:2017-03-28 发布日期:2017-03-31
通讯作者: 朱明姬,教授,硕士研究生导师(Tel:0431-84995523,E-mail:zhumingji33@163.com);陈凤,主治医师(Tel:0431-84995523,E-mail:chenfengdoctor@163.com) E-mail:zhumingji33@163.com;chenfengdoctor@163.com
作者简介:周明伟(1983-),女,吉林省长春市人,主治医师,在读医学博士,主要从事瘢痕及皮肤肿瘤诊治方面的研究。
基金资助:
吉林省科技厅科研基金资助课题（20150101166JC，20140414032GH，20170414056GH）

Evaluation on efficacy and adverse reactions of combined therapy with botulinum toxin type A in treatment of keloid

ZHOU Mingwei¹, WANG Lianyou², JIANG Rihua¹, ZHU Mingji¹, CHEN Feng¹

1. Department of Dermatology, China-Japan Union Hospital, Jilin University, Changchun 130033, China;
2. Department of Pathology, China-Japan Union Hospital, Jilin University, Changchun 130033, China

Received:2016-12-23 Online:2017-03-28 Published:2017-03-31

摘要/Abstract

摘要： 目的：比较A型肉毒素联合得宝松局部注射及透明质酸外用与单纯得宝松局部注射及透明质酸外用对瘢痕疙瘩的疗效及不良反应。方法：选取瘢痕疙瘩患者58例，分为A型肉毒素联合得宝松（复方倍他米松注射液）局部注射及透明质酸外用组（联合治疗组）28例和单纯得宝松局部注射及透明质酸外用组（对照组）30例。2组患者均局部注射得宝松，每4 周1次，连续3 次，每日外用透明质酸。联合治疗组患者在第1次得宝松注射后皮损周边注射1次A型肉毒素。收集入组病例每次治疗前后参数数据、不良反应观察指标和每次治疗前后临床照片，并进行对比分析。结果：与对照组比较，3次治疗后联合治疗组患者皮损外观改善更好。对照组患者在治疗1个月时痛痒感的视觉模拟评分（VAS）下降，但在2和3个月时又逐渐上升；联合治疗组患者在治疗3个月内VAS 值逐渐下降，与对照组比较在2和3个月时VAS值差异有统计学意义（P<0.05）。治疗3个月内，联合治疗组患者皮损厚度逐渐下降，而对照组降低幅度不明显；治疗3个月时，联合治疗组患者疗效明显优于对照组（P<0.05）。对照组患者痛痒症状及皮损厚度在每次注射2周后出现反跳，而联合治疗组无反跳。对照组患者不良反应发生率为 26.7%，联合治疗组患者不良反应发生率为 25.0%，2组各项不良反应发生率比较差异无统计学意义（P>0.05）。结论：A型肉毒素联合得宝松局部注射及透明质酸外用治疗瘢痕疙瘩与单纯得宝松局部注射及透明质酸外用相比疗效更好，不良反应发生率无明显差异，值得临床上推广应用。

关键词: 疼痛测定, 瘢痕疙瘩, A型肉毒素, 倍他米松

Abstract: Objective: To compare the efficacy and adverse reactions between intralesional betamethasone injection combined with botulinum toxin type A and topical hyaluronic acid and simple intralesional betamethasone injection and topical hyaluronic acid in treatment of keloid. Methods: A total of 58 patients with keloid were divided into two groups:intralesional betamethasone injection combined with botulinum toxin type A and topical hyaluronic acid group (combined group, n=28) and intralesional betamethasone injection combined with topical hyaluronic acid group (control group, n=30). In both two groups, the intralesional betamethasone injection was given once every 4 weeks for 3 times totally, and topical hyaluronic acid was applied every day. In combined group, an injection of botulinum toxin type A was given around the lesion after the first intralesional injection of betamethasone. The parameters for therapeutic efficacy and adverse reactions of the patients in two groups were recorded, and the clinical pictures were taken before and after each treatment, and they were analyzed and compared. Results: After 3 treatments, compared with control group, the lesion appearance in combined group was improved. In control group, the VAS value was reduced at 1 month, but was increased gradually at 2 and 3 months. In combined group, the VAS value was reduced gradually in 3 months. There was a significant difference in VAS value at 2 and 3 months between two groups (P<0.05). In combined group, the thickness of keloids were reduced gradually in 3 months, while the reduction was not obvious in control group (P<0.05). The recurrence of pain, itching and lesion height were observed 2 weeks after each treatment in control group, but there was no recurrence in combined group. The incidence rate of adverse reactions was 26.7% in control group, which had no significant difference compared with combined group(25.0%) (P>0.05). Conclusion: Compared with control group, the combined group shows better efficiency in the treatment of keloid and there is no increase of adverse reactions. The therapy is worthy of clinical application.

Key words: keloid, botulinum toxin type A, betamethasone, pain measurement

中图分类号:

R622

周明伟, 王连有, 姜日花, 朱明姬, 陈凤. A型肉毒素联合疗法治疗瘢痕疙瘩临床疗效和不良反应评价[J]. 吉林大学学报(医学版), 2017, 43(02): 386-390.

ZHOU Mingwei, WANG Lianyou, JIANG Rihua, ZHU Mingji, CHEN Feng. Evaluation on efficacy and adverse reactions of combined therapy with botulinum toxin type A in treatment of keloid[J]. Journal of Jilin University Medicine Edition, 2017, 43(02): 386-390.

参考文献

[1] Al-Attar A, Mess S, Thomassen JM, et al.Keloid pathogenesis and treatment [J]. Plast Reconstr Surg, 2006, 117(1):286-300.
[2] Gassner HG, Brissett AE, Otley CC, et al. Botulinum toxin to improve facial wound healing:a prospective, blinded, placebo-controlled study [J]. Mayo Clin Proc, 2006, 81(8):1023-1028.
[3] Xiao Z, Zhang F, Cui Z. Treatment of hypertrophic scars with intralesional botulinum toxin type A injections:a preliminary report [J]. Aesthetic Plast Surg, 2009, 33(3):409-412.
[4] Haubner F, Leyh M, Ohmann E, et al. Effects of botulinum toxin A on patient-specific keloid fibroblasts in vitro [J]. Laryngoscope, 2014, 124(6):1344-1351.
[5] Darzi MA, Chowdri NA, Kaul SK, et al. Evaluation of various methods of treating keloids and hypertrophic scars:a 10-year follow-up study [J]. Br J Plast Surg, 1992, 45(5):374-379.
[6] 孙兵. 视觉模拟评分法 (VAS)[J]. 中华神经外科杂志, 2012, 28(6):645-645.
[7] 严广斌. 视觉模拟评分法 [J]. 中华关节外科杂志:电子版,2014,8(2):34.
[8] 吴晓琰,范红梅,陈晓栋,等. 无针注射器瘢痕疙瘩内注射糖皮质激素的疗效研究 [J]. 中华皮肤科杂志,2015,48(9):606-610.
[9] 高琳,殷荣,王媛丽,等. 肉毒毒素和透明质酸联合使用在面部年轻化处理中的应用 [J]. 中国美容医学,2016,25(4):94-97.
[10] Insalaco L, Saxon S, Spiegel JH. What is the role of intralesional corticosteroid injections for keloids before considering surgery? [J]. Laryngoscope, 2016, 126(3):549-550.
[11] 蔡景龙. 瘢痕疙瘩的诊疗指南建议 [J]. 中国美容医学,2016,25(6):38-40.
[12] 李荟元. 瘢痕的药物治疗进展 [J]. 中国临床康复,2002,6(8):1090-1092.
[13] 姜日花,白爽,戴跃,等. 瘢痕疙瘩的生物力学特性 [J]. 吉林大学学报:工学版, 2011,41(6):675-677.
[14] Ogawa R, Akaishi S, Huang C, et al. Clinical applications of basic research that shows reducing skin tension could prevent and treat abnormal scarring:the importance of fascial and flap surgery for keloid and hypertrophic scar reconstruction [J]. J Nihon Med Sch, 2011, 78(2):68-76.
[15] Lee BJ, Jeong JH, Wang SG, et al. Effect of botulinum toxin type a on a rat surgical wound model [J]. Clin Exp Otorhinolaryngol, 2009, 2(1):20-27.
[16] Viera MH, Amini S, Valins W, et al. Innovative therapies in the treatment of keloids and hypertrophic scars [J]. J Clin Aesthet Dermatol, 2010, 3(5):20-26.
[17] Xiao ZB,Zhang MB. Botulinum toxin type A affects cell cycle distribution of fibroblasts derived from hypertrophic scar [J]. J Plast Reconstr Aesthet Surg, 2008, 61(9):1128-1129.
[18] Xiao Z, Zhang F, Lin W, et al. Effect of botulinum toxin type A on transforming growth factor beta1 in fibroblasts derived from hypertrophic scar:a preliminary report [J]. Aesthetic Plast Surg, 2010, 34(4):424-427.
[19] Xiao ZB,Zhang MB. Intralesional botulinum toxin type A injection as a new treatment measure for keloids [J]. Plast Reconstr Surg, 2009, 124(5):275-277.
[20] Maderal AD, Tang JC, Vivas AC, et al. Hypertrophic scars and keloids, part 2:newer and investigational therapies [J]. Cosmet Dermatol, 2012, 25(8):373-379.
[21] Hochman B, Nahas FX, Sobral CS, et al. Nerve fibres:a possible role in keloid pathogenesis [J]. Br J Dermatol, 2008, 158(3):651-652.
[22] Lucioni A, Bales GT, Lotan TL, et al. Botulinum toxin type A inhibits sensory neuropeptide release in rat bladder models of acute injury and chronic inflammation [J]. BJU Int, 2008, 101(3):366-370.
[23] Wen WD, Yuan F, Wang JL, et al. Botulinum toxin therapy in the ovalbumin-sensitized rat [J]. Neuroimmunomodulation, 2007, 14(2):78-83.
[24] Trisliana PA, Lazzeri D, Su W, et al. Recent developments in the use of intralesional injections keloid treatment [J]. Arch Plast Surg, 2014, 41(6):620-629.

A型肉毒素联合疗法治疗瘢痕疙瘩临床疗效和不良反应评价

Evaluation on efficacy and adverse reactions of combined therapy with botulinum toxin type A in treatment of keloid

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