A型肉毒毒素联合糖皮质激素治疗瘢痕疙瘩疗效观察
Investigation on Curative Effects of Botulinum Toxin Type A Combined with Glucocorticoid on Keloid
DOI: 10.12677/ACM.2023.13122873, PDF,    科研立项经费支持
作者: 吴 浩, 和晓蓉：青海大学附属医院皮肤病与性病科，青海 西宁
关键词: 瘢痕疙瘩；A型肉毒毒素；醋酸泼尼松龙；TGF-β1；Keloid； Botulinum Toxin Type A； Prednisolone Acetate； TGF-β1
摘要: 目的：研究注射用A型肉毒毒素联合醋酸泼尼松龙治疗瘢痕疙瘩的临床疗效及其对患者血清中TGF-β1含量的影响。方法：收集2020年1月~2022年12月就诊于青海大学附属医院符合瘢痕疙瘩诊断的86例患者为研究对象，将患者随机分为治疗组43例、对照组43例。治疗组给予A型肉毒毒素及醋酸泼尼松龙间隔两周交替使用，首次予注射A型肉毒毒素，共治疗6次；对照组给予单一醋酸泼尼松龙注射液局部病灶内注射治疗每两周一次，共6次。治疗前后通过温哥华瘢痕量表(VSS)、患者与观察者瘢痕评估量表(POSAS)比较两组患者的疗效，测患者治疗前后TGF-β1水平以及不良反应发生率，观察A型肉毒素联合糖皮质激素治疗瘢痕疙瘩的临床疗效。结果：治疗前治疗组及对照组患者一般资料及评价指标无统计学差异(P > 0.05)，有可比性；治疗组治疗后VSS及POSAS评分改善程度高于对照组，有统计学差异(P < 0.05)；治疗组在POSAS评分中瘙痒及疼痛得分改善明显高于对照组，有统计学差异(P < 0.05)；治疗后两组血清TGF-β1较前降低，治疗组降低程度高于对照组，有统计学差异(P < 0.05)。结论：1. A型肉毒毒素联合糖皮质激素治疗瘢痕疙瘩效果优于与单纯糖皮质激素治疗；联合治疗副作用更低，在缓解患者瘢痕疙瘩疼痛瘙痒方面尤其具优势。2. A型肉毒毒素联合糖皮质激素治疗后患者血清TGF-β1表达下调明显优于对照组，提示A型肉毒毒素可能通过TGF-β1相关信号通路，抑制瘢痕疙瘩的进展。
Abstract: Objective: To investigate the clinical efficacy of botulinum toxin type A for injection combined with prednisolone acetate in the treatment of keloid and its effect on serum TGF-β1 content of patients. Methods: A total of 86 patients with keloid diagnosis admitted to the Affiliated Hospital of Qinghai University from January 2020 to December 2022 were collected as the research subjects, and the patients were randomly divided into observation group (43 cases) and control group (43 cases). The observation group was given botulinum toxin type A and prednisol one acetate alternately at two-week intervals, and botulinum toxin type A was injected for the first time for a total of 6 treat-ments; The control group was given a single prednisolone acetate injection for local intralesional injection once every two weeks for a total of 6 times. Before and after treatment, the efficacy of the two groups of patients was compared through the Vancouver Scar Scale (VSS) and the Patient and Observer Scar Assessment Scale (POSAS), measuring the level of TGF-β1 before and after treatment and the incidence of adverse reactions, to compare the clinical efficacy of botulinum toxin type A combined with glucocorticoids in the treatment of keloids. Results: Before treatment, the observa-tion group and the control group had no statistical difference in general data and evaluation indi-cators (P > 0.05), and they were comparable; after treatment, the improvement of VSS and POSAS scores in the observation group was higher than that of the control group (P < 0.05); The improve-ment of itching and pain scores in the POSAS score of the observation group was significantly higher than that of the control group (P < 0.05); after treatment, the serum TGF-β1 of the two groups de-creased compared with before, and the degree of decrease in the observation group was higher than that of the treatment group. Conclusion: 1. Botulinum toxin type A combined with glucocorticoids is better than glucocorticoid therapy alone in the treatment of keloids. The combined treatment has lower side effects and is particularly advantageous in relieving the pain and itching of patients with keloids. 2. After treatment with botulinum toxin type A combined with glucocorticoids, serum TGF-β1 decreased more significantly. Botulinum toxin type A may inhibit keloids through TGF-β1 related signaling pathways.
文章引用：吴浩, 和晓蓉. A型肉毒毒素联合糖皮质激素治疗瘢痕疙瘩疗效观察[J]. 临床医学进展, 2023, 13(12): 20401-20410. https://doi.org/10.12677/ACM.2023.13122873

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