Objective: To observe the effects of a combination treatment with narrow-spectrum intense pulsed light and fractional carbon dioxide laser on hypertrophic scar pruritus in clinic. Methods: A prospective randomized controlled study was conducted. A total of 90 patients with hypertrophic scars conforming to the inclusion criteria who were hospitalized in our ward from March to December 2017 were divided into combination treatment group and control group according to the random number table, with 45 patients in each group. For scar pruritus, patients in control group were treated twice by narrow-spectrum intense pulsed light with a one-month interval, while patients in combination treatment group were firstly treated by narrow-spectrum intense pulsed light combined with fractional carbon dioxide laser once, and with narrow-spectrum intense pulsed light once one month later. Before and 3 months after treatment, scar pruritus was evaluated by the Visual Analogue Scale and the Four-item Itch Questionnaire, and the improvement of scar was assessed by photography. Three months after treatment, the treatment satisfaction of scar pruritus was self-rated by patients. Meanwhile, adverse effects were recorded during the procedures and follow-up periods. Data were processed with Chi-square test, paired t test, Wilcoxon rank-sum test, and Fisher's exact probability test. Results: Before treatment, there was no statistically significant difference in scar pruritus degree evaluated by the Visual Analogue Scale and score distribution of scar pruritus location, extent, frequency, and sleep effect of the Four-item Itch Questionnaire between patients of two groups (Z=-1.08, -0.91, -0.03, -0.69, -1.49, P>0.05). Three months after treatment, there was reducing degree of scar pruritus of patients evaluated by the Visual Analogue Scale in control group or combination treatment group compared with before treatment within the same group (Z=-1.98, -4.65, P<0.05 or P<0.01), while the latter was more obvious than the former (Z=-2.14, P<0.05). There were reducing scores of scar pruritus extent and frequency of patients in control group, along with location, extent, frequency, and sleep effect of patients in combination treatment group compared with those before treatment within the same group (Z=-2.33, -2.34, -3.53, -4.96, -3.32, -4.84, P<0.05 or P<0.01). However, scores of scar pruritus location and sleep effect of patients in control group were similar to those before treatment within the same group (Z=-0.58, -1.34, P>0.05). The scores of scar pruritus location, extent, frequency, and sleep effect of patients were obviously lower in combination treatment group compared with control group (Z=-2.09, -2.69, -1.99, -2.23, P<0.05 or P<0.01). It was much better of scar improvement of patients in combination treatment group compared with control group (Z=-4.00, P<0.01). The percentages of treatment satisfaction of scar pruritus of patients with 0, 1%-25%, 26%-50%, 51%-75%, 76%-100% were 0, 2.2% (1/45), 17.8% (8/45), 48.9% (22/45), and 31.1% (14/45) respectively in combination treatment group, which were obviously better than 0, 11.1% (5/45), 53.3% (24/45), 28.9% (13/45), and 6.7% (3/45) in control group (Z=-4.42, P<0.01). During the treatment and follow-up periods, the adverse effect ratio of patients in control group was 6.7% (3/45), similar to 2.2% (1/45) of combination treatment group (P>0.05). Conclusions: The combination of narrow-spectrum intense pulsed light and fractional carbon dioxide laser can greatly reduce pruritus, improve effect of scar treatment, and bring higher patient satisfaction compared with narrow-spectrum intense pulsed light alone in treating hypertrophic scar pruritus. Clinical trial registration: Chinese Clinical Trial Registry, ChiCTR-ONH-17012350.
目的： 观察临床上应用窄谱强脉冲光联合点阵二氧化碳激光治疗增生性瘢痕瘙痒的效果。 方法： 2017年3—12月，笔者单位收治符合入选标准的增生性瘢痕患者90例，采用随机数字表法分为联合治疗组和对照组各45例，进行前瞻性随机对照研究。针对瘢痕瘙痒，对照组患者采用窄谱强脉冲光治疗2次，治疗间隔1个月；联合治疗组患者采用窄谱强脉冲光联合点阵二氧化碳激光治疗1次，1个月后再行窄谱强脉冲光治疗1次。治疗前及治疗后3个月，采用视觉模拟评分法和四项目瘙痒量表评定瘢痕瘙痒程度，拍照对比评定瘢痕改善度；治疗后3个月患者自评瘢痕瘙痒治疗满意度；记录治疗及随访期间不良反应。对数据行χ(2)检验、配对t检验、Wilcoxon秩和检验、Fisher确切概率法检验。 结果： 治疗前，2组患者瘢痕视觉模拟评分法评定的瘙痒严重程度和四项目瘙痒量表瘙痒部位、程度、频率及睡眠影响得分分布差异均无统计学意义(Z＝－1.08、－0.91、－0.03、－0.69、－1.49，P>0.05)。治疗后3个月，对照组、联合治疗组患者瘢痕视觉模拟评分法评定的瘙痒严重程度均较组内治疗前明显减轻(Z＝－1.98、－4.65，P<0.05或P<0.01)，联合治疗组患者视觉模拟评分法评定的瘙痒严重程度明显轻于对照组(Z＝－2.14，P<0.05)；对照组患者瘢痕瘙痒程度、频率及联合治疗组患者瘢痕瘙痒部位、程度、频率与睡眠影响得分均较组内治疗前明显降低(Z＝－2.33、－2.34、－3.53、－4.96、－3.32、－4.84，P<0.05或P<0.01)，对照组患者瘢痕瘙痒部位和睡眠影响得分与组内治疗前相近(Z＝－0.58、－1.34，P>0.05)，联合治疗组患者瘢痕瘙痒部位、程度、频率与睡眠影响得分较对照组明显降低(Z＝－2.09、－2.69、－1.99、－2.23，P<0.05或P<0.01)。联合治疗组患者瘢痕改善度明显优于对照组(Z＝－4.00，P<0.01)。联合治疗组患者对瘢痕瘙痒治疗的满意度为0、1%～25%、26%～50%、51%～75%、76%～100%的百分比分别为0、2.2%(1/45)、17.8%(8/45)、48.9%(22/45)、31.1%(14/45)，明显优于对照组的0、11.1%(5/45)、53.3%(24/45)、28.9%(13/45)、6.7%(3/45)，Z＝－4.42，P<0.01。对照组患者治疗及随访期间不良反应发生率为6.7%(3/45)，与联合治疗组的2.2%(1/45)相近(P>0.05)。 结论： 窄谱强脉冲光联合点阵二氧化碳激光治疗增生性瘢痕瘙痒优于单用窄谱强脉冲光，更能降低瘙痒程度，瘢痕治疗效果更好，患者满意度更高。 临床试验注册： 中国临床试验注册中心，ChiCTR-ONH-17012350。.
Keywords: Cicatrix; Fractional carbon dioxide laser; Narrow-spectrum intense pulsed light; Phototherapy; Pruritus.